The Severity of Covid- 19 Among Pregnant Women and The Risk of Adverse Maternal Outcome

2021 ◽  
Vol 15 (9) ◽  
pp. 2938-2942
Author(s):  
Maria Anwar ◽  
Kiran Jabeen ◽  
Safia Khan ◽  
Shazia Anwar ◽  
Aalia Jadaan ◽  
...  
Keyword(s):  
Intensive Care ◽  
Pregnant Women ◽  
Severe Disease ◽  
Mode Of Delivery ◽  
Maternal Outcome ◽  
Adverse Outcomes ◽  
Maternal Outcomes ◽  
Maternal Risk ◽  
Icu Admission ◽  
Severe Stage

Background and Aim: The obstetrical complications of pregnant women might elevate to a severe stage due to ongoing severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2). Limited study focused on association between COVID-19 and pregnant women adverse outcomes. The present study was carried out to evaluate the severity of COVID-19 among pregnant women and risk of adverse maternal outcome. Materials and Methods: This cross-sectional study was carried out on 242 pregnant women of confirmed COVID-19 cases hospitalized in Aziz Fatimah Hospital, Faisalabad and Holy Family hospital Rawalpindi for six months duration from 5th December 2020 to 5th May 2021. Pregnant women demographic details, obstetric characterizations, adverse maternal outcomes, and laboratory findings were noted. Positive tested pregnant women through RT-PCR regardless of clinical symptoms and signs were enrolled as confirmed cases while negative tested pregnant women were excluded. Hypertensive disorders, preexisting pulmonary, obesity, renal, nulliparity, and cardiovascular disease were the maternal risk factors. Different variables were assessed through fisher’s test and regression logistics model. Results: Of the total 242 pregnant women, the prevalence of mild to moderate symptoms, and severe disease were 187 (77.3%) and 43 (17.7%) respectively. About 12 (5%) had a critical stage of the disease. During this study period, about 31 (12.8%) were admitted to the intensive care unit (ICU) and 9 (3.7%) died. Mode of delivery, maternal age, underlying conditions, parity, and admission to ICU were the important demographic factors in severe COVID-19 disease. Other severe maternal outcomes were fever, cough, breath shortness and anosmia. Increase ICU admission and cesarean section delivery were significantly associated with disease severity. Conclusion: Our study founds a mortality rate of 3.7% among pregnant women with COVID-19. A higher prevalence of intensive care admission and cesarean delivery were reported in acute and severe COVID-19disease. The obstetrical and neonatal outcomes significantly affected by the severity of maternal disease; neonatal prematurity, ICU admission, and cesarean sections complications. Keywords: COVID- 19, Pregnant women, Adverse maternal outcomes

scholarly journals Obesity in COVID-19: A Systematic Review and Meta-analysis

2020 ◽  
Vol 49 (12) ◽  
pp. 996-1008
Author(s):  
Jamie SY Ho ◽  
Daniel I Fernando ◽  
Mark Y Chan ◽  
Ching-Hui Sia
Keyword(s):  
Systematic Review ◽  
Body Mass Index ◽  
Intensive Care ◽  
Body Mass ◽  
Meta Analysis ◽  
Severe Disease ◽  
Adverse Outcomes ◽  
Secondary Outcome ◽  
Icu Admission ◽  
Hospitalised Patients

