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Characteristics and outcomes of pregnant women admitted to hospital with confirmed SARS-CoV-2 infection in UK: national population based cohort study

BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m2107 (Published 08 June 2020) Cite this as: BMJ 2020;369:m2107

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Pregnancy outcomes and covid-19: benefits of a nine year gestation

  1. Marian Knight, professor of maternal and child population health1,
  2. Kathryn Bunch, epidemiologist1,
  3. Nicola Vousden, registrar in public health2,
  4. Edward Morris, consultant obstetrician and gynaecologist3,
  5. Nigel Simpson, senior lecturer in obstetrics and gynaecology4,
  6. Chris Gale, reader in neonatal medicine5,
  7. Patrick O’Brien, consultant obstetrician and gynaecologist6,
  8. Maria Quigley, professor of statistical epidemiology1,
  9. Peter Brocklehurst, professor of women’s health7,
  10. Jennifer J Kurinczuk, professor of perinatal epidemiology1
  11. on behalf of the UK Obstetric Surveillance System SARS-CoV-2 Infection in Pregnancy Collaborative Group
  1. 1National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
  2. 2Faculty of Life Sciences and Medicine, King’s College London, London, UK
  3. 3Norfolk and Norwich University Hospital, Norwich, UK
  4. 4Department of Women's and Children's Health, School of Medicine, University of Leeds, Leeds, UK
  5. 5Neonatal Medicine, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
  6. 6Institute for Women’s Health, University College London, London, UK
  7. 7Birmingham Clinical Trials Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
  1. Correspondence to: M Knight marian.knight{at}npeu.ox.ac.uk (or @Marianfknight and @NPEU_UKOSS on Twitter)
  • Accepted 27 May 2020

Abstract

Objectives To describe a national cohort of pregnant women admitted to hospital with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the UK, identify factors associated with infection, and describe outcomes, including transmission of infection, for mothers and infants.

Design Prospective national population based cohort study using the UK Obstetric Surveillance System (UKOSS).

Setting All 194 obstetric units in the UK.

Participants 427 pregnant women admitted to hospital with confirmed SARS-CoV-2 infection between 1 March 2020 and 14 April 2020.

Main outcome measures Incidence of maternal hospital admission and infant infection. Rates of maternal death, level 3 critical care unit admission, fetal loss, caesarean birth, preterm birth, stillbirth, early neonatal death, and neonatal unit admission.

Results The estimated incidence of admission to hospital with confirmed SARS-CoV-2 infection in pregnancy was 4.9 (95% confidence interval 4.5 to 5.4) per 1000 maternities. 233 (56%) pregnant women admitted to hospital with SARS-CoV-2 infection in pregnancy were from black or other ethnic minority groups, 281 (69%) were overweight or obese, 175 (41%) were aged 35 or over, and 145 (34%) had pre-existing comorbidities. 266 (62%) women gave birth or had a pregnancy loss; 196 (73%) gave birth at term. Forty one (10%) women admitted to hospital needed respiratory support, and five (1%) women died. Twelve (5%) of 265 infants tested positive for SARS-CoV-2 RNA, six of them within the first 12 hours after birth.

Conclusions Most pregnant women admitted to hospital with SARS-CoV-2 infection were in the late second or third trimester, supporting guidance for continued social distancing measures in later pregnancy. Most had good outcomes, and transmission of SARS-CoV-2 to infants was uncommon. The high proportion of women from black or minority ethnic groups admitted with infection needs urgent investigation and explanation.

Study registration ISRCTN 40092247.

Footnotes

  • Contributors: MK wrote the first draft of the manuscript with contributions from NV and KB. KB and MK did the analyses. All authors edited and approved the final version of the article. MK, NS, EM, JJK, CG, MQ, POB, PB, and KB contributed to the development and conduct of the study. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted. MK is the guarantor.

  • Funding: The study was funded by the National Institute for Health Research HTA Programme (project number 11/46/12). MK is an NIHR senior investigator. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care. The funder played no role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication. The corresponding author (MK) had full access to all the data in the study and had final responsibility for the decision to submit for publication.

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at http://www.icmje.org/coi_disclosure.pdf and declare: MK, MQ, PB, POB, and JJK received grants from the NIHR in relation to the submitted work; EM is trustee and president of the Royal College of Obstetricians and Gynaecologists, trustee of the British Menopause Society, and chair of the Multiprofessional Advisory Committee, Baby Lifeline; no other relationships or activities that could appear to have influenced the submitted work.

  • Ethical approval: This study was approved by the HRA NRES Committee East Midlands – Nottingham 1 (reference 12/EM/0365).

  • Data sharing: Data from this study will be shared according to the National Perinatal Epidemiology Unit Data Sharing Policy available at https://www.npeu.ox.ac.uk/downloads/files/npeu/policies/Data%20Sharing%20Policy.pdf

  • The lead author (the manuscript’s guarantor) affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

  • Dissemination to participants and related patient and public communities: Dissemination to participants is not possible as this study collected anonymous data only. Dissemination to women, families, and healthcare practitioners will be undertaken via social media and the programme website (https://www.npeu.ox.ac.uk/ukoss/publications-ukoss) and through summary articles for professional and third sector organisations.

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This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/.

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