Pregnancy Outcomes in COVID-19: A Prospective Cohort Study in Singapore

Ann Acad Med Singap. 2020 Nov;49(11):857-869. doi: 10.47102/annals-acadmedsg.2020437.

Abstract

Introduction: Pregnant women are reported to be at increased risk of severe coronavirus disease 2019 (COVID-19) due to underlying immunosuppression during pregnancy. However, the clinical course of COVID-19 in pregnancy and risk of vertical and horizontal transmission remain relatively unknown. We aim to describe and evaluate outcomes in pregnant women with COVID-19 in Singapore.

Methods: Prospective observational study of 16 pregnant patients admitted for COVID-19 to 4 tertiary hospitals in Singapore. Outcomes included severe disease, pregnancy loss, and vertical and horizontal transmission.

Results: Of the 16 patients, 37.5%, 43.8% and 18.7% were infected in the first, second and third trimesters, respectively. Two gravidas aged ≥35 years (12.5%) developed severe pneumonia; one patient (body mass index 32.9kg/m2) required transfer to intensive care. The median duration of acute infection was 19 days; one patient remained reverse transcription polymerase chain reaction (RT-PCR) positive >11 weeks from diagnosis. There were no maternal mortalities. Five pregnancies produced term live-births while 2 spontaneous miscarriages occurred at 11 and 23 weeks. RT-PCR of breast milk and maternal and neonatal samples taken at birth were negative; placenta and cord histology showed non-specific inflammation; and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-specific immunoglobulins were elevated in paired maternal and umbilical cord blood (n=5).

Conclusion: The majority of COVID-19 infected pregnant women had mild disease and only 2 women with risk factors (obesity, older age) had severe infection; this represents a slightly higher incidence than observed in age-matched non-pregnant women. Among the women who delivered, there was no definitive evidence of mother-to-child transmission via breast milk or placenta.

Publication types

  • Observational Study

MeSH terms

  • Abortion, Spontaneous / epidemiology
  • Adult
  • COVID-19 / epidemiology*
  • COVID-19 / physiopathology
  • COVID-19 / transmission
  • COVID-19 Nucleic Acid Testing
  • COVID-19 Serological Testing
  • Cohort Studies
  • Disease Transmission, Infectious / statistics & numerical data
  • Female
  • Fetal Blood / immunology
  • Humans
  • Infectious Disease Transmission, Vertical / statistics & numerical data
  • Live Birth / epidemiology
  • Maternal Age
  • Milk, Human / chemistry
  • Milk, Human / virology
  • Obesity, Maternal / epidemiology
  • Placenta / pathology
  • Pregnancy
  • Pregnancy Complications, Infectious / epidemiology*
  • Pregnancy Complications, Infectious / physiopathology
  • Pregnancy Outcome / epidemiology*
  • Pregnancy Trimester, First
  • Pregnancy Trimester, Second
  • Prospective Studies
  • RNA, Viral / analysis
  • Risk Factors
  • SARS-CoV-2
  • Severity of Illness Index
  • Singapore / epidemiology
  • Umbilical Cord / pathology
  • Young Adult

Substances

  • RNA, Viral