Maternal and perinatal characteristics and outcomes of pregnancies complicated with COVID-19 in Kuwait

Amal Ayed 1, Alia Embaireeg 2, Asmaa Benawadh 1, Wadha Al-Fouzan 3, Majdeda Hammoud 4, Monif Al-Hathal 5, Abeer Alzaydai 6, Ashraf Ahmad 1, Mariam Ayed 7

Affiliations

02 December 2020

-

doi: 10.1186/s12884-020-03461-2

Abstract

Background: The effect of SARS-CoV-2 infection in pregnant women and newborns is incompletely understood. Preliminary data shows a rather fluctuating course of the disease from asymptomatic or mild symptoms to maternal death. However, it is not clear whether the disease increases the risk of pregnancy-related complications. The aim of the study is to describe the maternal and neonatal clinical characteristics and outcome of pregnancies with SARS-CoV-2 infection.

Methods: In this retrospective national-based study, we analyzed the medical records of all pregnant women infected with SARS-CoV-2 and their neonates who were admitted to New-Jahra Hospital (NJH), Kuwait, between March 15th 2020 and May 31st 2020. During the study period and as part of the public health measures, a total of 185 pregnant women infected with SARS-CoV-2, regardless of symptoms, were hospitalized at NJH, and were included. Maternal and neonatal clinical manifestations, laboratory tests and treatments were collected. The outcomes of pregnancies included miscarriage, intrauterine fetal death (IUFD), preterm birth and live birth were assessed until the end date of the outcomes follow-up (November 10th 2020).

Results: A total of 185 pregnant women infected with SARS-CoV-2 were enrolled with a median age of 31 years (interquartile range, IQR: 27.5-34), and median gestational age at diagnosis of SARS-CoV2 infection was 29 weeks (IQR: 18-34). The majority (88%) of these women had mild symptoms, with fever (58%) being the most common presenting symptom followed by cough (50.6%). At the time of the analysis, out of the 185, 3 (1.6%) of the pregnant women had a miscarriage, 1 (0.54%) had IUFD which was not related to COVID-19, 16 (8.6%) had ongoing pregnancies and 165 (89%) had a live birth. Only 2 (1.1%) of these women developed severe pneumonia and required intensive care. A total of 167 neonates with two sets of twins were born with median gestational age at birth was 38 (IQR: 36-39) weeks. Most of the neonates were asymptomatic, and only 2 of them tested positive on day 5 by nasopharyngeal swab testing.

Conclusions: In this national-based study, most of the pregnant women infected with SARS-CoV-2 showed mild symptoms. Although mother-to-child vertical transmission of SARS-CoV-2 is possible, COVID-19 infection during pregnancy may not lead to unfavorable maternal and neonatal outcomes.

Keywords: COVID-19; Clinical features; Neonates; Pregnant women; SARS-CoV-2.

Conflict of interest statement

The authors declare that they have no competing interests.

Similar articles

Outcomes of Neonates Born to Mothers With Severe Acute Respiratory Syndrome Coronavirus 2 Infection at a Large Medical Center in New York City.

Dumitriu D, Emeruwa UN, Hanft E, Liao GV, Ludwig E, Walzer L, Arditi B, Saslaw M, Andrikopoulou M, Scripps T, Baptiste C, Khan A, Breslin N, Rubenstein D, Simpson LL, Kyle MH, Friedman AM, Hirsch DS, Miller RS, Fernández CR, Fuchs KM, Keown MK, Glassman ME, Stephens A, Gupta A, Sultan S, Sibblies C, Whittier S, Abreu W, Akita F, Penn A, D'Alton ME, Orange JS, Goffman D, Saiman L, Stockwell MS, Gyamfi-Bannerman C.JAMA Pediatr. 2021 Feb 1;175(2):157-167. doi: 10.1001/jamapediatrics.2020.4298.PMID: 33044493 Free PMC article.

Association of Maternal Perinatal SARS-CoV-2 Infection With Neonatal Outcomes During the COVID-19 Pandemic in Massachusetts.

