Delivery outcomes in a cohort of pregnant patients with COVID-19 with and without viral pneumonia

BACKGROUND: Among pregnant people, COVID-19 can lead to adverse outcomes, but the specific pregnancy outcomes that are affected by the disease are unclear. In addition, the effect of the severity of COVID-19 on pregnancy outcomes has not been clearly identified. OBJECTIVE: This study aimed to evaluate the associations between COVID-19 with and without viral pneumonia and cesarean delivery, pre -term delivery, preeclampsia, and stillbirth. STUDY DESIGN: We conducted a retrospective cohort study (April 2020-May 2021) of deliveries between 20 and 42 weeks of gestation from US hospitals in the Premier Healthcare Database. The primary out-comes were cesarean delivery, preterm delivery, preeclampsia, and still-birth. We used a viral pneumonia diagnosis (International Classification of Diseases-Tenth-Clinical Modification codes J12.8 and J12.9) to catego-rize patients by severity of COVID-19. Pregnancies were categorized into 3 groups: NOCOVID (no COVID-19), COVID (COVID-19 without viral pneu-monia), and PNA (COVID-19 with viral pneumonia). Groups were balanced for risk factors by propensity-score matching. RESULTS: A total of 814,649 deliveries from 853 US hospitals were included (NOCOVID: n=799,132; COVID: n=14,744; PNA: n=773). After propensity-score matching, the risks of cesarean delivery and pre-eclampsia were similar in the COVID group compared with the NOCOVID group (matched risk ratio, 0.97; 95% confidence interval, 0.94-1.00; and matched risk ratio, 1.02; 95% confidence interval, 0.96-1.07; respectively). The risks of preterm delivery and stillbirth were greater in the COVID group than in the NOCOVID group (matched risk ratio, 1.11; 95% confidence interval, 1.05-1.19; and matched risk ratio, 1.30; 95% confidence interval, 1.01-1.66; respectively). The risks of cesar-ean delivery, preeclampsia, and preterm delivery were higher in the PNA group than in the COVID group (matched risk ratio, 1.76; 95% confi-dence interval, 1.53-2.03; matched risk ratio, 1.37; 95% confidence interval, 1.08-1.74; and matched risk ratio, 3.33; 95% confidence interval, 2.56-4.33; respectively). The risk of stillbirth was similar in the PNA and COVID group (matched risk ratio, 1.17; 95% confidence interval, 0.40-3.44). CONCLUSION: Within a large national cohort of hospitalized pregnant people, we found that the risk of some adverse delivery outcomes was ele-vated in people with COVID-19 with and without viral pneumonia, with much higher risks in the group with viral pneumonia.