Abstract Objective: Obesity has been shown to be associated with adverse outcomes in viral infections such as influenza, but previous studies on coronavirus disease 2019 (COVID-19) had mixed results. The aim of this systematic review is to investigate the relationship between COVID-19 and obesity. Methods: We performed a systematic review and meta-analysis. A literature search of MEDLINE, EMBASE, Scopus, Web of Science, CENTRAL, OpenGrey and preprint servers medRxiv and bioRxiv was performed, with no restriction on language or date of publication. Primary outcomes of this study were intensive care unit (ICU) admission or critical disease, severe disease and mortality. Secondary outcome was a positive COVID-19 test. Meta-analysis was performed using OpenMeta-Analyst software, and heterogeneity was tested using Cochran’s Q test and I2 statistic. The study protocol was registered on PROSPERO (CRD42020184953). Results: A total of 1,493 articles were identified and 61 studies on 270,241 patients were included. The pooled prevalence of obesity was 27.6% (95% confidence interval [CI] 22.0–33.2) in hospitalised patients. Obesity was not significantly associated with increased ICU admission or critical illness (odds ratio [OR] 1.25, 95% CI 0.99–1.58, P=0.062, I2=31.0) but was significantly associated with more severe disease (OR 3.13, 95% CI 1.41–6.92, P=0.005, I2=82.6), mortality (OR 1.36, 95% CI 1.09–1.69, P=0.006, I2=88.5) and a positive COVID-19 test (OR 1.50, 95% CI 1.25–1.81, P<0.001). Conclusion: Obesity increased the risk of severe disease, mortality and infection with COVID-19. Higher body mass index was associated with ICU admission and critical disease. Patients who are obese may be more susceptible to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, and infected patients should be monitored closely for adverse outcomes. Keywords: Body mass index, coronavirus, intensive care, mortality, prognosis

Fetal and Maternal Outcome Asymptomatic vs. Symptomatic Covid Positive Pregnant Women

2021 ◽  
Vol 15 (10) ◽  
pp. 3423-3425
Author(s):  
Amna Najam ◽  
Samreen Fakeer Muhammad ◽  
Samia Saifullah ◽  
Maryam Shoaib ◽  
Maria Anwar
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Cesarean Section ◽  
Pregnant Women ◽  
Apgar Score ◽  
Adverse Outcomes ◽  
Maternal Outcomes ◽  
Group A ◽  
Nicu Admission ◽  
Group B

Objective: The aim of this study is to compare the fetal and maternal outcomes in between asymptomatic and symptomatic COVID positive pregnant women. Study Design: Retrospective cohort study Place and Duration: The study was conducted at Gynae and Obs department of Sandeman Provincial Hospital, Quetta for duration of six months from November 2020 to April 2021. Methods: One hundred and ten pregnant women with ages 18-45 years had corona virus disease were presented. Informed written consent was taken from all patients for detailed demographics. COVID -19 was diagnosed by PCR. 55 patients had symptoms of coronavirus were included in group A and 55 patients did not show symptoms were included in group B. Frequency of pre-eclampsia, gestational diabetes mellitus and post-partum haemorrhage were calculated. Maternal adverse outcomes (cesarean section, instrumental delivery, induction of labor and prolong labor, hypertensive disorder) were calculated among both groups. Fetal outcomes perinatal mortality, Low birth weight, Low Apgar score and NICU admission were observed. SPSS 20.0 version was used to analyze all data. Results: Mean age of the patients in group A was 28.47±3.18 years with mean BMI 24.03±5.24 Kg/m2 and in group B mean age was 27.99±4.17 years with mean BMI 24.44±6.41 Kg/m2. Maternal outcomes (cesarean section, instrumental delivery, induction of labor and prolong labor,) in symptomatic group were significantly higher than that of asymptomatic group. Fetal outcomes, perinatal mortality in group A 9 (16.4%) and in group B was 5 (9.1%), low birth weight in group A was among 21 (38.2%) and in group B was 10 (18.2%), low apgar score in group A was 11 (20%) and in group B was 8 (14.4%), 15 (27.3%) in group A went to NICU admission and 3 (5.5%) patient in group II admitted to NICU. Conclusion: In this study we concluded that adverse outcomes among symptomatic COVID pregnant women were higher than that of asymptomatic coronavirus pregnant women in terms maternal and perinatal outcomes. Keywords: Pregnant women, Coronavirus, Symptomatic, Asymptomatic, Adverse Outcomes

scholarly journals Pregnancy and COVID-19

2021 ◽  
Author(s):  
Sushruti Kaushal ◽  
Harpreet Kaur
Keyword(s):  
Pregnant Women ◽  
Regional Anaesthesia ◽  
Physiological State ◽  
Severe Disease ◽  
Mode Of Delivery ◽  
Fetal Monitoring ◽  
Hospital Environment ◽  
Second Stage Of Labor ◽  
Second Stage ◽  
Delivery Services

