Pregnancy Complications in COVID-19: A Retrospective Review of Medical Records

Abstract

Background: The coronavirus 2019 (COVID 19) is a novel virus that led to a global public health emergency. Several case reports highlighted the severity of infection in pregnant women given their immunocompromised state. Nevertheless, the exact effect of COVID 19 on pregnancy and childbirth is unknown due to lack of sufficient studies and guidelines. Aims: To evaluate the adverse effects and maternal-fetal outcomes that COVID-19 has on pregnancy in a sample of women who delivered at a tertiary medical center in 2021, compare the maternal and fetal outcomes of these women to a comparison group of healthy women matched by age and parity, and identify the predictors of select maternal and fetal outcomes. Methods: This study used a retrospective descriptive comparative design. Data were collected through chart review on the maternal fetal outcomes of pregnant women that contracted COVID-19 throughout the course of their pregnancy, and delivered in the year of 2021 in Emirates Hospital Jumeirah, a tertiary healthcare center in Dubai, UAE and the comparison group. Women who contracted COVID-19 infection prior to their pregnancy were excluded from the study. Results: From January to December 2021, 43 pregnant women contracted COVID-19 infection that were matched with 43 healthy pregnant women for a total sample of 86 with a mean age of 31 and parity 0.72. The incidence of preterm deliveries was significantly higher in the COVID-19 group, with a rate of 20.9% vs. 4.7% in the comparison group (p = 0.049). A higher number of premature rupture of membranes was notably observed with an incidence of 18.6% in the COVID-19 group versus none in the comparison group (p = 0.005). No significant difference was found in maternal outcomes; however, women who delivered prematurely were 46 times more likely to experience fetal distress (20.9% vs. 2.3%, p=0.015). While controlling for confounders, multivariable logistic regression showed that fetal distress was the only significant predictor of premature birth, whereas history of prior maternal complications and premature birth predicted fetal distress, with a positive trend for exposure to COVID-19. Conclusion: The findings suggest that women who contract COVID-19 infection are more likely to deliver prematurely and experience fetal distress than those who do not. However, a limitation of the study was the small sample size that was recruited from one medical center. A comprehensive maternal-fetal assessment and monitoring is required in women exposed to COVID-19 until more evidence becomes available from rigorous studies.