Clinical Outcomes of COVID-19 Infection in Pregnant and Nonpregnant Women: Results from The Philippine CORONA Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Participants
2.2. Setting
2.3. Patient Selection, Sampling, and Cohort Description
2.4. Information Sources, Data Collection, Patient Variables, and Bias
2.5. Outcome Variables
2.6. Statistical Analysis
3. Results
3.1. Demographic Data and Clinical/ Neurological Profile of Included Patients
3.2. Comparison of Clinical/ Neurological Outcomes of Included Pregnant and Nonpregnant Women
3.3. Estimated Odds Ratio of Outcomes Comparing Pregnant and Nonpregnant Women (Logistic Regression Models)
3.4. Kaplan–Meier Plots and Estimated Hazard Ratios of Outcomes Comparing Pregnant and Nonpregnant Women (Cox Regression Models)
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Characteristics | Overall | Nonpregnant | Pregnant | p Value |
---|---|---|---|---|
Frequency | 2448 | 2126 (86.85%) | 322 (13.15%) | - |
Age in years | 33 (13) | 33 (14) | 30 (9) | |
15–20 years | 64 (2.61%) | 40 (1.88%) | 24 (7.45%) | <0.01 * |
21–30 years | 957 (39.09%) | 803 (37.77%) | 154 (47.83%) | |
31–40 years | 827 (33.78%) | 697 (32.78%) | 130 (40.37%) | |
41–49 years | 600 (24.51%) | 586 (27.56%) | 14 (4.35%) | |
Presence of comorbid conditions | ||||
Hypertension | 267 (10.91%) | 249 (11.71%) | 18 (5.59%) | <0.01 * |
Diabetes mellitus | 167 (6.82%) | 161 (7.57%) | 6 (1.86%) | <0.01 * |
Kidney disease | 79 (3.23%) | 78 (3.67%) | 1 (0.31%) | <0.01 * |
Bronchial asthma | 132 (5.39%) | 126 (5.93%) | 6 (1.86%) | <0.01 * |
Coronary artery disease | 19 (0.78%) | 19 (0.89%) | - | 0.16 |
Malignancy | 41 (1.67%) | 41 (1.93%) | - | 0.01 * |
COPD | 1 (0.04%) | - | 1 (0.31%) | 0.13 |
Heart failure | 6 (0.25%) | 5 (0.24%) | 1 (0.31%) | 0.80 |
Liver disease | 6 (0.25%) | 5 (0.24%) | 1 (0.31%) | 0.80 |
Immunocompromised conditions | 3 (0.12%) | 3 (0.14%) | - | 0.50 |
Obesity | 22 (0.90%) | 21 (0.99%) | 1 (0.31%) | 0.23 |
Other conditions | 309 (12.62%) | 289 (13.59%) | 20 (6.21%) | <0.01 * |
Relevant history | ||||
Smoker | 55 (2.25%) | 55 (2.59%) | - | <0.01 * |
Healthcare worker | 393 (16.05%) | 387 (18.20%) | 6 (1.86%) | <0.01 * |
COVID-19 disease severity | ||||
Mild | 2025 (83.57%) | 1734 (82.30%) | 291 (92.09%) | <0.01 * |
Severe | 272 (11.23%) | 252 (11.96%) | 20 (6.33%) | |
Critical | 126 (5.20%) | 121 (5.74%) | 5 (1.58%) | |
Respiratory and constitutional symptoms | ||||
Cough | 712 (29.08%) | 669 (31.47%) | 43 (13.35%) | <0.01 * |
Fever | 619 (25.29%) | 598 (28.13%) | 21 (6.52%) | <0.01 * |
Dyspnea | 352 (14.38%) | 337 (15.85%) | 15 (4.66%) | <0.01 * |
Sore throat | 198 (8.09%) | 191 (8.98%) | 7 (2.17%) | <0.01 * |
Fatigue | 112 (4.58%) | 108 (5.08%) | 4 (1.24%) | <0.01 * |
Sputum production | 94 (3.84%) | 88 (4.14%) | 6 (1.86%) | 0.05 * |
Rhinorrhea | 182 (7.43%) | 169 (7.95%) | 13 (4.04%) | 0.01 * |
Diarrhea | 136 (5.56%) | 132 (6.21%) | 4 (1.24%) | <0.01 * |
Arthralgia | 34 (1.39%) | 32 (1.51%) | 2 (0.62%) | 0.21 |
Hemoptysis | 1 (0.04%) | 1 (0.05%) | - | 0.70 |
Treatment Received | ||||
Systematic glucocorticoids | 314 (12.83%) | 300 (14.11%) | 14 (4.35%) | <0.01 * |
Remdesivir | 132 (5.39%) | 129 (6.07%) | 3 (0.93%) | <0.01 * |
Tocilizumab | 65 (2.66%) | 63 (2.96%) | 2 (0.62%) | <0.01 * |
