Incidence and clinical profiles of COVID-19 pneumonia in pregnant women: A single-centre cohort study from Spain

Rafael San-Juan; Patricia Barbero; Mario Fernández-Ruiz; Francisco López-Medrano; Manuel Lizasoáin; Pilar Hernández-Jiménez; José Tiago Silva; María Ruiz-Ruigómez; Laura Corbella; Isabel Rodríguez-Goncer; María Dolores Folgueira; Antonio Lalueza; Emma Batllori; Inma Mejía; Laura Forcén; Carlos Lumbreras; Antonio García-Burguillo; Alberto Galindo; José María Aguado

doi:10.1016/j.eclinm.2020.100407

Incidence and clinical profiles of COVID-19 pneumonia in pregnant women: A single-centre cohort study from Spain

EClinicalMedicine. 2020 Jun 15:23:100407. doi: 10.1016/j.eclinm.2020.100407. eCollection 2020 Jun.

Authors

Rafael San-Juan¹, Patricia Barbero², Mario Fernández-Ruiz¹, Francisco López-Medrano¹, Manuel Lizasoáin¹, Pilar Hernández-Jiménez¹, José Tiago Silva¹, María Ruiz-Ruigómez¹, Laura Corbella¹, Isabel Rodríguez-Goncer¹, María Dolores Folgueira³, Antonio Lalueza⁴, Emma Batllori², Inma Mejía², Laura Forcén², Carlos Lumbreras⁴, Antonio García-Burguillo², Alberto Galindo², José María Aguado¹

Affiliations

¹ Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Complutense University, 2ª planta, bloque D. Avda. de Córdoba, s/n. Madrid, Spain.
² Unit of Perinatal Medicine, Obstetrics and Gynaecology Department, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Complutense University, Madrid, Spain.
³ Department of Microbiology, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Complutense University, Madrid, Spain.
⁴ Department of Internal Medicine, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Complutense University, Madrid, Spain.

Abstract

Background: Information regarding the incidence and characteristics of COVID-19 pneumonia amongst pregnant women is scarce.

Methods: Single-centre experience with 32 pregnant women diagnosed with COVID-19 between March 5 to April 5, 2020 at Madrid, Spain.

Findings: COVID-19 pneumonia was diagnosed in 61·5% (32/52) women. Only 18·7% (6/32) had some underlying condition (mostly asthma). Supplemental oxygen therapy was required in 18 patients (56·3%), with high-flow requirements in six (18·7%). Eight patients (25·0%) fulfilled the criteria for acute distress respiratory syndrome. Invasive mechanical ventilation was required in two patients (6·2%). Tocilizumab was administered in five patients (15·6%). Delivery was precipitated due to COVID-19 in three women (9·4%). All the newborns had a favourable outcome, with no cases of neonatal SARS-CoV-2 transmission. Severe cases of pneumonia requiring supplemental oxygen were more likely to exhibit bilateral alveolar or interstitial infiltrates on chest X-ray (55·6% vs. 0·0%; P-value = 0·003) and serum C-reactive protein (CRP) levels >10 mg/dL (33·0% vs. 0·0%; P-value = 0·05) at admission than those with no oxygen requirements.

Interpretation: Pregnant women with COVID-19 have a high risk of developing pneumonia, with a severe course in more than half of cases. The presence of bilateral kung infiltrates and elevated serum CRP at admission may identify women at-risk of severe COVID-19 pneumonia.

Funding: Instituto de Salud Carlos III (COV20/00,181), Spanish Ministry of Science and Innovation.

Keywords: ALT, alanine aminotransferase; ARDS, acute respiratory distress syndrome; AST, aspartate aminotransferase; COVID-19; COVID-19, coronavirus disease 2019; CRP, C-reactive protein; CT, computerized tomography; Coronavirus; HCQ, hydroxychloroquine; ICU, intensive care unit; IFN-β, interferon-β; IMV, invasive mechanical ventilation; IQR, interquartile range; IV, intravenous; LPV/r, lopinavir/ritonavir; Pneumonia; Pregnancy; RT-PCR, reverse transcription polymerase chain reaction; Risk stratification; SARS-CoV-2; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; TCZ, tocilizumab; URTI, upper respiratory tract infection; ePaO2/FiO2, estimated arterial oxygen/fraction of inspired oxygen ratio.