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Am J Perinatol 2024; 41(16): 2290-2297
DOI: 10.1055/s-0044-1786868
Original Article

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

Grecio J. Sandoval 
1   Biostatistics Center, George Washington University, Washington, District of Columbia
,
Torri D. Metz
2   Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah
,
William A. Grobman
3   Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
,
Tracy A. Manuck
4   Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina
,
Brenna L. Hughes
4   Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina
,
George R. Saade
5   Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas
,
Monica Longo
6   Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
,
Hyagriv N. Simhan
7   Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, Pennsylvania
,
Dwight J. Rouse
8   Department of Obstetrics and Gynecology, Brown University, Providence, Rhode Island
,
Hector Mendez-Figueroa
9   Department of Obstetrics and Gynecology, Children's Memorial Hermann Hospital, University of Texas Health Science Center at Houston, Houston, Texas
,
Cynthia Gyamfi-Bannerman
10   Department of Obstetrics and Gynecology, Columbia University, New York, New York
,
Angela C. Ranzini
11   Department of Obstetrics and Gynecology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
,
Maged M. Costantine 
12   Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
,
Harish M. Sehdev
13   Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania
,
Alan T.N. Tita
14   Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
,
for the Eunice Kennedy Shriver National Institute of Child Health Human Development Maternal-Fetal Medicine Units Network, Bethesda, MD› Author Affiliations
Funding This work is funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (UG1 HD087230, UG1 HD027869, UG1 HD027915, UG1 HD034208, UG1 HD040500, UG1 HD040485, UG1 HD053097, UG1 HD040544, UG1 HD040545, UG1 HD040560, UG1 HD040512, UG1 HD087192, U24 HD036801) and the National Center for Advancing Translational Sciences (UL1TR001873).The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
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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.

Keywords

SARS-CoV-2 - COVID-19 pandemic - prediction

* See [Appendix] for a list of other members of the NICHD MFMU Network.


Supplementary Material



Publication History

Received: 31 July 2023

Accepted: 16 April 2024

Article published online:
10 May 2024

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