This is a summary, written by members of the CITF Secretariat, of:

Smith ER, Oakley E, Grandner GW, Rukundo G, Farooq F, Ferguson K, Baumann S, Adams Waldorf KM, Afshar Y, Ahlberg M, Ahmadzia H, Akelo V, Aldrovandi G, Bevilacqua E, Bracero N, Brandt JS, Broutet N, Carrillo J, Conry J, Cosmi E, Crispi F, Crovetto F, Del Mar Gil M, Delgado-López C, Divakar H, Driscoll AJ, Favre G, Fernandez Buhigas I, Flaherman V, Gale C, Godwin CL, Gottlieb S, Gratacós E, He S, Hernandez O, Jones S, Joshi S, Kalafat E, Khagayi S, Knight M, Kotloff KL, Lanzone A, Laurita Longo V, Le Doare K, Lees C, Litman E, Lokken EM, Madhi SA, Magee LA, Martinez-Portilla RJ, Metz TD, Miller ES, Money D, Moungmaithong S, Mullins E, Nachega JB, Nunes MC, Onyango D, Panchaud A, Poon LC, Raiten D, Regan L, Sahota D, Sakowicz A, Sanin-Blair J, Stephansson O, Temmerman M, Thorson A, Thwin SS, Tippett Barr BA, Tolosa JE, Tug N, Valencia-Prado M, Visentin S, von Dadelszen P, Whitehead C, Wood M, Yang H, Zavala R, Tielsch JM. Clinical risk factors of adverse outcomes among women with COVID-19 in the pregnancy and postpartum period: a sequential, prospective meta-analysis. Am J Obstet Gynecol. 2023 Feb;228(2):161-177. doi: 10.1016/j.ajog.2022.08.038.

The results and/or conclusions contained in the research do not necessarily reflect the views of all CITF members.

A study funded in part by CITF, published in the American Journal of Obstetrics and Gynecology, found that comorbidities, nutritional status, and older age were associated with severe COVID-19-related outcomes, adverse pregnancy outcomes, and fetal/neonatal morbidity and mortality. This study also identified several less commonly known risk factors for adverse outcomes, including HIV infection, being underweight or overweight before pregnancy, and anemia. This study was led by Dr. James M Tielsch (George Washington University) in collaboration with CITF-funded researcher Dr. Deborah Money (University of British Columbia).

This analysis used data from 33 countries and territories, including 21,977 cases of SARS-CoV-2 infection during pregnancy or postpartum.

Key findings:

  • People with comorbidities (pre-existing diabetes mellitus, hypertension, cardiovascular disease) were at higher risk for severe COVID-19 and adverse pregnancy outcomes (fetal death, preterm birth, low birth weight) than those without these comorbidities.
  • Participants with COVID-19 and HIV were 1.74 times more likely to be admitted to the intensive care unit (ICU).
  • Those underweight before pregnancy were at higher risk of severe COVID-19 outcomes including ICU admission (relative risk, 5.53), ventilation (relative risk, 9.36), and pregnancy-related death (relative risk, 14.10).
  • Pre-pregnancy obesity was also a risk factor for severe COVID-19 outcomes including ICU admission (relative risk, 1.81), ventilation (relative risk, 2.05), any critical care (relative risk, 1.89), and pneumonia (relative risk, 1.66).
  • Anemic pregnant people with COVID-19 also had an increased risk of ICU admission (relative risk, 1.63) and death (relative risk, 2.36).
  • Older maternal age (35-45 years) was associated with increased risk of ICU admission (RR, 1.60; 16 studies, 18,758 pregnancies), ventilation (RR, 2.13; 16 studies, 18,407 pregnancies), critical care (RR, 1.62; 15 studies, 18,452 pregnancies) and pneumonia diagnosis (RR, 1.51; 10 studies, 15,670 pregnancies).
  • Older pregnant women also had increased risk for placental abruption (RR, 3.94) and caesarean delivery (RR, 1.21).
  • Infants born to older pregnant women with COVID-19 had higher risk of stillbirth, perinatal death, NICU admission, preterm birth, and low birthweight.