Prediction of COVID-19 Severity at Delivery after Asymptomatic or Mild COVID-19 during Pregnancy

Grecio J Sandoval; Torri D Metz; William A Grobman; Tracy A Manuck; Brenna L Hughes; George R Saade; Monica Longo; Hyagriv N Simhan; Dwight J Rouse; Hector Mendez-Figueroa; Cynthia Gyamfi-Bannerman; Angela C Ranzini; Maged M Costantine; Harish M Sehdev; Alan T N Tita; Eunice Kennedy Shriver National Institute of Child Health Human Development Maternal-Fetal Medicine Units Network, Bethesda, MD

doi:10.1055/s-0044-1786868

Prediction of COVID-19 Severity at Delivery after Asymptomatic or Mild COVID-19 during Pregnancy

Am J Perinatol. 2024 May 10. doi: 10.1055/s-0044-1786868. Online ahead of print.

Authors

Grecio J Sandoval¹, Torri D Metz², William A Grobman³, Tracy A Manuck⁴, Brenna L Hughes⁴, George R Saade⁵, Monica Longo⁶, Hyagriv N Simhan⁷, Dwight J Rouse⁸, Hector Mendez-Figueroa⁹, Cynthia Gyamfi-Bannerman¹⁰, Angela C Ranzini¹¹, Maged M Costantine¹², Harish M Sehdev¹³, Alan T N Tita¹⁴; Eunice Kennedy Shriver National Institute of Child Health Human Development Maternal-Fetal Medicine Units Network, Bethesda, MD

Affiliations

¹ Biostatistics Center, George Washington University, Washington, District of Columbia.
² Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah.
³ Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois.
⁴ Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina.
⁵ Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas.
⁶ Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland.
⁷ Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, Pennsylvania.
⁸ Department of Obstetrics and Gynecology, Brown University, Providence, Rhode Island.
⁹ Department of Obstetrics and Gynecology, Children's Memorial Hermann Hospital, University of Texas Health Science Center at Houston, Houston, Texas.
¹⁰ Department of Obstetrics and Gynecology, Columbia University, New York, New York.
¹¹ Department of Obstetrics and Gynecology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio.
¹² Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio.
¹³ Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania.
¹⁴ Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama.

PMID: 38729164
DOI: 10.1055/s-0044-1786868

Abstract

Objective: This study aimed to develop a prediction model that estimates the probability that a pregnant person who has had asymptomatic or mild coronavirus disease 2019 (COVID-19) prior to delivery admission will progress in severity to moderate, severe, or critical COVID-19.

Study design: This was a secondary analysis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive patients who delivered from March through December 2020 at hospitals across the United States. Those eligible for this analysis presented for delivery with a current or previous asymptomatic or mild SARS-CoV-2 infection. The primary outcome was moderate, severe, or critical COVID-19 during the delivery admission through 42 days postpartum. The prediction model was developed and internally validated using stratified cross-validation with stepwise backward elimination, incorporating only variables that were known on the day of hospital admission.

Results: Of the 2,818 patients included, 26 (0.9%; 95% confidence interval [CI], 0.6-1.3%) developed moderate-severe-critical COVID-19 during the study period. Variables in the prediction model were gestational age at delivery admission (adjusted odds ratio [aOR], 1.15; 95% CI, 1.08-1.22 per 1-week decrease), a hypertensive disorder in a prior pregnancy (aOR 3.05; 95% CI, 1.25-7.46), and systolic blood pressure at admission (aOR, 1.04; 95% CI, 1.02-1.05 per mm Hg increase). This model yielded an area under the receiver operating characteristic curve of 0.82 (95% CI, 0.72-0.91).

Conclusion: Among individuals presenting for delivery who had asymptomatic-mild COVID-19, gestational age at delivery admission, a hypertensive disorder in a prior pregnancy, and systolic blood pressure at admission were predictive of delivering with moderate, severe, or critical COVID-19. This prediction model may be a useful tool to optimize resources for SARS-CoV-2-infected pregnant individuals admitted for delivery.

Key points: · Three factors were associated with delivery with more severe COVID-19.. · The developed model yielded an area under the receiver operating characteristic curve of 0.82 and model fit was good.. · The model may be useful tool for SARS-CoV-2 infected pregnancies admitted for delivery..