Lopinavir-Ritonavir | 64 (2.61%) | 64 (3.01%) | - | <0.01 * |
Hydroxychloroquine | 112 (4.58%) | 110 (5.17%) | 2 (0.62%) | <0.01 * |
Chloroquine | 38 (1.55%) | 37 (1.74%) | 1 (0.31%) | 0.06 |
Convalescent plasma | 21 (0.86%) | 21 (0.99%) | - | 0.10 |
Antibiotic therapy | 831 (33.95%) | 641 (30.15%) | 190 (59.01%) | <0.01 * |
Other regimens | 600 (24.51%) | 527 (24.79%) | 73 (22.67%) | 0.41 |
Outcomes | Overall | Nonpregnant | Pregnant | p-Value |
---|---|---|---|---|
Frequency | 2448 | 2126 (86.85%) | 322 (13.15%) | - |
Mortality and associated causes | ||||
Mortality | 123 (5.02%) | 118 (5.55%) | 5 (1.55%) | <0.01 * |
Acute respiratory distress syndrome | 55 (44.72%) | 52 (44.07%) | 3 (60%) | 0.48 |
Septic shock | 35 (28.46%) | 32 (27.12%) | 3 (60%) | 0.11 |
Multi-organ dysfunction syndrome | 14 (11.38%) | 14 (11.86%) | - | 0.41 |
Acute coronary syndrome | 7 (5.69%) | 7 (5.93%) | - | 0.58 |
Cardiac arrhythmia | 5 (4.07%) | 5 (4.24%) | - | 0.64 |
Brain herniation | 7 (5.69%) | 7 (5.93%) | - | 0.58 |
Decompensated heart failure | 1 (0.81%) | 1 (0.85%) | - | 0.84 |
Other causes | 31 (35.20%) | 29 (24.58%) | 2 (40%) | 0.44 |
Respiratory failure and causes | ||||
Respiratory failure | 128 (5.23%) | 121 (5.69%) | 7 (2.17%) | 0.01 * |
Pneumonia | 71 (55.47%) | 67 (55.37%) | 4 (57.14%) | 0.93 |
Acute respiratory distress syndrome | 58 (45.31%) | 56 (46.28%) | 2 (28.57%) | 0.36 |
Shock | 9 (7.03%) | 8 (6.61%) | 1 (14.29%) | 0.44 |
Central neurological cause | 4 (3.13%) | 4 (3.31%) | - | 0.63 |
Pulmonary edema | 2 (1.56%) | 2 (1.65%) | - | 0.73 |
Pulmonary embolism | 5 (3.91%) | 5 (4.13%) | - | 0.58 |
Duration of ventilator dependence | 11 (10) | 12 (9) | 5 (11) | 0.20 |
1–5 days | 75 (58.89%) | 70 (57.85%) | 5 (71.43%) | 0.48 |
6 or more days | 53 (41.41%) | 51 (42.15%) | 2 (28.57%) | |
ICU Admission and reasons | ||||
Needed intensive care | 139 (5.68%) | 131 (6.16%) | 8 (2.48%) | 0.01 * |
Respiratory failure | 84 (60.43%) | 78 (59.54%) | 6 (75%) | 0.39 |
Acute respiratory distress syndrome | 63 (45.32%) | 61 (46.56%) | 2 (25%) | 0.23 |
Shock | 13 (9.35%) | 11 (8.40%) | 2 (25%) | 0.12 |
Impaired level of consciousness | 12 (8.63%) | 10 (7.63%) | 2 (25%) | 0.09 |
Acute myocardial infarction | 4 (2.88%) | 4 (3.05%) | - | 0.62 |
Acute kidney injury | 10 (7.19%) | 9 (6.87%) | 1 (12.50%) | 0.55 |
Treatment-related indication | 13 (9.35%) | 11 (8.40%) | 2 (25%) | 0.12 |
Acute stroke | 5 (3.60%) | 4 (3.05%) | 1 (12.50%) | 0.16 |
Cardiac arrhythmia | 2 (1.44%) | 2 (1.53%) | - | 0.73 |
Post-cardiac arrest | 2 (1.44%) | 2 (1.53%) | - | 0.73 |
Cerebral edema | 2 (1.44%) | 1 (0.76%) | 1 (12.50%) | 0.01 * |
Venous thromboembolism | 1 (0.72%) | 1 (0.76%) | - | 0.80 |
Time to ICU Admission | 5 (4) | 5 (4) | 5 (4) | 0.65 |
Duration of ICU Stay | 14 (11) | 14 (11) | 5 (8) | 0.02 * |
1–7 days | 80 (57.55%) | 73 (55.73%) | 7 (87.50%) | 0.08 |
8 or more days | 59 (42.45%) | 58 (44.27%) | 1 (12.50%) | |
Duration of Hospital Stay | 13 (8) | 13 (7) | 14 (10) | <0.01 * |
1–14 days | 1353 (55.27%) | 1213 (57.06%) | 140 (43.48%) | <0.01 * |
15 or more days | 1095 (44.73%) | 913 (42.94%) | 182 (56.52%) | |
Neurologic Outcomes | ||||
Full recovery | 1973 (80.60%) | 1762 (82.88%) | 211 (65.53%) | <0.01 * |
Stable with improvement | 333 (13.60%) | 227 (10.68%) | 106 (32.92%) | |
