LB02 Maternal and neonatal outcomes of pregnant patients with coronavirus disease 2019 (COVID-19): A multistate cohort

Objective: To describe COVID-19 disease course in a multistate cohort of pregnant patients and evaluate whether more severe disease is associated with worse maternal and neonatal outcomes Study Design: Cohort of all pregnant patients with a singleton gestation and positive SARS-CoV-2 nucleic acid or antigen test (either in- or out-patient), who delivered at one of 33 U S hospitals from March 1 to July 31, 2020 Disease severity was classified by NIH criteria Perinatal outcomes included death, cesarean delivery (CD), postpartum hemorrhage (PPH), hypertensive disorders of pregnancy (HDP), and preterm birth < 37 weeks’ (PTB) Centrally-trained perinatal research staff abstracted data from medical records We evaluated trends in maternal characteristics and outcomes across COVID-19 severity classes and associations between severity and outcomes by multivariable modeling Results: 1,219 patients were included: 47% asymptomatic, 27% mild, 14% moderate, 8% severe and 4% critical Those with more severe illness had an older mean age, higher median body mass index, and higher frequency of medical comorbidities (asthma/COPD, diabetes, hypertension, liver disease, seizure disorder) The majority of included patients were Hispanic ethnicity;however, there was no trend in race-ethnicity distribution by severity (Table 1) The most common symptoms were cough (34%), dyspnea (19%), and myalgias (19%) Four maternal deaths (0 3%) were attributed to COVID-19 Adverse perinatal outcomes became more frequent with increasing severity of COVID-19, including a 6% (95% CI 2 5-10 9%) VTE rate with severe/critical (Table 2) In adjusted analyses, severe/critical COVID-19 was associated with CD, PPH, HDP, and PTB compared with asymptomatic patients Approximately 1% (95% CI 0 5-1 8%) of neonates tested positive for SARS-CoV-2 before discharge Conclusion: Medical comorbidities were present more often in patients with more severe disease Compared with asymptomatic patients, those with severe/critical COVID-19, but not those with mild/moderate COVID-19, were at increased risk of perinatal complications Perinatal transmission was rare [Formula presented] [Formula presented]