Clinical Course of 54 Pregnant Women with COVID-19: A Retrospective Review of Medical Records

Background: Previous retrospective case series with small sample sizes have reported reassuring maternal outcomes for pregnant women with COVID-19 infection. Nevertheless, the available data remain scarce. This study aimed to report the maternal characteristics and clinical outcomes of pregnant women with COVID-19 infection. Methods: This retrospective single centre study includes all consecutive pregnant women with confirmed (laboratory-confirmed) or suspected (according to the Chinese management guideline (version 7·0) COVID-19 infection, regardless of gestational age at diagnosis, admitted to the Strasbourg University Hospital (France) from March 1 to April 3, 2020. Maternal characteristics, laboratory and imaging findings, and maternal and neonatal outcomes were extracted from medical records. Findings: The study includes 54 pregnant women with confirmed (n=38) and suspected (n=16) COVID-19 infection. Of these, 32 had an ongoing pregnancy, one a miscarriage, and 21 live births: 12 vaginal and 9 caesarean deliveries. Five (23·8%), three (14·3%) and two (9·5) delivered before 37, 32 and 28 weeks' gestation; in all cases, prematurity was related to COVID-19 infection. 13 (24·1%) women received oxygen support, including high flow oxygen (n=2), non-invasive (n=1) and invasive (n=3) mechanical ventilation, and extracorporeal membrane oxygenation (n=1). Of these, three, aged 35 years or older with positive COVID-19 RT-PCR, had respiratory failure warranting elective delivery before 29 weeks' gestation. All three women were overweight or obese, and two had additional comorbidity. Interpretation: COVID-19 infection can cause severe maternal morbidity in pregnant women, warranting elective very preterm deliveries. Further studies are required to determine whether its association with other well-known risk factors for severe maternal morbidity in non-infected pregnant women, including maternal age above 35 years, overweight or obesity, are also associated with poorer maternal outcome in these women.Funding Statement: This study was funded by the Strasbourg University Hospital.Declaration of Interests: Dr. Sentilhes reports receiving lecture and consulting fees from Ferring, and lecture fees from Bayer, GSK and SIGVARIS. No other potential conflict of interest relevant to this article was reported.Ethics Approval Statement: The Ethics Committee of Strasbourg University Hospital approved this study under a waiver of informed consent(RNI 2020 - HUS N°7794).