Obstetrical outcomes and follow-up for patients with asymptomatic COVID-19 at delivery: A multicenter prospective cohort study

Am J Obstet Gynecol MFM. 2021 Aug 7:100454. doi: 10.1016/j.ajogmf.2021.100454. Online ahead of print.


BACKGROUND: Universal testing for coronavirus disease (COVID-19) on labor and delivery identifies asymptomatic patients. Whether or not these patients are at increased risk for adverse outcomes and go on to develop clinically significant disease is uncertain.

OBJECTIVE: To assess the prevalence of asymptomatic COVID-19 among pregnant patients admitted for delivery and to determine if these patients become symptomatic or require hospital readmission after discharge.

METHODS: We performed a multicenter prospective cohort study of pregnant patients between 200/7 and 416/7 weeks gestation who were found to have COVID-19 based on universal screening on delivery admission at four medical centers in New Jersey (exposed group). The unexposed group comprised of patients who tested negative for COVID-19 were identified from the primary study site. The primary outcomes were the asymptomatic positive COVID-19 rate and the development of symptoms in the asymptomatic positive patients and hospital readmission in the two weeks following discharge. We compared the frequency distribution of risk factors and outcomes in relation to COVID-19 status, with COVID-19 positive patients across all centers and COVID-19 negative patients at the primary site. Associations for categorical risk factors with respect to COVID-19 status were expressed as relative risks (RR) with 95% confidence intervals (CI).

RESULTS: Between 10 April 2020 to 15 June 2020, there were 218 COVID-19 positive patients from the four sites and 413 COVID-19 negative patients from the primary site. The majority (188 [83.2%]) of COVID-19 positive patients were asymptomatic. Compared to negative controls, these asymptomatic patients were not at increased risk for obstetric complications that may increase the risk for COVID-19, including gestational diabetes (8.2% versus 11.4%, RR 0.72, 95% CI 0.24-2.01) and gestational hypertension (6.1% versus 7.0%, RR 0.88, 95% CI 0.29-2.67). Postpartum follow-up via telephone surveys revealed that these patients remained asymptomatic and had low rates of family contacts acquiring the disease, but their adherence with social distancing guidelines waned during the two weeks postpartum. Review of inpatient and emergency department records revealed low rates of hospital readmission.

CONCLUSIONS: The majority of pregnant patients who screened positive for COVID-19 are asymptomatic and do not go on to develop clinically significant infection after delivery. Routine surveillance of these patients after hospital discharge appears sufficient.

PMID:34375750 | DOI:10.1016/j.ajogmf.2021.100454

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