Pregnancy is a physiological state that alters the body’s response to infections. COVID-19 has been found to cause severe disease in pregnancy with morbidity and mortality that is higher than in non-pregnant adults. There is risk of transmission of SARS-CoV2 infection to fetus during ante-natal period, intra-partum and post-delivery from an infected mother. It is necessary to provide an un-interrupted ante-natal care and delivery services to pregnant women during the pandemic. Tele-consultation is important modality to reduce the physical exposure of pregnant women to the hospital environment and should be utilised. Screening, isolation, testing and treatment for SARS-CoV2 infection in pregnant women should follow the local guidelines and remain essentially the same as in non-pregnant adults. Admission, if required, should be in a facility that can provide obstetric maternal and fetal monitoring in addition to care for COVID-19 illness. Use of nitrous oxide and inhalational oxygen for fetal indication should be avoided during labor. Second stage of labor is considered an aerosol generating procedure and should be managed with adequate precautions. Mode of delivery should be as per obstetric indications. Regional anaesthesia should be preferred during caesarean. COVID-19 is not a contra-indication to breast feeding. For antenatal women, COVID-19 vaccination can be considered after shared decision making.

scholarly journals Early elevation of FIB-4 liver fibrosis score is associated with adverse outcomes among patients with COVID-19

2020 ◽  
Author(s):  
Fangfei Xiang ◽  
Jing Sun ◽  
Po-Hung Chen ◽  
Peijin Han ◽  
Haipeng Zheng ◽  
...  
Keyword(s):  
Regression Models ◽  
Cox Regression ◽  
Early Stage ◽  
Severe Disease ◽  
High Flow ◽  
Adverse Outcomes ◽  
Prolonged Hospitalization ◽  
Severe Stage ◽  
Increased Risk ◽  
High Flow Oxygen

Background Limited prior data suggest that pre-existing liver disease was associated with adverse outcomes among patients with COVID-19. FIB-4 is a noninvasive index of readily available laboratory measurements that represents hepatic fibrosis. The association of FIB-4 with COVID-19 outcomes has not been previously evaluated. Methods FIB-4 was evaluated at admission in a cohort of 267 patients admitted with early-stage COVID-19 confirmed through RT-PCR. Hazard of ventilator use and of high-flow oxygen was estimated using Cox regression models controlled for covariates. Risk of progress to severe cases and of death/prolonged hospitalization (>30 days) were estimated using logistic regression models controlled for same covariates. Results Forty-one (15%) patients progressed to severe cases, 36 (14%) required high-flow oxygen support, 10 (4%) required mechanical ventilator support, and 1 died. Patients with high FIB-4 score (>3.25) were more likely to be older with pre-existing conditions. FIB-4 between 1.45-3.25 was associated with over 5-fold (95% CI: 1.2-28) increased hazard of high-flow oxygen use, over 4-fold (95% CI: 1.5-14.6) increased odds of progress to severe stage, and over 3-fold (95% CI: 1.4-7.7) increased odds of death or prolonged hospitalization. FIB-4>3.25 was associated with over 12-fold (95% CI: 2.3-68. 7) increased hazard of high-flow oxygen use and over 11-fold (95% CI: 3.1-45) increased risk of progress to severe disease. All associations were independent of sex, number of comorbidities, and inflammatory markers (D-dimer, C-reactive protein). Conclusions FIB-4 at early-stage of COVID-19 disease had an independent and dose-dependent association with adverse outcomes during hospitalization. FIB-4 provided significant prognostic value to adverse outcomes among COVID-19 patients.

Management and Outcomes of Pregnancy in Patients with Pulmonary Arterial Hypertension Associated with Congenital Heart Disease

2020 ◽  
pp. 29-37
Author(s):  
Wen Zhang ◽  
Mengyuan Yang ◽  
Mei Peng ◽  
Yanling Ding
Keyword(s):  
Pulmonary Arterial Hypertension ◽  
Arterial Hypertension ◽  
Pregnant Women ◽  
Congenital Heart ◽  
Heart Diseases ◽  
Severe Disease ◽  
Functional Class ◽  
Adverse Outcomes ◽  
Mother And Child ◽  
Pulmonary Arterial

