Risk factors for severe and critical Covid-19 in pregnant women in a single center in Brazil.

Abstract

BACKGROUND\nRisk factors for severe SARS-CoV2 infection in pregnancy have not been extensively studied. This information can help guide the management of pregnant women with COVID-19.\n\n\nOBJECTIVE\nExamine risk factors for severe COVID-19 in pregnant women.\n\n\nMETHODS\nWe reviewed the records of all pregnant women with positive SARS-CoV2 tests (qRT-PCR) managed at a single tertiary private maternity in Sao Paulo, Brazil. We categorized women as having non-severe (mild or moderate) or severe (severe or critical) COVID-19. We conducted multivariable analyses to identify differences in sociodemographic and clinical characteristics of the two groups as risk factors for severe COVID-19.\n\n\nRESULTS\nBetween March 13 and June 7 2020, 114 women tested positive for SARS-CoV-2; 80.7% (n\u2009=\u200992) had non-severe disease (69 mild, 23 moderate), 15.7% (n\u2009=\u200918) had severe, and 3.5% (n\u2009=\u20094) had critical COVID-19. Women with severe/critical COVID-19 (n\u2009=\u200922) were significantly older (35.0\u2009±\u20095.9\u2009×\u200931.8\u2009±\u20095.1\u2009years, p\u2009=\u20090.011), more likely to have at least one medical comorbidity (81.8% × 52.2%, p\u2009=\u2009.011) or a history of asthma (18.2% × 3.3%, p\u2009=\u2009.025), and tended to have a higher median body mass index (30.1\u2009kg/m2, IQR 28.1-33.9\u2009×\u200928.6, IQR 26.2-32.0, p\u2009=\u2009.056) than women with non-severe disease. Multivariate logistic regression analysis identified four factors as independent predictors of severe/critical COVID-19: asthma (OR 34.469, 95% CI 1.151-78.030, p\u2009=\u2009.026), non-white ethnicity (OR 7.932, 95% CI 1.311-47.973, p\u2009=\u2009.024), maternal age with a best cutoff of ≥ 34\u2009years (OR 1.195, 95% CI 1.001-1.427, p\u2009=\u2009.048) and gestational age at diagnosis with a best cut-off of ≥ 35\u2009weeks (OR 0.876, 95% CI 0.780-0.983, p\u2009=\u2009.025). The predictive value of the model including all variables was 0.823 (p\u2009<\u2009.001).\n\n\nCONCLUSION\nA history of asthma, non-white ethnicity, and older maternal age were risk factors for, while higher gestational age was protective against severe/critical COVID-19 in pregnant Brazilian women.