Clinical characteristics, symptoms, management and health outcomes in 8,598 pregnant women diagnosed with COVID-19 compared to 27,510 with seasonal influenza in France, Spain and the US: a network cohort analysis
Creators
- Lana Yin Hui Lai
- Asieh Golozar
- Anthony Sena
- Andrea V. Margulis
- Nuria Haro
- Paula Casajust
- Neus Valveny
- Albert Prats-Uribe
- Evan P. Minty
- Waheed-Ul-Rahman Ahmed
- Thamir M Alshammari
- Daniel R. Morales
- Heba Alghoul
- Osaid Alser
- Dalia Dawoud
- Lin Zhang
- Jose D. Posada
- Nigam H. Shah
- Clair Blacketer
- Carlos Areia
- Vignesh Subbian
- Fredrik Nyberg
- Jennifer C E Lane
- Marc A Suchard
- Mengchun Gong
- Martina Recalde
- Jitendra Jonnagaddala
- Karishma Shah
- Elena Roel
- David Vizcaya
- Stephen Fortin
- Ru-fong Joanne Cheng
- Christian Reich
- George Hripcsak
- Peter Rijnbeek
- Patrick Ryan
- Kristin Kostka
- Talita Duarte-Salles
- Daniel Prieto-Alhambra
Description
OBJECTIVES To describe comorbidities, symptoms at presentation, medication use, and 30-day outcomes after a diagnosis of COVID-19 in pregnant women, in comparison to pregnant women with influenza.
DESIGN Multinational network cohort
SETTING A total of 6 databases consisting of electronic medical records and claims data from France, Spain, and the United States.
PARTICIPANTS Pregnant women with ≥ 1 year in contributing databases, diagnosed and/or tested positive, or hospitalized with COVID-19. The influenza cohort was derived from the 2017-2018 influenza season.
OUTCOMES Baseline patient characteristics, comorbidities and presenting symptoms; 30-day inpatient drug utilization, maternal complications and pregnancy-related outcomes following diagnosis/hospitalization.
RESULTS 8,598 women diagnosed (2,031 hospitalized) with COVID-19 were included. Hospitalized women had, compared to those diagnosed, a higher prevalence sof pre-existing comorbidities including renal impairment (2.2% diagnosed vs 5.1% hospitalized) and anemia (15.5% diagnosed vs 21.3% hospitalized).
The ten most common inpatient treatments were systemic corticosteroids (29.6%), enoxaparin (24.0%), immunoglobulins (21.4%), famotidine (20.9%), azithromycin (18.1%), heparin (15.8%), ceftriaxone (7.9%), aspirin (7.0%), hydroxychloroquine (5.4%) and amoxicillin (3.5%).
Compared to 27,510 women with influenza, dyspnea and anosmia were more prevalent in those with COVID-19. Women with COVID-19 had higher frequency of cesarean-section (4.4% vs 3.1%), preterm delivery (0.9% vs 0.5%), and poorer maternal outcomes: pneumonia (12.0% vs 2.7%), ARDS (4.0% vs 0.3%) and sepsis (2.1% vs 0.7%). COVID-19 fatality was negligible (N<5 in each database respectively).
CONCLUSIONS Comorbidities that were more prevalent with COVID-19 hospitalization (compared to COVID-19 diagnosed) in pregnancy included renal impairment and anemia. Multiple medications were used to treat pregnant women hospitalized with COVID-19, some with little evidence of benefit. Anosmia and dyspnea were indicative symptoms of COVID-19 in pregnancy compared to influenza, and may aid differential diagnosis. Despite low fatality, pregnancy and maternal outcomes were worse in COVID-19 than influenza.
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2020 - Lai - Clinical characteristics, symptoms, management and health outcomes in 8,598 pregnant women diagnosed with COVID-19 compared to 27,510 with seasonal influenza in France, Spain and the US a network cohort analys.pdf
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