Adverse delivery hospitalisation outcomes in 2020 during the COVID‐19 pandemic

Abstract

AbstractObjectiveTo evaluate risk for adverse obstetric outcomes associated with the coronavirus disease 2019 (COVID‐19) pandemic period and with COVID‐19 diagnoses.DesignSerial cross‐sectional study.SettingA national sample of US delivery hospitalisations before (1/2016 to 2/2020) and during the first 10 months of (3/2020 to 12/2020) the COVID‐19 pandemic.PopulationAll 2016–2020 US delivery hospitalisations in the National Inpatient Sample.MethodsDelivery hospitalisations were identified and stratified into pre‐pandemic and pandemic periods and the likelihood of adverse obstetric outcomes was compared using logistic regression models with adjusted odds ratios (aOR) with 95% confidence intervals (CI) as measures of association. Risk for adverse outcomes was also analysed specifically for 2020 deliveries with a COVID‐19 diagnosis.Main Outcome MeasureAdverse maternal outcomes including respiratory complications and cardiac morbidity.ResultsOf an estimated 18.2 million deliveries, 2.9 million occurred during the pandemic. The proportion of delivery hospitalisations with a COVID‐19 diagnosis increased from 0.1% in March 2020 to 3.1% in December. Comparing the pandemic period to the pre‐pandemic period, there were higher adjusted odds of transfusion (aOR 1.12, 95% CI 1.05–1.19), a respiratory complication composite (aOR 1.37, 95% CI 1.29–1.46), cardiac severe maternal morbidity (aOR 1.30, 95% 1.20–1.39), postpartum haemorrhage (aOR 1.19, 95% CI 1.15–1.24), placental abruption/antepartum haemorrhage (OR 1.04, 95% CI 1.00–1.08), and hypertensive disorders of pregnancy (OR 1.23, 95% CI 1.21–1.26). These associations were similar to unadjusted analysis. Risk for these outcomes during the pandemic period was significantly higher in the presence of a COVID‐19 diagnosis.ConclusionsIn a national estimate of delivery hospitalisations, the odds of cardiac and respiratory outcomes were higher in 2020 compared with 2016–2019. COVID‐19 diagnoses were specifically associated with a range of serious complications.