Angelidou A, Sullivan K, Melvin PR, Shui JE, Goldfarb IT, Bartolome R, Chaudhary N, Vaidya R, Culic I, Singh R, Yanni D, Patrizi S, Hudak ML, Parker MG, Belfort MB.JAMA Netw Open. 2021 Apr 1;4(4):e217523. doi: 10.1001/jamanetworkopen.2021.7523.PMID: 33890989 Free PMC article.

Pregnancy and neonatal outcomes of COVID-19: coreporting of common outcomes from PAN-COVID and AAP-SONPM registries.

Mullins E, Hudak ML, Banerjee J, Getzlaff T, Townson J, Barnette K, Playle R, Perry A, Bourne T, Lees CC; PAN-COVID investigators and the National Perinatal COVID-19 Registry Study Group.Ultrasound Obstet Gynecol. 2021 Apr;57(4):573-581. doi: 10.1002/uog.23619.PMID: 33620113 Free PMC article.

A systematic review of pregnant women with COVID-19 and their neonates.

Mirbeyk M, Saghazadeh A, Rezaei N.Arch Gynecol Obstet. 2021 Jul;304(1):5-38. doi: 10.1007/s00404-021-06049-z. Epub 2021 Apr 2.PMID: 33797605 Free PMC article. Review.

Maternal and perinatal outcomes in pregnant women infected by SARS-CoV-2: A meta-analysis.

Bellos I, Pandita A, Panza R.Eur J Obstet Gynecol Reprod Biol. 2021 Jan;256:194-204. doi: 10.1016/j.ejogrb.2020.11.038. Epub 2020 Nov 13.PMID: 33246205 Free PMC article. Review.

Cited by

Effect of COVID-19 on Pregnancy and Neonate's Vital Parameters: A Systematic Review.

Charuta A, Smuniewska M, Woźniak Z, Paziewska A.J Pregnancy. 2023 May 13;2023:3015072. doi: 10.1155/2023/3015072. eCollection 2023.PMID: 37215313 Free PMC article.

Maternal Outcomes Among Pregnant Women Diagnosed With COVID-19.

Al-Zahrani A, Alanazi L, Thabet H, Alenezi F.Cureus. 2023 Jan 17;15(1):e33887. doi: 10.7759/cureus.33887. eCollection 2023 Jan.PMID: 36819426 Free PMC article.

COVID-19 and Pregnancy.

Chowdhury S, Bappy MH, Desai S, Chowdhury S, Patel V, Chowdhury MS, Fonseca A, Sekzer C, Zahid S, Patousis A, Gerothanasi A, Masenga MJ.Discoveries (Craiova). 2022 Jun 30;10(2):e147. doi: 10.15190/d.2022.6. eCollection 2022 Apr-Jun.PMID: 36438440 Free PMC article. Review.

Effects of COVID-19 on Pregnant Women and Newborns: A Review.

Patel BM, Khanna D, Khanna S, Hapshy V, Khanna P, Kahar P, Parmar MS.Cureus. 2022 Oct 21;14(10):e30555. doi: 10.7759/cureus.30555. eCollection 2022 Oct.PMID: 36415402 Free PMC article. Review.

Prognosis of COVID-19 in the middle eastern population, knowns and unknowns.

Dandachi I, Aljabr W.Front Microbiol. 2022 Aug 31;13:974205. doi: 10.3389/fmicb.2022.974205. eCollection 2022.PMID: 36118201 Free PMC article. Review.

