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Clinical risk factors of adverse outcomes among women with COVID-19 in the pregnancy and postpartum period: a sequential, prospective meta-analysis

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dc.contributor.authorSmith, Emily
dc.contributor.authorOakley, Erin
dc.contributor.authorWable Grandner, Gargi
dc.contributor.authorRukundo, Gordon
dc.contributor.authorFarooq, Fouzia
dc.contributor.authorFerguson, Kacey
dc.contributor.authorBaumann, Sasha
dc.contributor.authorAdams Waldorf, Kristina Maria
dc.contributor.authorAfshar, Yalda
dc.contributor.authorAhlberg, Mia
dc.contributor.authorAhmadzia, Homa
dc.contributor.authorAkelo, Victor
dc.contributor.authorAldrovandi, Grace
dc.contributor.authorBevilacqua, Elisa
dc.contributor.authorBracero, Nabal
dc.contributor.authorBrandt, Justin S.
dc.contributor.authorBroutet, Natalie
dc.contributor.authorCarrillo Termini, Jorge
dc.contributor.authorJeanne Conry, Jeanne
dc.contributor.authorCosmi, Erich
dc.contributor.authorCrispi, Fatima
dc.contributor.authorCrovetto, Francesca
dc.contributor.authorGil, Maria del Mar
dc.contributor.authorDelgado-López, Camille
dc.contributor.authorDivakar, Jeanne Hema
dc.contributor.authorDriscoll, Amanda J.
dc.contributor.authorFavre, Guillaume
dc.contributor.authorFernandez Buhigas, Irene
dc.contributor.authorFlaherman, Valerie
dc.contributor.authorGale, Christopher
dc.contributor.authorGodwin, Christine L.
dc.contributor.authorGottlieb, Sami
dc.contributor.authorGratacós, Eduard
dc.contributor.authorHe, Siran
dc.contributor.authorOlivia Hernandez, Olivia
dc.contributor.authorJones, Stephanie
dc.contributor.authorJoshi, Sheetal
dc.contributor.authorKalafat, Erkan
dc.contributor.authorKhagayi, Sammy
dc.contributor.authorKnight, Marian
dc.contributor.authorKotloff, Karen L.
dc.date.accessioned2024-06-04T20:30:44Z
dc.date.available2024-06-04T20:30:44Z
dc.date.issued2023
dc.descriptionAntonio Lanzone, Valentina Laurita Longo, Kirsty Le Doare, Christoph Lees, Ethan Litman, Erica M Lokken, Shabir A Madhi, Laura A Magee, Raigam Jafet Martinez-Portilla, Torri D Metz, Emily S Miller, Deborah Money, Sakita Moungmaithong, Edward Mullins, Jean B Nachega, Marta C Nunes, Dickens Onyango, Alice Panchaud, Liona C Poon, Daniel Raiten, Lesley Regan, Daljit Sahota, Allie Sakowicz, Jose Sanin-Blair, Olof Stephansson, Marleen Temmerman, Anna Thorson, Soe Soe Thwin, Beth A Tippett Barr, Jorge E Tolosa, Niyazi Tug, Miguel Valencia-Prado, Silvia Visentin, Peter von Dadelszen, Clare Whitehead, Mollie Wood, Huixia Yang, Rebecca Zavala, James M Tielsch
dc.description.abstractObjective This sequential, prospective meta-analysis sought to identify risk factors among pregnant and postpartum women with COVID-19 for adverse outcomes related to disease severity, maternal morbidities, neonatal mortality and morbidity, and adverse birth outcomes. Data Sources We prospectively invited study investigators to join the sequential, prospective meta-analysis via professional research networks beginning in March 2020. Study Eligibility Criteria Eligible studies included those recruiting at least 25 consecutive cases of COVID-19 in pregnancy within a defined catchment area. Methods We included individual patient data from 21 participating studies. Data quality was assessed, and harmonized variables for risk factors and outcomes were constructed. Duplicate cases were removed. Pooled estimates for the absolute and relative risk of adverse outcomes comparing those with and without each risk factor were generated using a 2-stage meta-analysis. Results We collected data from 33 countries and territories, including 21,977 cases of SARS-CoV-2 infection in pregnancy or postpartum. We found that women with comorbidities (preexisting diabetes mellitus, hypertension, cardiovascular disease) vs those without were at higher risk for COVID-19 severity and adverse