Stable without improvement | 40 (1.63%) | 40 (1.88%) | - | |
Not applicable | 102 (4.17%) | 97 (4.56%) | 5 (1.55%) | |
Final Disposition | ||||
Discharged | 2308 (94.28%) | 1991 (93.65%) | 317 (98.45%) | <0.01 * |
HAMA | 17 (0.69%) | 17 (0.80%) | - | |
Died | 123 (5.02%) | 118 (5.55%) | 5 (1.55%) |
Outcomes | OR (95% CI) | p-Value |
---|---|---|
Mortality | ||
Crude estimates for pregnancy | 0.26 (0.11–0.66) | <0.01 * |
Adjusted for age, disease severity, and NNS | 0.51 (0.16–1.68) | 0.27 |
Respiratory Failure | ||
Crude estimates for pregnancy | 0.37 (0.17–0.80) | 0.01 * |
Adjusted for age, disease severity, and NNS | 0.89 (0.32–2.49) | 0.82 |
Ventilator dependence (>5 days) | ||
Crude estimates for pregnancy | 0.55 (0.10–2.94) | 0.48 |
Adjusted for age, disease severity, and NNS | 0.88 (0.14–5.56) | 0.90 |
Need for Intensive Care | ||
Crude estimates for pregnancy | 0.39 (0.19–0.80) | 0.01 * |
Adjusted for age, disease severity, and NNS | 0.90 (0.39–2.11) | 0.81 |
ICU Length of Stay (>7 days) | ||
Crude estimates for pregnancy | 0.18 (0.02–1.50) | 0.11 |
Adjusted for age, disease severity, and NNS | 0.15 (0.02–1.39) | 0.09 |
Hospital Length of Stay (>14 days) | ||
Crude estimates for pregnancy | 1.73 (1.36–2.19) | <0.01 * |
Adjusted for age, disease severity, and NNS | 1.99 (1.56–2.54) | <0.01 * |
Outcomes | HR (95% CI) | p-Value |
---|---|---|
Time to Mortality | ||
Crude estimates for pregnancy | 0.22 (0.09–0.55) | <0.01 * |
Adjusted for age, disease severity, NNS, hypertension, diabetes | 0.65 (0.26–1.64) | 0.35 |
Time to Respiratory Failure | ||
Crude estimates for pregnancy | 1.27 (0.59–2.75) | 0.54 |
Adjusted for age, disease severity, NNS, hypertension, diabetes | 1.54 (0.68–3.49) | 0.30 |
Time to ICU Admission | ||
Crude estimates for pregnancy | 1.91 (0.93–3.93) | 0.08 |
Adjusted for age, disease severity, NNS, hypertension, diabetes | 2.01 (0.94–4.29) | 0.07 |
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Espiritu, A.I.; Bravo, S.L.R.; Sombilla, H.A.A.; Tantengco, O.A.G.; Sy, M.C.C.; Sy, A.D.R.; Anlacan, V.M.M.; Jamora, R.D.G. Clinical Outcomes of COVID-19 Infection in Pregnant and Nonpregnant Women: Results from The Philippine CORONA Study. Vaccines 2023, 11, 226. https://doi.org/10.3390/vaccines11020226
Espiritu AI, Bravo SLR, Sombilla HAA, Tantengco OAG, Sy MCC, Sy ADR, Anlacan VMM, Jamora RDG. Clinical Outcomes of COVID-19 Infection in Pregnant and Nonpregnant Women: Results from The Philippine CORONA Study. Vaccines. 2023; 11(2):226. https://doi.org/10.3390/vaccines11020226
Chicago/Turabian StyleEspiritu, Adrian I., Sybil Lizanne R. Bravo, Hannah Andrea A. Sombilla, Ourlad Alzeus G. Tantengco, Marie Charmaine C. Sy, Alvin Duke R. Sy, Veeda Michelle M. Anlacan, and Roland Dominic G. Jamora. 2023. "Clinical Outcomes of COVID-19 Infection in Pregnant and Nonpregnant Women: Results from The Philippine CORONA Study" Vaccines 11, no. 2: 226. https://doi.org/10.3390/vaccines11020226
APA StyleEspiritu, A. I., Bravo, S. L. R., Sombilla, H. A. A., Tantengco, O. A. G., Sy, M. C. C., Sy, A. D. R., Anlacan, V. M. M., & Jamora, R. D. G. (2023). Clinical Outcomes of COVID-19 Infection in Pregnant and Nonpregnant Women: Results from The Philippine CORONA Study. Vaccines, 11(2), 226. https://doi.org/10.3390/vaccines11020226