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To account for the number of stillbirths and miscarriages, the researchers included another 50% in the first sensitivity analysis. In the second, they included only those women who required invasive mechanical ventilation since pregnant women might be more readily admitted to the ICU than others. The third analysis used both aspects.
As a control group, and to understand how many patients would need ICU care in an epidemic, the researchers looked at the total number of pregnant women in this age group who required intensive care with influenza, in the flu season of 2015-16, was collected. The total number of pregnant women in Sweden in the same period was also estimated. What did the study show?
There were 53 women in the age group 20-45 with COVID-19 who required ICU admission in the study period. This includes 13 pregnant and newly postpartum women. The age ranged from 20-35 years, with pregnancy term between weeks 13 and 40.
Some women had gestational diabetes, and others had obesity. Seven of them delivered the baby, five by Cesarean section. Of these, two were for non-obstetric reasons, namely, COVID-19 symptoms.
There were seven pregnant women in all who needed mechanical ventilation compared to the 29 (out of 40) non-pregnant women. The median stay in the ICU was six days.
The incidence of COVID-19 cases requiring intensive care in Sweden was 14.4/100,000 for pregnant or postpartum women, and 2.5/100,000 for non-pregnant women in this age group. The sensitivity analyses showed the same trend, with an incidence of 7.4 and 1.8 per 100,000 for pregnant and non-pregnant women, respectively, when considering only those women who underwent invasive mechanical ventilation.
The analysis covering the risk of requiring ICU care in the flu season was about 4 and 1.8 per 100,000 pregnant and non-pregnant women, respectively. The relative risk of receiving intensive care was, therefore, higher for pregnant and postpartum women with COVID-19 than for non-pregnant women with COVID-19 in the same age group, in all analyses.
The scientists acknowledge that they could not find out why each woman was admitted to the ICU, whether pregnant or non-pregnant, other than all of them had tested positive for COVID-19. The number of women in the sample was very small, moreover. Why is the research important?
The research findings prompted immediate responses from the PHAS. Sweden also began a joint investigation into the effect of COVID-19 on pregnancy and the fetus/newborn, using data from various national registries.
The paper concludes, “Pregnant women should be cautious considering the potentially severe consequences of SARS-CoV-2 infection and those with additional risk factors such as overweight or obesity, hypertension, and gestational diabetes should take extra precautions.” Journal reference: Collin, J. et al. (2020). Pregnant and Postpartum Women With SARS-Cov-2 Infection In Intensive Care In Sweden. Public Health Agency of Sweden’s Brief Report . Available at: https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1111/aogs.13901
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