KMEL References

https://pubmed.ncbi.nlm.nih.gov/

References

  1.  
    1. World Health Organization . Novel coronavirus situation report-2. 2020.
  2.  
    1. Centers for Disease Control and Prevention. First travel-related case of 2019 novel coronavirus detected in United States, January 21st, 2020. https://www.cdc.gov/media/releases/2020/p0121-novel-coronavirus-travel-c.... Accessed 5 July 2020.
  3.  
    1. European Centre for Disease Prevention and Control. Novel coronavirus in China. https://www.ecdc.europa.eu/en/novel-coronavirus-china. Accessed 5 July 2020.
  4.  
    1. Singhal T. A review of coronavirus Disease-2019 (COVID-19) Indian J Pediatr. 2020;87:281–286. doi: 10.1007/s12098-020-03263-6. - DOI - PMC - PubMed
  5.  
    1. Fan C, Lei D, Fang C, Li C, Wang M, Liu Y, et al. Perinatal Transmission of COVID-19 Associated SARS-CoV-2: Should We Worry? Clin Infect Dis. 2020;ciaa226. 10.1093/cid/ciaa226. - PMC - PubMed
  6.  
    1. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395:p1054–p106. - PMC - PubMed
  7.  
    1. Mor G, Cardenas I. The immune system in pregnancy: a unique complexity. Am J Reprod Immunol. 2010;63:425–433. doi: 10.1111/j.1600-0897.2010.00836.x. - DOI - PMC - PubMed
  8.  
    1. Coronavirus infection and pregnancy. The Royal College of Obstetricians and Gynaecologists. 2020. https://www.rcog.org.uk/en/guidelines-research-services/guidelines/coron.... Accessed 5 July 2020.
  9.  
    1. Docherty AB, Harrison EM, Green CA, et al. Features of 20 133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: prospective observational cohort study. BMJ. 2020;369:m1985. - PMC - PubMed
  10.  
    1. ICNARC . Report on COVID-19 in critical care. 2020.
  11.  
    1. Chen Y, Li Z, Zhang YY, Zhao WH, Yu ZY. Maternal health care management during the outbreak of coronavirus disease 2019. J Med Virol. 2020;92:731–739. doi: 10.1002/jmv.25787. - DOI - PubMed
  12.  
    1. Zhu H, Wang L, Fang C, Peng S, Zhang L, Chang G, et al. Clinical analysis of 10 neonates born to mothers with 2019-nCoVpneumonia. Transl Pediatr. 2020;9:51–60. doi: 10.21037/tp.2020.02.06. - DOI - PMC - PubMed
  13.  
    1. Chen H, Guo J, Wang C, Luo F, Yu X, Zhang W, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet. 2020;395:809–815. doi: 10.1016/S0140-6736(20)30360-3. - DOI - PMC - PubMed
  14.  
    1. Breslin N, Baptiste C, Gyamfi-Bannerman C, Miller R, Martinez R, Bernstein K, et al. COVID-19 infection among asymptomatic and symptomatic pregnant women: two weeks of confirmed presentations to an affiliated pair of New York City hospitals. Am J Obstet Gynecol MFM. 2020;2:100118. doi: 10.1016/j.ajogmf.2020.100118. - DOI - PMC - PubMed
  15.  
    1. Chen L, Li Q, Zheng D, Zhao Y, Qiao J. Clinical characteristics of pregnant women with covid-19 in Wuhan, China. N Engl J Med. 2020;382:e100. doi: 10.1056/NEJMc2009226. - DOI - PMC - PubMed
  16.  
    1. Pierce-Williams RAM, Burd J, Felder L, Khoury R, Bernstein PS, Avila K, et al. Clinical course of severe and critical COVID-19 in hospitalized pregnancies: a US cohort study. Am J Obstet Gynecol MFM. 2020;2(3):100134. - PMC - PubMed
  17.  
    1. Smith V, Seo D, Warty R, Payne O, Salih M, Chin KL, et al. Maternal and neonatal outcomes associated with COVID-19 infection: a systematic review. Plos One. 2020;15:e0234187. doi: 10.1371/journal.pone.0234187. - DOI - PMC - PubMed
  18.  
    1. Muhidin S, Behboodi Moghadam Z, Vizheh M. Analysis of maternal coronavirus infections and neonates born to mothers with 2019-nCoV; a systematic review. Arch Acad Emerg Med. 2020;8:e49. - PMC - PubMed
