Temporal Trend in SARS-CoV-2 Symptoms in Pregnant Women

Abstract

Objective The objective of this study was to examine temporal trends in the clinical presentation of patients diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in pregnancy.

Study Design This is a retrospective cohort study of pregnant women who were universally screened for SARS-CoV-2 and tested positive. This multi-center study of admissions to labor and delivery units in New York City and Long Island included all SARS-CoV-2-infected pregnant women admitted to labor and delivery units between April 10th and June 4th 2020. Six Northwell Health hospitals and Maimonides Medical Center were included in the study. The main measures of the study included patient reports of COVID-19 symptoms: fever, cough, chest pain, shortness of breath, nausea, vomiting, and intensive care unit (ICU) admissions. The main outcome measure was the percentage of all infected women who reported any of the above symptoms.

Results In total, 427 infected pregnant women were included in the study. There was a statistically significant decline in the percentage of patients presenting with any symptoms over the course of the study. In addition, disease severity, symptoms of fever, cough, and chest pain/shortness of breath also significantly declined over time, and no ICU admissions were noted after the third week of April.

Conclusion There was a temporal shift away from symptomatic presentation in pregnant women diagnosed with SARS-CoV-2 over the course of the first months of the epidemic in New York. Further studies are necessary to elucidate the cause of this change in presentation among pregnant women, to determine whether this trend is also observed in other patient populations.

Key Points

• Retrospective cohort review of 427 SARS-CoV-2-infected pregnant women admitted to labor and delivery units.

• A significant decline in the percentage of patients presenting with symptoms over time was noted.

• Further studies are necessary to elucidate the cause of this change in presentation.

• Theories for the noted trend: viral evolution, decreased viral inoculums, and prolonged polymerase chain reaction positivity.

Keywords

SARS-CoV-2 - pregnancy - temporal trend - clinical presentation

Publication History

Received: 23 October 2020

Accepted: 04 October 2021

Article published online:
16 December 2021

• References

• 1 Wölfel R, Corman VM, Guggemos W. et al. Virological assessment of hospitalized patients with COVID-2019. Nature 2020; 581 (7809): 465-469
• 2 London V, McLaren Jr R, Atallah F. et al. The relationship between status at presentation and outcomes among pregnant women with COVID-19. Am J Perinatol 2020; 37 (10) 991-994
• 3 Berngruber TW, Froissart R, Choisy M, Gandon S. Evolution of virulence in emerging epidemics. PLoS Pathog 2013; 9 (03) e1003209
• 4 Cressler CE, McLEOD DV, Rozins C, VAN DEN Hoogen J, Day T. The adaptive evolution of virulence: a review of theoretical predictions and empirical tests. Parasitology 2016; 143 (07) 915-930
• 5 Geoghegan JL, Holmes EC. The phylogenomics of evolving virus virulence. Nat Rev Genet 2018; 19 (12) 756-769
• 6 Erdley D. Doctors say COVID-19 at UPMC is declining in virulence, infection levels. TribLive website. https://triblive.com/local/regional/upmc-doctors-say-covid-19-declining-in-virulence-and-infection-levels/ June 4th, 2020. Accessed September 1, 2020
• 7 Cha EA, Morris L, Birnbaum M. COVID19 death rates are lower worldwide, but no one is sure whether that's a blip or a trend. https://www.washingtonpost.com/health/2020/10/09/covid-mortality-rate-down/ . Accessed October 18th, 2020
• 8 COVID-19 Treatment Guidelines Panel. Coronavirus Disease 2019 (COVID-19) Treatment Guidelines. National Institutes of Health. Accessed October 18, 2020 https://www.covid19treatmentguidelines.nih.gov/
• 9 Blitz MJ, Rochelson B, Minkoff H. et al. Maternal mortality among women with coronavirus disease 2019 admitted to the intensive care unit. Am J Obstet Gynecol 2020; 223 (04) 595-599.e5
• 10 Blitz MJ, Rochelson B, Prasannan L. et al. Racial and ethnic disparity and spatiotemporal trends in severe acute respiratory syndrome coronavirus 2 prevalence on obstetrical units in New York. Am J Obstet Gynecol MFM 2020; 2 (04) 100212
• 11 Prasannan L, Rochelson B, Shan W. et al. Social determinants of health and coronavirus disease 2019 in pregnancy. Am J Obstet Gynecol MFM 2021; 3 (04) 100349
• 12 McLaren Jr RA, London V, Atallah F. et al. Delivery for respiratory compromise among pregnant women with coronavirus disease 2019. Am J Obstet Gynecol 2020; 223 (03) 451-453
• 13 Korber B, Fischer WM, Gnanakaran S. et al; Sheffield COVID-19 Genomics Group. Tracking changes in SARS-CoV-2 spike: evidence that D614G increases infectivity of the COVID-19 virus. Cell 2020; 182 (04) 812-827.e19
• 14 Callaway E. The coronavirus is mutating - does it matter?. Nature 2020; 585 (7824): 174-177
• 15 Memoli MJ, Czajkowski L, Reed S. et al. Validation of the wild-type influenza A human challenge model H1N1pdMIST: an A(H1N1)pdm09 dose-finding investigational new drug study. Clin Infect Dis 2015; 60 (05) 693-702
• 16 Tao X, Garron T, Agrawal AS. et al. Characterization and demonstration of the value of a lethal mouse model of Middle East respiratory syndrome coronavirus infection and disease. J Virol 2015; 90 (01) 57-67
• 17 Eurekalert. US study shows decline in viral load of patients with COVID-19 as pandemic progressed. https://www.eurekalert.org/pub_releases/2020-09/esoc-uss092320.php Sept 23, 2020. Accessed October 18th, 2020
• 18 Zhang L, Li C, Zhou Y, Wang B, Zhang J. Persistent viral shedding lasting over 60 days in a mild COVID-19 patient with ongoing positive SARS-CoV-2. Quant Imaging Med Surg 2020; 10 (05) 1141-1144