COVID-19 during pregnancy linked to maternal mortality or morbidity from obstetric complications

Pregnant and postpartum individuals infected with SARS-CoV-2 during pregnancy have an increased risk of maternal mortality or morbidity from obstetric complications, according to a recent study published in JAMA.

If you’ve had COVID-19 at any time during pregnancy and then you have obstetric complications, you are more likely to have morbidity related to those complications, particularly if your disease had been severe or critical."

William Grobman, MD, MBA, '97 GME, adjunct professor of Obstetrics and Gynecology in the Division of Maternal Fetal Medicine and co-author of the study

Data from the past two years of the COVID-19 pandemic has demonstrated that pregnant individuals infected with SARS-CoV-2, the virus that causes COVID-19, have increased risk of maternal morbidity or mortality related to the virus. However, it remained unclear whether these individuals, as well as postpartum individuals who had a previous SARS-CoV-2 infection, also have a higher risk of morbidity or mortality from obstetric complications.

The current study evaluated more than 14,000 pregnant and postpartum individuals who delivered between March 1, 2020 and December 31, 2020 at 17 U.S. hospitals participating in the National Institute of Child Health and Human Development's Gestational Research Assessments of COVID-19 (GRAVID) Study.

A total of 2,352 patients with SARS-CoV-2 infection were compared to 11,752 patients without a positive SARS-CoV-2 test for rates of maternal death or serious morbidity related to obstetric complications, notably hypertensive disorders of pregnancy, postpartum hemorrhage or infection unrelated to SARS-CoV-2.

Overall, the investigators found SARS-CoV-2 infection was associated with an increased risk of serious maternal morbidity or mortality from obstetric complications. Additionally, the five maternal deaths occurred only in patients with SARS-CoV-2 infection. On the other hand, SARS-CoV-2 infection was not associated with increased cesarean births.

The findings underscore the importance of COVID-19 vaccinations in helping prevent SARS-CoV-2 infection in pregnant and postpartum individuals and limiting possible infection to just mild or asymptomatic disease, according to Grobman.

"A common reason for not getting the COVID-19 vaccine or not getting treatment during pregnancy is because of concern for the pregnancy. This provides more information for clinicians to be able to counsel individuals with clarity, which is to say that what puts you and your pregnancy at risk are both being infected by SARS-CoV-2 and having that progress to severe disease," Grobman said.

Northwestern is part of the Eunice Kennedy Shriver National Institute of Child Health and Human Development's Maternal-Fetal Medicine Units Network, which aims to reduce maternal, fetal and infant morbidity and provide support and rationale for evidence-based, cost-effective obstetric care.