New coronavirus infection COVID-19 in pregnant women: epidemiology, course, outcomes, prevention options

Objective. Assessment of the epidemic prevalence, clinical course, maternal and perinatal outcomes of COVID-19, and measures used in the population of pregnant women. Methods. A prospective population-based study based on the analysis of latest information on the incidence, course, and outcomes of NCI COVID-19 in pregnant women, women in labor and postpartum women was performed. Data were provided by the chief specialists in obstetrics and gynecology of the Far Eastern and Siberian Federal Districts from March 11 to December 25, 2020. Mathematical analysis included methods of descriptive statistics, analysis of contingency tables, where the chi-square value and the achieved significance level (P) were estimated. Results. In the Far Eastern Federal District and the Siberian Federal District, during the COVID-19 epidemic in 2020, SARS-CoV-2 infection was detected in 8485 pregnant women, women in labor and postpartum women. The incidence rate in pregnant women was 3.0 times higher than the general population: 5933.2 versus 1960.8 per 100 thousand people (p<0.001). the majority of patients developed mild infection (53.0%), several times less often they had moderate (16.6%), severe (2.5%) and extremely severe (0.5%) infection. In 27.4% of cases, SARS-CoV-2 infection had no clinical symptoms. Pregnant women were hospitalized in intensive care units more often than patients of the general population: 3.57 versus 2.24% (p<0.001); it was regarded as a measure of risk strategy, since invasive mechanical ventilation was performed in pregnant women less frequently than among the population in overall: 0.48 versus 1.05% (p<0.001). in mothers with confirmed NCI COVID-19, preterm delivery was 2.7 times more often than in the general population of pregnant women (18.3 versus 6.7%); the frequency of cesarean section was 1.6 times higher (42.0 versus 25.7%), and operative vaginal delivery (vacuum extraction of the fetus, obstetric forceps), on the contrary, was 6.5 times less frequent (0.2 versus 1.2 %). The maternal mortality rate was lower than the mortality rate in the population (1948.93 per 100 thousand sick population), and amounted to 505.69 per 100 thousand liveborns (0.51% of the number of patients with COVID-19 who gave birth; 0.14 % of all sick pregnant women, women in labor and postpartum women). Perinatal losses amounted to 1.56% (37 cases), of which 1.30% (31) - stillbirths, 0.26% (6) - early neonatal mortality. The SARS-CoV-2 virus was detected in the nasopharyngeal contents in 148 (6.2%) newborns, subject to anti-epidemic measures and separation of the mother and child immediately after birth. Conclusion. During the 2020 pandemic, in pregnant women, women in labor and parturient women, the frequency of detection of SARS-CoV-2 virus RNA was 3.0 times higher than in the general population, while the infectious process had a milder course (less need for invasive mechanical ventilation, lower mortality rate). Mothers with COVID-19 had statistically significantly higher rates of preterm birth and delivery by caesarean section compared to the general population. Identification of SARS-CoV-2 in 6.2% of newborns against the background full compliance with anti-epidemic measures is indicative of the possibility of vertical transmission.

COVID-19, COVID-19, pregnancy, morbidity, childbirth, maternal mortality, perinatal mortality, prevention