Background: Pregnant women with pulmonary arterial hypertension associated with congenital heart diseases (PAH-CHD) have a high incidence of mortality and adverse outcomes for mother and child. Methods: We retrospectively examined the treatment strategies and analyzed the outcomes of pregnancy in patients with pulmonary arterial hypertension managed at a single clinical hospital from 2009 to 2018. Results: Analysis of all 102 patients with PAH-CHD in pregnancy showed that maternal and newborn death from the disease was low(<3%, 3/102) compared to rates previously reported. Although patients with mild pulmonary hypertension can deliver safely, those with moderate to severe pulmonary artery pressure (PAP), and high functional class tend to have a high risk of heart failure. Medications were selectively administered to patients with more severe disease, and it was, therefore, challenging to make a universal statement on their benefit, but they appear having some benefits in improving birth outcomes for mother and child. While some treatments such as anticoagulant therapy during pregnancy, and oxytocin after delivery, did not improve the health outcome of pregnant women but seemed to provide some benefits to the newborns. Conclusion: Our retrospective analysis of existing clinical data provides preliminary results for further studies to formally evaluate the efficacy of clinical management of patients with pulmonary arterial hypertension.

scholarly journals O-197 Maternal and neonatal characteristics and outcomes of COVID-19 from early pregnancy until labor: an overview of systematic reviews

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
H Siristatidis ◽  
M Papapanou ◽  
M Papaioannou ◽  
A Petta ◽  
E Routsi ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Pregnant Women ◽  
Vertical Transmission ◽  
Systematic Reviews ◽  
Mode Of Delivery ◽  
Separate Analysis ◽  
High Quality ◽  
Icu Admission ◽  
Vaginal Deliveries ◽  
The Impact

Abstract Study question What is the current obstetric-perinatal and neonatal outcome of infected pregnant women and their newborns during the COVID-19 pandemic? Summary answer Miscarriage rates were &lt;2.5%, even when only studies of moderate/high-quality were included. Increased rates of CS and preterm birth were found, with uncertain vertical transmission. What is known already A considerable number of systematic reviews, with substantial heterogeneity regarding their methods and included populations, on the impact of COVID-19 on infected pregnant women and their neonates, has emerged. Study design, size, duration Three bibliographical databases were searched (last search: September 10, 2020). Quality assessment was performed using the AMSTAR-2 tool. Primary outcomes included mode of delivery, preterm delivery/labor, premature rupture of membranes (PROM/pPROM) and abortions/miscarriages. Outcomes were mainly presented as ranges. A separate analysis, including only moderate and high-quality systematic reviews, was also conducted. The protocol was registered with PROSPERO (CRD42020214447); Participants/materials, setting, methods The search strategy followed the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guideline. Keywords employed were (COVID-19 OR SARS-CoV-2 OR “Coronavirus disease 2019”) AND (“Neonatal outcom*” OR “Neonatal characteristic*” OR “Maternal outcom*” OR “maternal characteristic*” OR “pregnancy outcom*” OR “vertical transmission”). All retrieved studies were imported into the Rayyan QCRI and duplicated articles were removed. A snow-ball procedure was also implemented by hand-searching the reference lists of included systematic reviews for additional sources. Main results and the role of chance Thirty-nine reviews were analyzed. Twelve reviews (30.8%) were found to be of “very low quality”, 11 of “low quality”, 13 (33.3%) of “moderate”, and three (7.7%) of “high quality”. Ten articles dealt with miscarriages. One review integrated them into pregnancy terminations (1.4% (4/295)), one into intrauterine fetal deaths (1(3%)), while another one described them as “spontaneous abortions” (0.8% (3/385)). Taking into account reviews, which calculated these rates for their entire included population, miscarriage rates were &lt;2.5%. The reported rates by moderate and high-quality studies were ≤ 2%. Reported rates,regarding both preterm and term gestations, varied between 52.3%-95.8% for caesarean sections; 4.2%-44.7% for vaginal deliveries; 14.3%-63.8% specifically for preterm deliveries and 22.7%-32.2% for preterm labor; 5.3%-12.7% for PROM and 6.4%-16.1% for pPROM. Maternal anxiety for potential fetal infection contributed to abortion decisions, while SARS-CoV-2-related miscarriages could not be excluded. Maternal ICU admission and mechanical ventilation rates were 3%-28.5% and 1.4%-12%, respectively. Maternal mortality rate was &lt;2%, while stillbirth, neonatal ICU admission and mortality rates were &lt;2.5%, 3.1%-76.9% and &lt;3%, respectively. Neonatal PCR positivity rates ranged between 1.6% and 10%. After accounting for quality of studies, ranges of our primary outcomes remained unchanged. Limitations, reasons for caution Results are presented in a narrative way using ranges as the primary mean of quantification. We also included studies with both RT-PCR positive women and women with suspected infection based on their clinical and imaging manifestations, whereas, if excluding them, we might have missed a considerable source of information. Wider implications of the findings In conclusion, a rapid increase of CS was observed, especially at the beginning of the pandemic, most likely due to lack of knowledge and robust recommendations. Preterm birth rates were elevated, with iatrogenic reasons potentially involved. Even though neonatal infections were rare, the probability of vertical transmission cannot be eliminated. Trial registration number not applicable’

