Download PDF
Am J Perinatol 2021; 38(06): 614-621
DOI: 10.1055/s-0041-1723938
Original Article

SARS-CoV-2 Infection during Pregnancy in a Rural Midwest All-delivery Cohort and Associated Maternal and Neonatal Outcomes

Haley A. Steffen   *
1   University of Iowa Carver College of Medicine, Iowa City, Iowa
,
Samantha R. Swartz   *
1   University of Iowa Carver College of Medicine, Iowa City, Iowa
,
J. Brooks Jackson
2   Department of Pathology, University of Iowa, Iowa City, Iowa
,
Kimberly A. Kenne
3   Department of Obstetrics and Gynecology, University of Iowa, Iowa City, Iowa
,
Patrick P. Ten Eyck
4   Institute for Clinical and Translational Science, University of Iowa, Iowa City, Iowa
,
Abbey S. Merryman
3   Department of Obstetrics and Gynecology, University of Iowa, Iowa City, Iowa
,
Claire N. Castaneda
1   University of Iowa Carver College of Medicine, Iowa City, Iowa
,
Katharine Marsden
1   University of Iowa Carver College of Medicine, Iowa City, Iowa
,
Timothy Maxwell
1   University of Iowa Carver College of Medicine, Iowa City, Iowa
,
Anna E. Merrill
2   Department of Pathology, University of Iowa, Iowa City, Iowa
,
Matthew D. Krasowski
2   Department of Pathology, University of Iowa, Iowa City, Iowa
,
Mary B. Rysavy 
3   Department of Obstetrics and Gynecology, University of Iowa, Iowa City, Iowa
› Author Affiliations Funding This study was funded internally. The study was also supported in part by the University of Iowa Institute for Clinical and Translational Science, which is granted with Clinical and Translational Science Award funds from the National Institutes of Health (UL1TR002537).
› Further Information
Also available at
   Permissions and Reprints

Abstract

Objective This study aimed to estimate the prevalence of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) among pregnant patients at the time of delivery in a rural Midwest tertiary care hospital and to examine demographics, clinical factors, and maternal and neonatal outcomes associated with SARS-CoV-2 infection during pregnancy.

Study Design This prospective cohort study included all delivering patients between May 1 and September 22, 2020 at the University of Iowa Hospitals and Clinics. Plasma SARS-CoV-2 antibody testing was performed. SARS-CoV-2 viral reverse-transcription polymerase chain reaction (RT-PCR) results and maternal and neonatal outcomes were collected from the electronic medical record. Data were analyzed using univariate statistical methods with clustering for multiple births.

Results In total, 1,000 patients delivered between May 1 and September 22, 2020. Fifty-eight (5.8%) were SARS-CoV-2 antibody positive. Twenty-three also tested viral positive during pregnancy. Three of 1,000 (0.3%) were viral positive on admission but antibody negative. The median age was 30 years (interquartile range [IQR]: 26–33 years) and body mass index was 31.75 kg/m2 (IQR 27.7–37.5 kg/m2). The cesarean delivery rate was 34.0%. The study population was primarily white (71.6%); however, 41.0% of SARS-CoV-2 infected patients identified as Black, 18.0% as Hispanic/Latino, 3.3% as Native Hawaiian/Pacific Islander, and only 27.9% as White (p < 0.0001). SARS-CoV-2 infection was more likely in patients without private insurance (p = 0.0243). Adverse maternal and/or neonatal outcomes were not more likely in patients with evidence of infection during pregnancy. Two SARS-CoV-2 infected patients were admitted to the intensive care unit. There were no maternal deaths during the study period.

Conclusion In this largely rural Midwest population, 6.1% of delivering patients had evidence of past or current SARS-CoV-2 infection. Rates of SARS-CoV-2 during pregnancy were higher among racial and ethnic minorities and patients without private insurance. The SARS-CoV-2 infected patients and their neonates were not found to be at increased risk for adverse outcomes.

Key Points

  • SARS-CoV-2 seroprevalence rate in pregnant population in Iowa is 5.8%.

  • Infections are higher among minorities, non-English speakers, and patients without private insurance.

