(795) Maternal and neonatal outcomes of pregnancies complicated by intrapartum SARS-CoV-2 infection across three COVID waves

Friday, February 10, 2023

10:30 AM – 12:00 PM

Objective: To compare the rates of composite adverse maternal and neonatal outcomes associated with a diagnosis of a primary intrapartum COVID infection across the three waves of the COVID19 pandemic.

Study Design: This was a prospective cohort study of individuals with a singleton pregnancy who sought care and delivered in two safety-net hospitals in Southeast Texas from March 2020 to January 2022. Individuals who acquired COVID >10 days from their delivery were excluded. The initial COVID wave was defined as March 11, 2020–May 31, 2021, the Delta wave as June 1, 2021–November 25, 2021, and the Omicron wave as November 26, 2021–January 8, 2022. The primary outcome was a composite of adverse maternal outcomes (CMO) including need for invasive ventilation, ICU admission, preeclampsia or gestational hypertension, infectious morbidity, postpartum hemorrhage, need for blood transfusion, and death. The secondary outcomes were a composite of adverse neonatal outcomes (CNO) including 5-minute APGAR < 7, NICU admission, sepsis, RDS, NEC, IVH, seizures, and SGA, and a comparison of COVID infection severity across the three waves based on the NIH classification.

Results: Of the 5216 deliveries that occurred during the study period, 3202 occurred during the initial wave, 1613 during the Delta wave, and 401 during the Omicron wave, of which 3.9%, 1.2%, and 6.0% tested positive for COVID, respectively. There were no differences in obstetric and demographic characteristics of the study population. The CMO was significantly higher in COVID positive individuals during the initial (RR 1.77, 95% CI [1.32, 2.37]) and the Delta waves (RR 2.11, 95% CI [1.07, 4.16]), however this difference was not observed during the Omicron wave (RR 0.23, 95% CI [0.03, 1.60]) (Table 1). There was no difference in the CNO between COVID positive and negative individuals in all waves, nor in the severity of COVID infection (Table 2).

Conclusion: Initial COVID waves were associated with a higher rate of adverse maternal outcomes compared to the Omicron wave. Improved treatment strategies and vaccination practices may have contributed to these findings.

Primary & Presenting Author(s)

Khalil Chahine, MD
Resident
McGovern Medical School at UTHealth
Houston, Texas, United States

Coauthor(s)

Irene A. Stafford, MD, MS
Associate Professor
Department of Obstetrics, Gynecology and Reproductive Sciences McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth)
Houston, Texas, United States
Baha M. Sibai, MD
Professor
Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth)
Houston, Texas, United States
HC
Han-Yang Chen, PhD
Department of Obstetrics, Gynecology and Reproductive Sciences
McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth)
Houston, Texas, United States