pregnancy outcomes (fetal death, preterm birth, low birthweight). Participants with COVID-19 and HIV were 1.74 times (95% confidence interval, 1.12–2.71) more likely to be admitted to the intensive care unit. Pregnant women who were underweight before pregnancy were at higher risk of intensive care unit admission (relative risk, 5.53; 95% confidence interval, 2.27–13.44), ventilation (relative risk, 9.36; 95% confidence interval, 3.87–22.63), and pregnancy-related death (relative risk, 14.10; 95% confidence interval, 2.83–70.36). Prepregnancy obesity was also a risk factor for severe COVID-19 outcomes including intensive care unit admission (relative risk, 1.81; 95% confidence interval, 1.26–2.60), ventilation (relative risk, 2.05; 95% confidence interval, 1.20–3.51), any critical care (relative risk, 1.89; 95% confidence interval, 1.28–2.77), and pneumonia (relative risk, 1.66; 95% confidence interval, 1.18–2.33). Anemic pregnant women with COVID-19 also had increased risk of intensive care unit admission (relative risk, 1.63; 95% confidence interval, 1.25–2.11) and death (relative risk, 2.36; 95% confidence interval, 1.15–4. Conclusion We found that pregnant women with comorbidities including diabetes mellitus, hypertension, and cardiovascular disease were at increased risk for severe COVID-19–related outcomes, maternal morbidities, and adverse birth outcomes. We also identified several less commonly known risk factors, including HIV infection, prepregnancy underweight, and anemia. Although pregnant women are already considered a high-risk population, special priority for prevention and treatment should be given to pregnant women with these additional risk factors.
dc.description.versionVersión publicada
dc.format.extent17 p.
dc.identifier.citationSmith ER, Oakley E, Grandner GW, Rukundo G, Farooq F, Ferguson K, Baumann S, Adams Waldorf KM, Afshar Y, Ahlberg M, Ahmadzia H, Akelo V, Aldrovandi G, Bevilacqua E, Bracero N, Brandt JS, Broutet N, Carrillo J, Conry J, Cosmi E, Crispi F, Crovetto F, Del Mar Gil M, Delgado-López C, Divakar H, Driscoll AJ, Favre G, Fernandez Buhigas I, Flaherman V, Gale C, Godwin CL, Gottlieb S, Gratacós E, He S, Hernandez O, Jones S, Joshi S, Kalafat E, Khagayi S, Knight M, Kotloff KL, Lanzone A, Laurita Longo V, Le Doare K, Lees C, Litman E, Lokken EM, Madhi SA, Magee LA, Martinez-Portilla RJ, Metz TD, Miller ES, Money D, Moungmaithong S, Mullins E, Nachega JB, Nunes MC, Onyango D, Panchaud A, Poon LC, Raiten D, Regan L, Sahota D, Sakowicz A, Sanin-Blair J, Stephansson O, Temmerman M, Thorson A, Thwin SS, Tippett Barr BA, Tolosa JE, Tug N, Valencia-Prado M, Visentin S, von Dadelszen P, Whitehead C, Wood M, Yang H, Zavala R, Tielsch JM. Clinical risk factors of adverse outcomes among women with COVID-19 in the pregnancy and postpartum period: a sequential, prospective meta-analysis. Am J Obstet Gynecol. 2023 Feb;228(2):161-177. doi: 10.1016/j.ajog.2022.08.038.
dc.identifier.doihttps://doi.org/10.1016/j.ajog.2022.08.038
dc.identifier.urihttps://hdl.handle.net/11447/9028
dc.language.isoen
dc.rightsAtribución-NoComercial-CompartirIgual 3.0 Chile (CC BY-NC-SA 3.0 CL)
dc.rights.urihttp://creativecommons.org/licenses/by-nc-sa/3.0/cl/
dc.subjectOVID-2019
dc.subjectSARS-CoV-2
dc.subjectMaternal mortality
dc.subjectNeonatal mortality
dc.subjectPneumonia
dc.subjectPregnancy
dc.subjectSmall-for gestational-age
dc.subjectPreterm birth
dc.titleClinical risk factors of adverse outcomes among women with COVID-19 in the pregnancy and postpartum period: a sequential, prospective meta-analysis
dc.typeArticle
dcterms.accessRightsAcceso abierto
dcterms.sourceAmerican Journal of Obstetrics & Gynecology
dspace.entity.typePublication
relation.isAuthorOfPublication423ecc04-599a-4f1c-8773-72bd3b556bdb
relation.isAuthorOfPublication.latestForDiscovery423ecc04-599a-4f1c-8773-72bd3b556bdb

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