  • No increased adverse maternal/neonatal outcomes observed for SARS-CoV-2 infected mothers.

Keywords

COVID-19 - pregnancy - racial disparities - SARS-CoV-2 - seroprevalence

* Co-first authors.




Publication History

Received: 30 November 2020

Accepted: 09 January 2021

Article published online:
21 February 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 COVID in Iowa. Positive case analysis. Accessed November 3, 2020 at: https://coronavirus.iowa.gov/pages/case-counts
    Google Scholar
  • 2 Qiao J. What are the risks of COVID-19 infection in pregnant women?. Lancet 2020; 395 (10226): 760-762
    CrossrefPubMedGoogle Scholar
  • 3 Schwartz DA, Graham AL. Potential maternal and infant outcomes from (Wuhan) coronavirus 2019-nCoV infecting pregnant women: lessons from SARS, MERS, and other human coronavirus infections. Viruses 2020; 12 (02) 194
    Google Scholar
  • 4 Ellington S, Strid P, Tong VT. et al. Characteristics of women of reproductive age with laboratory-confirmed SARS-CoV-2 infection by pregnancy status - United States, January 22-June 7, 2020. MMWR Morb Mortal Wkly Rep 2020; 69 (25) 769-775
    CrossrefPubMedGoogle Scholar
  • 5 Akhtar H, Patel C, Abuelgasim E, Harky A. COVID-19 (SARS-CoV-2) infection in pregnancy: a systematic review. Gynecol Obstet Invest 2020; 85 (04) 295-306
    CrossrefPubMedGoogle Scholar
  • 6 Narang K, Enninga EAL, Gunaratne MDSK. et al. SARS-CoV-2 infection and COVID-19 during pregnancy: a multidisciplinary review. Mayo Clin Proc 2020; 95 (08) 1750-1765
    CrossrefPubMedGoogle Scholar
  • 7 Di Mascio D, Khalil A, Saccone G. et al. Outcome of coronavirus spectrum infections (SARS, MERS, COVID-19) during pregnancy: a systematic review and meta-analysis. Am J Obstet Gynecol MFM 2020; 2 (02) 100107
    Google Scholar
  • 8 Azar KMJ, Shen Z, Romanelli RJ. et al. Disparities in outcomes among COVID-19 patients in a large health care system in California. Health Aff (Millwood) 2020; 39 (07) 1253-1262
    CrossrefPubMedGoogle Scholar
  • 9 Akbar AN, Gilroy DW. Aging immunity may exacerbate COVID-19. Science 2020; 369 (6501): 256-257
    CrossrefPubMedGoogle Scholar
  • 10 Andrikopoulou M, Madden N, Wen T. et al. Symptoms and critical illness among obstetric patients with coronavirus disease 2019 (COVID-19) infection. Obstet Gynecol 2020; 136 (02) 291-299
    CrossrefPubMedGoogle Scholar
  • 11 Savasi VM, Parisi F, Patanè L. et al. Clinical findings and disease severity in hospitalized pregnant women with coronavirus disease 2019 (COVID-19). Obstet Gynecol 2020; 136 (02) 252-258
    CrossrefPubMedGoogle Scholar
  • 12 Merrill AE, Jackson JB, Ehlers A, Voss D, Krasowski MD. Head-to-head comparison of two SARS-CoV-2 serology assays. J Appl Lab Med 2020; 5 (06) 1351-1357
    CrossrefPubMedGoogle Scholar
  • 13 Miller TE, Garcia Beltran WF, Bard AZ. et al. Clinical sensitivity and interpretation of PCR and serological COVID-19 diagnostics for patients presenting to the hospital. FASEB J 2020; 34 (10) 13877-13884
    CrossrefPubMedGoogle Scholar
  • 14 National Institutes of Health. Racial and ethnic categories and definitions for NIH diversity programs and for other reporting purposes. Accessed January 5, 2021 at: https://grants.nih.gov/grants/guide/notice-files/not-od-15-089.html
    Google Scholar
  • 15 Larson SB, Watson SN, Eberlein M, Simmons JS, Doerschug KC, Leslie KK. Survival of pregnant coronavirus patient on extracorporeal membrane oxygenation. Ann Thorac Surg 2020; S0003–4975 (20) 31634-31639
