(233) COVID-19 Disease and Medications in Pregnancy: Pooled Analysis of International Network of Obstetric Survey Systems (INOSS) Population-Based Studies

Friday, August 26, 2022

8:00 AM – 6:00 PM CEST

Location: Hall C

Publication Number: 564

Presenting Author(s)

Odette de Bruin
– UMC Utrecht, UMC Utrecht, Utrecht, Utrecht, Netherlands

Co-Author(s)

Hilde Engjom, PhD
– Specialist consultant and postdoctoral researcher, Division for Mental and Physical Health, the Norwegian Institute of Public Health,, Bergen, Norway
Nicola Vousden
– National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK, Oxford, United Kingdom
Marian Knight
– National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK, Oxford, United Kingdom
Serena Donati
– National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità – Italian National Institute of Health, Rome, Italy, Rome, Italy
Miriam C. Sturkenboom, PharmD, PhD, FISPE
– prof. dr., University Medical Center Utrecht, Utrecht, Utrecht, Netherlands
Kitty WM Bloemenkamp
– Department of Obstetrics, WKZ Birth Centre, Division Woman and Baby, UMC Utrecht, Utrecht, the Netherlands, Utrecht, Utrecht, Netherlands

Background: There is an urgent need for information on the management and outcomes of COVID-19 in pregnant women.

Objectives: To determine the incidence rate of hospitalization and severe maternal and perinatal outcomes and to investigate medication use among pregnant women infected with SARS-CoV-2 across multiple European countries.

Methods: This is a multi-national population-based cohort study using the International Network of Obstetric Survey Systems (INOSS). Countries participating in this network adapted their surveillance system during the COVID-19 pandemic to monitor pregnant women with SARS-CoV-2 infection. The study population comprised all pregnant women admitted to hospital with a positive SARS-CoV-2 PCR test within 7 days prior to or during admission and up to 2 days after giving birth between February/March and December 31, 2020. Pregnant women were eligible for inclusion if they were admitted due to COVID-19 or were symptomatic. Common protocols with uniform definitions were used in each country to retrieve information from hospital records, including medicine use, maternal and perinatal outcomes.

Results: In the source population of 1 898 811 maternities, 2 347 women were admitted due to COVID-19. The rate of hospitalization due to COVID-19 ranged from 0.2 to 1.9 per 1000 maternities across countries, 308 (13%) women were admitted to ICU, and 147 (6%) needed mechanical ventilation or extracorporeal membrane oxygenation. Approximately one-fifth of women gave birth prior to 37 weeks, and 43% delivered by ceaserean section. Few pregnant women received steroids for maternal indication (10%), antiviral treatment (2%) and anticoagulant treatment (3%). Hydroxychloroquine was prescribed more frequently in Italy (30%) and Belgium (22%) compared to the other countries (0% - 5%). Among 2281 births, 21 stillbirths (0.9%), and 496 (22%) neonatal admissions were reported.

Conclusions: This multi-national collaborative approach allows comparison of the impact of varying timing and nature of public health measures implemented by different nations. We observed that the rate of hospitalization due to COVID-19 and medication use among pregnant women varied across different European countries in 2020. Admission due to COVID-19 was associated with a high risk of ICU admission, mechanical ventilation, preterm delivery and ceaserean section. It is striking that only a few pregnant women received medical treatment directed at COVID-19. A planned meta-analysis will give more insight into the effect of medicines in pregnant women with COVID-19, data on which are lacking since this vulnerable group were mostly excluded from RCTs on effectiveness and safety of COVID-19 medication.