Prediction of COVID-19 Severity at Delivery after Asymptomatic or Mild COVID-19 during Pregnancy
Document Type
Journal Article
Publication Date
5-10-2024
Journal
American journal of perinatology
DOI
10.1055/s-0044-1786868
Abstract
OBJECTIVE: This study aimed to develop a prediction model that estimates the probability that a pregnant person who has had asymptomatic or mild coronavirus disease 2019 (COVID-19) prior to delivery admission will progress in severity to moderate, severe, or critical COVID-19. STUDY DESIGN: This was a secondary analysis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive patients who delivered from March through December 2020 at hospitals across the United States. Those eligible for this analysis presented for delivery with a current or previous asymptomatic or mild SARS-CoV-2 infection. The primary outcome was moderate, severe, or critical COVID-19 during the delivery admission through 42 days postpartum. The prediction model was developed and internally validated using stratified cross-validation with stepwise backward elimination, incorporating only variables that were known on the day of hospital admission. RESULTS: Of the 2,818 patients included, 26 (0.9%; 95% confidence interval [CI], 0.6-1.3%) developed moderate-severe-critical COVID-19 during the study period. Variables in the prediction model were gestational age at delivery admission (adjusted odds ratio [aOR], 1.15; 95% CI, 1.08-1.22 per 1-week decrease), a hypertensive disorder in a prior pregnancy (aOR 3.05; 95% CI, 1.25-7.46), and systolic blood pressure at admission (aOR, 1.04; 95% CI, 1.02-1.05 per mm Hg increase). This model yielded an area under the receiver operating characteristic curve of 0.82 (95% CI, 0.72-0.91). CONCLUSION: Among individuals presenting for delivery who had asymptomatic-mild COVID-19, gestational age at delivery admission, a hypertensive disorder in a prior pregnancy, and systolic blood pressure at admission were predictive of delivering with moderate, severe, or critical COVID-19. This prediction model may be a useful tool to optimize resources for SARS-CoV-2-infected pregnant individuals admitted for delivery. KEY POINTS: · Three factors were associated with delivery with more severe COVID-19.. · The developed model yielded an area under the receiver operating characteristic curve of 0.82 and model fit was good.. · The model may be useful tool for SARS-CoV-2 infected pregnancies admitted for delivery..
APA Citation
Sandoval, Grecio J.; Metz, Torri D.; Grobman, William A.; Manuck, Tracy A.; Hughes, Brenna L.; Saade, George R.; Longo, Monica; Simhan, Hyagriv N.; Rouse, Dwight J.; Mendez-Figueroa, Hector; Gyamfi-Bannerman, Cynthia; Ranzini, Angela C.; Costantine, Maged M.; Sehdev, Harish M.; and Tita, Alan T., "Prediction of COVID-19 Severity at Delivery after Asymptomatic or Mild COVID-19 during Pregnancy" (2024). GW Authored Works. Paper 4949.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/4949
Department
Biostatistics and Bioinformatics