    PubMedGoogle Scholar
  • 16 Haizler-Cohen L, Davidov A, Blitz MJ, Fruhman G. Severe acute respiratory syndrome corona virus 2 antibodies in pregnant women admitted to labor and delivery units. Am J Obstet Gynecol 2020; S0002–9378 (20) 31101-31107
    PubMedGoogle Scholar
  • 17 Crovetto F, Crispi F, Llurba E, Figueras F, Gómez-Roig MD, Gratacós E. Seroprevalence and presentation of SARS-CoV-2 in pregnancy. Lancet 2020; 396 (10250): 530-531
    CrossrefPubMedGoogle Scholar
  • 18 Sutton D, Fuchs K, D'Alton M, Goffman D. Universal screening for SARS-CoV-2 in women admitted for delivery. N Engl J Med 2020; 382 (22) 2163-2164
    CrossrefPubMedGoogle Scholar
  • 19 Miller ES, Grobman WA, Sakowicz A, Rosati J, Peaceman AM. Clinical implications of universal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing in pregnancy. Obstet Gynecol 2020; 136 (02) 232-234
    CrossrefPubMedGoogle Scholar
  • 20 Centers for Disease Control and Prevention. Births - method of delivery. Accessed September 2, 2020 at: https://www.cdc.gov/nchs/fastats/delivery.htm
    Google Scholar
  • 21 Iowa Public Health Tracking Portal. Adult obesity information. Accessed November 13, 2020 at: https://tracking.idph.iowa.gov/Health/Obesity/Adult-Obesity-Data
    Google Scholar
  • 22 Swank ML, Caughey AB, Farinelli CK. et al. The impact of change in pregnancy body mass index on the development of gestational hypertensive disorders. J Perinatol 2014; 34 (03) 181-185
    CrossrefPubMedGoogle Scholar
  • 23 Price-Haywood EG, Burton J, Fort D, Seoane L. Hospitalization and mortality among black patients and white patients with COVID-19. N Engl J Med 2020; 382 (26) 2534-2543
    CrossrefPubMedGoogle Scholar
  • 24 Khalil A, Kalafat E, Benlioglu C. et al. SARS-CoV-2 infection in pregnancy: A systematic review and meta-analysis of clinical features and pregnancy outcomes. EClinicalMedicine 2020; 25: 100446
    CrossrefPubMedGoogle Scholar
  • 25 Kingston EV. High rates of stillbirth and preterm delivery in women with covid-19 and the efficacy of ECMO in pregnancy. BMJ 2020; 370: m2921
    CrossrefPubMedGoogle Scholar
  • 26 Huntley BJF, Huntley ES, Di Mascio D, Chen T, Berghella V, Chauhan SP. Rates of maternal and perinatal mortality and vertical transmission in pregnancies complicated by severe acute respiratory syndrome coronavirus 2 (SARS-Co-V-2) infection: a systematic review. Obstet Gynecol 2020; 136 (02) 303-312
    CrossrefPubMedGoogle Scholar
  • 27 Khoury R, Bernstein PS, Debolt C. et al. Characteristics and outcomes of 241 births to women with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection at five New York city medical centers. Obstet Gynecol 2020; 136 (02) 273-282
    CrossrefPubMedGoogle Scholar
  • 28 Leys T. Coronavirus infects more than 1,600 workers at four Iowa meatpacking plants. Accessed September 16, 2020 at: https://www.desmoinesregister.com/story/news/health/2020/05/05/coronavirus-infects-thousands-iowa-meatpacking-plant-workers-covid-19-waterloo-perry/5170796002/
    Google Scholar
  • 29 Dingel JI, Neiman B. How many jobs can be done at home?. J Public Econ 2020; 189: 104235
    CrossrefPubMedGoogle Scholar
  • 30 Liao J, He X, Gong Q, Yang L, Zhou C, Li J. Analysis of vaginal delivery outcomes among pregnant women in Wuhan, China during the COVID-19 pandemic. Int J Gynaecol Obstet 2020; 150 (01) 53-57
    CrossrefPubMedGoogle Scholar