scholarly journals The Age-AST-D Dimer (AAD) Regression Model Predicts Severe COVID-19 Disease

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Fátima Higuera-de-la-Tijera ◽  
Alfredo Servín-Caamaño ◽  
Daniel Reyes-Herrera ◽  
Argelia Flores-López ◽  
Enrique J. A. Robiou-Vivero ◽  
...  
Keyword(s):  
Intensive Care ◽  
Liver Injury ◽  
Clinical Course ◽  
Severe Disease ◽  
Lactic Dehydrogenase ◽  
Icu Patients ◽  
Derivation Cohort ◽  
Icu Admission ◽  
Admission Time ◽  
D Dimer

Aim. Coronavirus disease (COVID-19) ranges from mild clinical phenotypes to life-threatening conditions like severe acute respiratory syndrome (SARS). It has been suggested that early liver injury in these patients could be a risk factor for poor outcome. We aimed to identify early biochemical predictive factors related to severe disease development with intensive care requirements in patients with COVID-19. Methods. Data from COVID-19 patients were collected at admission time to our hospital. Differential biochemical factors were identified between seriously ill patients requiring intensive care unit (ICU) admission (ICU patients) versus stable patients without the need for ICU admission (non-ICU patients). Multiple linear regression was applied, then a predictive model of severity called Age-AST-D dimer (AAD) was constructed ( n = 166 ) and validated ( n = 170 ). Results. Derivation cohort: from 166 patients included, there were 27 (16.3%) ICU patients that showed higher levels of liver injury markers ( P < 0.01 ) compared with non-ICU patients: alanine aminotrasnferase (ALT) 225.4 ± 341.2 vs. 41.3 ± 41.1 , aspartate aminotransferase (AST) 325.3 ± 382.4 vs. 52.8 ± 47.1 , lactic dehydrogenase (LDH) 764.6 ± 401.9 vs. 461.0 ± 185.6 , D-dimer (DD) 7765 ± 9109 vs. 1871 ± 4146 , and age 58.6 ± 12.7 vs. 49.1 ± 12.8 . With these finding, a model called Age-AST-DD (AAD), with a cut-point of <2.75 ( sensitivity = 0.797 and specificity = 0.391 , c − statistic = 0.74 ; 95%IC: 0.62-0.86, P < 0.001 ), to predict the risk of need admission to ICU ( OR = 5.8 ; 95% CI: 2.2-15.4, P = 0.001 ), was constructed. Validation cohort: in 170 different patients, the AAD   model < 2.75 ( c − statistic = 0.80 (95% CI: 0.70-0.91, P < 0.001 ) adequately predicted the risk ( OR = 8.8 , 95% CI: 3.4-22.6, P < 0.001 ) to be admitted in the ICU (27 patients, 15.95%). Conclusions. The elevation of AST (a possible marker of early liver injury) along with DD and age efficiently predict early (at admission time) probability of ICU admission during the clinical course of COVID-19. The AAD model can improve the comprehensive management of COVID-19 patients, and it could be useful as a triage tool to early classify patients with a high risk of developing a severe clinical course of the disease.

