Impact of gestational age on the severity of Sars-CoV-2 infection in pregnant people, in a hospital in the Buenos Aires suburbs

Abstract

continues to be established, local evidence is key to guide decision-making in clinical practice. In this way, it is important to know variables that are associated with worse evolution.

Aim: to describe the evolution of the SARS COV2 infection in pregnant people and to determine variables associated with clinical severity.

Materials and Methods: Retrospective observational cohort study. Period: 01-03-2020 to 31-07-2021. We included pregnant people with a diagnosis of COVID 19, assisted in a public maternity hospital. The cases were classified according to clinical severity based on the NIH guidelines. For the analysis, the patients were divided into 2 groups: Gropu 1: mild (ambulatory management). Group 2: moderate, severe and critical (requiring hospitalization). The relationship between variables and clinical severity was analyzed. Variables studied: Obesity, DBT, HIE, gestational age, maternal age, influenza vaccination. Newborns of infected mothers were studied with PCR for SARS -COV 2 on nasopharyngeal secretions at 24 to 48 hours after birth. Statistical analysis: Chi-square or Fisher's exact test. Significance = p <0.05. Study approved by the Institutional Ethics Committee.

Results: 52 pregnant people with a diagnosis of COVID19 were included. Median age 29.6 years. 23 patients (44%) required hospitalization and 2 (4%) MRA (mechanical respiratory assistance). 29 cases (55.5%) were mild, 19 (36.5%) moderate, 2 (4%) severe, and 2 (4%) critical. 59.6% were diagnosed with more than 28 weeks of gestation. There were no maternal or fetal deaths up to 30 days postpartum. No relationship was observed between comorbidities and clinical severity (p = 0.8). Gestational age ≥ 28 weeks was the only variable associated with more severe clinical forms, p = 0.00004. 66% of the pregnancies ended by cesarean section, which was statistically significant against the historical records of the hospital, p = 0.00004. 48/52 newborns were studied with PCR for SARS-COV 2, with only 1 (2%) being positive. This was the only symptomatic newborn.

Conclusions: In our study, SARS COV2 infection during pregnancy was associated with more severe clinical presentations, especially when the infection occurred in the 3rd trimester of pregnancy. COVID 19 was also associated with a higher incidence of termination of pregnancy by cesarean section.