  19.  
    1. Rasmussen SA, Smulian JC, Lednicky JA, Wen TS, Jamieson DJ. Coronavirus disease 2019 (COVID-19) and pregnancy: what obstetricians need to know. Am J Obstet Gynecol. 2020;222:P415–P426. doi: 10.1016/j.ajog.2020.02.017. - DOI - PMC - PubMed
  20.  
    1. Schwartz DA, Graham AL. Potential maternal and infant outcomes from (Wuhan) coronavirus 2019-nCoV infecting pregnant women: lessons from SARS, MERS, and other human coronavirus infections. Viruses. 2020;12:194. doi: 10.3390/v12020194. - DOI - PMC - PubMed
  21.  
    1. Jamieson DJ, Honein MA, Rasmussen SA, Williams JL, Swerdlow DL, Biggerstaff MS, et al. H1N1 2009 influenza virus infection during pregnancy in the USA. Lancet. 2009;374:451–458. doi: 10.1016/S0140-6736(09)61304-0. - DOI - PubMed
  22.  
    1. Siston AM, Rasmussen SA, Honein MA, Fry AM, Seib K, Callaghan WM, et al. Pandemic 2009 influenza a (H1N1) virus illness among pregnant women in the United States. JAMA. 2010;303:1517–1525. doi: 10.1001/jama.2010.479. - DOI - PMC - PubMed
  23.  
    1. Australian and New Zealand Intensive Care Inlfuenza Investigators and the Australian Maternity Outcomes Surveillance System. Critical illness due to 2009 A/H1N1 influenza in pregnant and postpartum women: population based cohort study. BMJ. 2010;340:c127. - PMC - PubMed
  24.  
    1. Mullins E, Evans D, Viner RM, O’Brien P, Morris E. Coronavirus in pregnancy and delivery: rapid review. Ultrasound Obstet Gynecol. 2020;55:586–592. doi: 10.1002/uog.22014. - DOI - PubMed
  25.  
    1. Alfaraj SH, Al-Tawfiq JA, Memish ZA. Middle East respiratory syndrome coronavirus (MERS-CoV) infection during pregnancy: report of two cases & review of the literature. J Microbiol Immunol Infect. 2019;52:501–503. doi: 10.1016/j.jmii.2018.04.005. - DOI - PMC - PubMed
  26.  
    1. Yang P, Wang X, Liu P, Wei C, He B, Zheng J, et al. Clinical characteristics and risk assessment of newborns born to mothers with COVID-19. J ClinVirol. 2020;127:104356. - PMC - PubMed
  27.  
    1. Stuebe A. Should infants be separated from mothers with COVID-19? First, Do No Harm. Breastfeed Med. 2020;15:351–352. doi: 10.1089/bfm.2020.29153.ams. - DOI - PMC - PubMed
  28.  
    1. Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Cladwell E, Fan E, et al. Acute respiratory distress syndrome: the Berlin definitions. JAMA. 2012;307:2526–2533. - PubMed
  29.  
    1. Knight M, Bunch K, Vousden N, Morris E, Simpson N, Gale C, et al. Characteristics and outcomes of pregnant women admitted to hospital with confirmed SARS-CoV-2 infection in UK: national population based cohort study. BMJ. 2020;369:m2107. doi: 10.1136/bmj.m2107. - DOI - PMC - PubMed
  30.  
    1. Zhang L, Jiang Y, Wei M, Cheng BH, Zhou XC, Li J, et al. Analysis of the pregnancy outcomes in pregnant women with covid-19 in Hubei Province. Zhonghua Fu Chan KeZaZhi. 2020;55:166–171. - PubMed
  31.  
    1. Breslin N, Baptiste C, Miller R, Fuchs K, Goffman D, Gyamfi-Bannerman C, et al. Covid-19 in pregnancy: early lessons. Am J Obstet Gynecol. 2020;2:100111. - PMC - PubMed
  32.  
    1. Liu Y, Chen H, Tang K, Guo Y. Clinical manifestations and outcome of SARS-CoV-2 infection during pregnancy. J Infect. 2020;4453(2):30109–2. - PMC - PubMed
  33.  
    1. Juusela A, Nazir M, Gimovsky M. Two cases of coronavirus 2019-related cardiomyopathy in pregnancy. Am J Obstet Gynecol MFM. 2020;2:100113. doi: 10.1016/j.ajogmf.2020.100113. - DOI - PMC - PubMed
  34.  