scholarly journals Foetal and Neonatal Outcome in Pregnant Women with COVID-19

2020 ◽  
Vol 40 (3) ◽  
pp. 143-156
Author(s):  
Rupesh Shrestha ◽  
Srijana Basnet ◽  
Laxman Shrestha
Keyword(s):  
Cesarean Section ◽  
Pregnant Women ◽  
Neonatal Outcome ◽  
Mode Of Delivery ◽  
Conclusive Evidence ◽  
Adverse Outcomes ◽  
Delivery Mode ◽  
Still Births ◽  
Gestational Age At Delivery ◽  
Foetal Outcome

Introduction: The pandemic caused by coronavirus disease 2019 has adversely affected the health of all individuals including pregnant women. The susceptibility of pregnant women and their foetuses to severe acute respiratory syndrome coronavirus 2 infection is not clearly known. The objective of this review is to summarise the available evidence on foetal and neonatal outcomes of pregnant women with confirmed coronavirus disease 2019. Methods: The review was conduced by searching the PubMed and MedRxiv databases for studies reporting outcome of pregnancy with confirmed coronavirus disease from December 2019 to April 2020 using combination of terms "pregnancy", "coronavirus disease 2019", "foetal outcome" and "neonatal outcome". Only peer reviewed articles reporting outcome of pregnancy with confirmed coronavirus disease 2019 were included in the review irrespective of language. Ongoing pregnancies, induced abortion, and pregnancies without outcome were excluded from analysis. Variables extracted and analysed included gestational age at delivery, mode of delivery, foetal and neonatal outcome. Results: In total, 21 studies consisting 230 pregnant women including three twin pregnancies were enrolled in the study. Fever and cough were the most common symptoms reported in pregnant women. One hundred and sixty-two (70.4%) pregnant women underwent cesarean section and there were 68 (29.6%) preterm deliveries. Eight babies tested positive out of 161 newborns that were tested for coronavirus infection. Among adverse outcomes reported, there were two miscarriages, two still births and only one neonatal death. Conclusions: Outcome of pregnancy with coronavirus disease 2019 in late trimester appears to be favourable. Occurrence of preterm delivery and cesarean section appear higher among infected pregnant women in comparison to general population. There was no conclusive evidence of vertical transmission.

PREDICTORS FOR ADVERSE OUTCOMES IN DIABETIC KETOACIDOSIS IN A MULTIHOSPITAL HEALTH SYSTEM

2020 ◽  
Vol 26 (3) ◽  
pp. 259-266
Author(s):  
Allen C. Xu ◽  
David T. Broome ◽  
James F. Bena ◽  
M. Cecilia Lansang
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Confidence Interval ◽  
Health System ◽  
Diabetic Ketoacidosis ◽  
Disease Duration ◽  
Adverse Outcomes ◽  
White Race ◽  
Icu Admission

Objective: To determine predictors of prolonged length of stay (LOS), 30-day readmission, and 30-day mortality in a multihospital health system. Methods: We performed a retrospective review of 531 adults admitted with diabetic ketoacidosis (DKA) to a multihospital health system between November 2015 and December 2016. Demographic and clinical data were collected. Linear regression was used to calculate odds ratios (ORs) for predictors and their association with prolonged LOS (3.2 days), 30-day readmission, and 30-day mortality. Results: Significant predictors for prolonged LOS included: intensive care unit (ICU) admission (OR, 2.12; 95% confidence interval [CI], 1.38 to 3.27), disease duration (nonlinear) (OR, 1.28; 95% CI, 1.10 to 1.49), non-white race (OR, 1.73; 95% CI, 1.15 to 2.60), age at admission (OR, 1.03; 95% CI, 1.01 to 1.04), and Elixhauser index (EI) (OR, 1.21; 95% CI, 1.13 to 1.29). Shorter time to consult after admission (median [Q1, Q3] of 11.3 [3.9, 20.7] vs. 14.8 [7.4, 37.3] hours, P<.001) was associated with a shorter LOS. Significant 30-day readmission predictors included: Medicare insurance (OR, 2.35; 95% CI, 1.13 to 4.86) and EI (OR, 1.31; 95% CI, 1.21 to 1.41). Endocrine consultation was associated with reduced 30-day readmission (OR, 0.51; 95% CI, 0.28 to 0.92). A predictive model for mortality was not generated because of low event rates. Conclusion: EI, non-white race, disease duration, age, Medicare, and ICU admission were associated with adverse outcomes. Endocrinology consultation was associated with lower 30-day readmission, and earlier consultation resulted in a shorter LOS. Abbreviations: CI = confidence interval; DKA = diabetic ketoacidosis; EI = Elixhauser index; HbA1c = hemoglobin A1c; ICD = International Classification of Diseases; ICU = intensive care unit; LOS = length of stay; OR = odds ratio; Q = quartile