    1. Juan J, Gil MM, Rong Z, Zhang Y, Yang H, Poon LC. Effects of coronavirus disease 2019 (COVID-19) on maternal, perinatal and neonatal outcomes: a systematic review. Ultrasound Obstet Gynecol. 2020;56:15–27. doi: 10.1002/uog.22088. - DOI - PMC - PubMed
  35.  
    1. Public Health England. COVID-19: investigation and initial clinical management of possible cases. 2020. https://www.gov.uk/ government/publications/ wuhan-novel-coronavirus-ini...-of-possible-cases/investigation-and-initial-clinical-management-of-possible-cases-of-wuhannovel-coronavirus-wn-cov-infection. Accessed 1 June 2020.
  36.  
    1. Yang H, Hu B, Zhan S, Yang L. Effects of SARS-CoV-2 infection on pregnant women and their infants: a retrospective study in Wuhan, China. Arch Pathol Lab Med. 2020;144(10):1217–22. - PubMed
  37.  
    1. Shi L, Wang Y, Yang H, Duan G, Wang Y. Laboratory Abnormalities in Pregnant Women with Novel Coronavirus Disease 2019. Am J Perinatol. 2020;37(10):1070–3. - PMC - PubMed
  38.  
    1. Bremme KA. Haemostatic changes in pregnancy. Best Pract Res Clin Haematol. 2003;16:153–168. doi: 10.1016/S1521-6926(03)00021-5. - DOI - PubMed
  39.  
    1. Lokken EM, Walker CL, Delaney S, Kachikis A, Kretzer NM, Erickson A, Resnick R, et al. Clinical characteristics of 46 pregnant women with a SARS-CoV-2 infection in Washington state. Am J Obstetr Gynecol. 2020;223(6):911.e1–911.e14. - PMC - PubMed
  40.  
    1. Zaigham M, Andersson O. Maternal and perinatal outcomes with COVID-19: a systematic review of 108 pregnancies. Actaobstetricia et gynecologica Scandinavica. 2020;99(7):823–9. - PMC - PubMed
  41.  
    1. Yan J, Guo J, Fan C, Juan J, Yu X, Li J, et al. Coronavirus disease 2019 (COVID-19) in pregnant women: a report based on 116 cases. Am J Obstetr Gynecol. 2020;223(1):111.e1–111.e14. - PMC - PubMed
  42.  
    1. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu J, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395:497–506. doi: 10.1016/S0140-6736(20)30183-5. - DOI - PMC - PubMed
  43.  
    1. Yu N, Li W, Kang Q, Xiong Z, Wang S, Lin X, et al. Clinical features and obstetric and neonatal outcomes of pregnant patients with COVID-19 in Wuhan, China: a retrospective, single-Centre, descriptive study. Lancet Infect Dis. 2020;20:559–564. doi: 10.1016/S1473-3099(20)30176-6. - DOI - PMC - PubMed
  44.  
    1. Zeng H, Xu C, Fan J, Tang Y, Deng Q, Zhang W, et al. Antibodies in infants born to mothers with covid-19 pneumonia. JAMA. 2020;323:1848–1849. - PMC - PubMed
  45.  
    1. Zeng L, Xia S, Yuan W, Yan K, Xiao F, Shao J, et al. Neonatal early-onset infection with SARS-CoV-2 in 33 neonates born to mothers with covid-19 in Wuhan, China. JAMA Pediatr. 2020;174(7):722–5. - PMC - PubMed
  46.  
    1. Dong L, Tian J, He S, Zhu C, Wang J, Liu C, et al. Possible vertical transmission of SARSCoV-2 from an infected mother to her newborn. JAMA. 2020;323(18):1846–1848. - PMC - PubMed
  47.  
    1. Shah PS, Diambomba Y, Acharya G, Morris SK, Bitnun A. Classification system and case definition for SARS-CoV-2 infection in pregnant women, fetuses, and neonates. Acta Obstetriciaet Gynecol Scandinavica. 2020;99:565–568. doi: 10.1111/aogs.13870. - DOI - PMC - PubMed
  48.  
    1. Boskabadi H, Maamouri G, Mafinejad S. Neonatal complications related with prolonged rupture of membranes. Macedonian J Med Sci. 2011;4:93–98.
  49.  
    1. Simonsen KA, Anderson-Berry AL, Delair SF, Davies HD. Early-onset neonatal sepsis. Clin Microbiol Rev. 2014;27:21–47. doi: 10.1128/CMR.00031-13. - DOI - PMC - PubMed

Page Navigation