P2246Maternal and foetal outcomes of anticoagulation in pregnant women with preconception venous thromboembolism

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Soegaard ◽  
F Skjoth ◽  
P B Nielsen ◽  
J Beyer-Westendorf ◽  
T B Larsen
Keyword(s):  
Preterm Birth ◽  
Venous Thromboembolism ◽  
Pregnant Women ◽  
Gestational Age ◽  
First Trimester ◽  
Adverse Outcomes ◽  
Congenital Defects ◽  
Maternal Outcomes ◽  
Foetal Loss ◽  
Recurrent Vte

Abstract Background Anticoagulation is essential to prevent recurrent venous thromboembolism (VTE) during pregnancy in women with a history of preconception VTE. However, information on the safety of anticoagulant drugs in this setting is limited. Purpose To investigate the risk of maternal and foetal adverse outcomes associated with anticoagulant exposure during pregnancy. Methods Nationwide cohort of all pregnant women in Denmark with preconception VTE, 2000–2017. We linked individual-level data from nationwide registries on anticoagulant exposure, maternal and foetal outcomes. Results Among 5,099 pregnancies in 3,246 women with preconception VTE (mean age 31 years, 41% nulliparous), 36.4% were exposed to anticoagulants during first trimester (66.4% low-molecular-weight heparin (LMWH), 31.9% VKA, and 1.8% NOAC (Table). No maternal deaths occurred. Maternal outcomes were comparable among LMWH and unexposed women, whereas recurrent VTE and foetal loss was more prevalent in VKA and NOAC exposed women. Foetal risk was lowest in unexposed and LMWH exposed, whereas preterm birth was prevalent in VKA and NOAC exposed. Table 1. Maternal and foetal outcomes in pregnant women with preconception VTE according to first trimester anticoagulant exposure Maternal outcomes No anticoagulants LMWH VKA NOAC Total pregnancies/singleton foetuses, N 3,244/2,722 1231/1,124 591/442 33 /26 Recurrent VTE, % (N) 2.7 (89) 3.3 (41) 6.4 (38) – (<5) Antenatal bleeding, % (N) 2.3 (73) 2.7 (33) 1.5 (9) 0 Preeclampsia, % (N) 3.0 (98) 2.1 (26) 4.4 (26) – (<5) Foetal loss, % (N) 13.4 (436) 6.6 (81) 22.2 (131) 21.2 (7) Foetal outcomes in live singleton births, except stillbirth   Stillbirth, % (N) 0.6 (17) 0.6 (7) – (<5) 0   Mean gestational age, days/birthweight, gram 246/3,458 246/3,471 238/3,212 243/3,138   Preterm birth (<37 weeks), % (N) 41.1 (1,111) 38.3 (428) 63.2 (277) 57.7 (15)   Very preterm birth (<28 weeks), % (N) 0.9 (24) 1.3 (14) 2.7 (12) 0   Small for gestational age, % (N) 4.2 (109) 4.5 (49) 4.8 (20) – (<5)   Mean 5-minute Apgar score, (sd) 9.8 (0.8) 9.8 (0.7) 9.8 (1.0) 9.7 (1.0)   Congenital defects 8.4 (226) 9.0 (100) 10.0 (44) – (<5) Counts are supressed in cells with <5 observations to prevent disclosure of potentially identifiable information. Conclusion Our findings are reassuring and in support of the recommendation of LMWH for pregnant women with prior VTE. Few women were exposed to NOAC during pregnancy, and the safety of NOACs cannot be substantiated with the current level of evidence. Acknowledgement/Funding The Obel Family Foundation partly funded this research by an unrestricted grant.

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