Pregnant and Postpartum Women Requiring Intensive Care Treatment for COVID-19—First Data from the CRONOS-Registry
Abstract
:1. Introduction
2. Materials and Methods
2.1. CRONOS-Registry
2.2. Patient Selection
2.3. Additional Data Collection for ICU Population
2.4. Statistical Analyses
3. Results
3.1. Patient Population
3.2. Maternal Characteristics
3.3. ICU Treatment—Stage of Pregnancy
3.4. ICU Treatment—Respiratory Treatment
3.5. Obstetric Outcome
3.6. Neonatal Outcome
3.7. Follow-Up of Mother–Infant Dyads
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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N = 101 | |
---|---|
Maternal age at SARS-CoV-2 infection (years) | 33 (30–36) |
<20 years | 2 (2) |
20–34 years | 69 (68) |
≥35 years | 30 (30) |
Multiple pregnancy | 4 (4) |
Gestational age | 33 (28–35) |
Trimester enrolled | |
1st trimester | 1 (1) |
2nd trimester | 26 (26) |
3rd trimester | 74 (73) |
Ethnic origin | |
Middle East | 34 (34) |
Northern Europe | 30 (30) |
Africa (others) | 11 (11) |
Eastern Europe | 9 (9) |
South East Asia | 8 (8) |
Southern Europe | 2 (2) |
Northern Africa | 1 (1) |
Open/Unknown | 6 (6) |
Australia, New Zealand | 0 (0) |
North America | 0 (0) |
Baseline data | |
Body height (cm) | 164 (160–166) |
Body weight before pregnancy (kg) | 77 (65–80) |
Body weight at inclusion (kg) | 85 (72–98) |
BMI before pregnancy (kg/m2) | 31.2 (26.3–33.0) |
Underweight (<18.5) | 1 (1) |
Normal weight (18.5–25.0) | 18 (18) |
Overweight (25.0–30.0) | 27 (27) |
Obese (>30.0) | 26 (26) |
Unknown | 29 (29) |
BMI at inclusion (kg/mg2) | 32 (28.6–34.2) |
History of smoking before pregnancy | 1 (1) |
Smoking during pregnancy | 1 (1) |
Passive smoking | 5 (5) |
Medical History | N = 101 |
---|---|
Pre-existing illnesses a | |
None | 54 (53) |
Mild | 27 (27) |
Moderate | 13 (13) |
Severe | 2 (2) |
Pre-existing conditions | |
Hypertension | 3 (3) |
Diabetes | |
Diabetes mellitus Type I | 1 (1) |
Diabetes mellitus Type II | 3 (3) |
Gestational Diabetes | 16 (16) |
Thyroid Disease | |
Hypothyroidism | 5 (5) |
Asthma | 4 (4) |
Hepatitis B | 3 (3) |
Others | 5 (5) |
Concomitant Medication | |
None | 63 (62) |
Antibiotics | 6 (6) |
Acetylsalicylic Acid | 3 (3) |
Other NSAIDs | 2 (2) |
Immunosuppressive Drugs | 1 (1) |
Antihypertensive Drugs | 5 (5) |
Asthma Medication | 1 (1) |
Antidiabetic Drugs | 10 (10) |
Heparin derivative | 11 (11) |
Important Others | 3 (3) |
COVID-19 | |
Symptoms b | n = 99 (98) |
Number of symptoms per patient | 6 (±3) |
Cough | 79 (78) |
Dyspnea | 84 (83) |
Malaise | 77 (76) |
Fever | 70 (69) |
Fatigue | 57 (56) |
Clinical examination—diagnostic Imaging | |
Imaging | n = 45 (45) |
Ultrasound examination of the lungs | 5 (11) |
Thoracic X-ray | 31 (69) |
Thoracic CAT-Scan | 14 (31) |
Thoracic MRI | 2 (4) |
Radiological Findings typical for COVID-19 | 41 (91) |
Treatment for COVID-19 | All N = 101 a | |||||
---|---|---|---|---|---|---|
Monitoring n = 6 | O2 n = 30 | NIV n = 22 | ITN n = 28 | ECMO n = 15 | ||
General Information | ||||||
Maternal age (years), mean (±SD) | 30 (29–34) | 33 (30–36) | 34 (31–35) | 34 (30–38) | 34 (30–37) | 34 (30–36) |
Booking BMI (kg/m2) | 31 (29–35) | 29 (24–34) | 27 (23–31) | 29 (25–32) | 29 (26–30) | 31 (26–33) |
Gestational age at diagnosis (weeks), median (IQR) | 36 (35–36) | 35 (31–37) | 29 (25–33) | 33 (28–35) | 31 (27–36) | 33 (28–35) |
Gestational age at childbirth (weeks) b, median (IQR) | 37 (36–40) | 38 (36–39) | 39 (37–41) | 33 (29–36) | 33 (31–36) | 36 (33–39) |
Time between diagnosis and childbirth (weeks) c, median (IQR) | 0 (0–2) | 1 (0–5) | 8 (4–14) b | 0 (0–2) | 1 (0–2) | 3 (0–4) |
Length of ICU stay (days), median (IQR) | 1 (1–2) | 4 (2–5) | 7 (5–9) | 20 (11–28) | 38 (16–71) | 9 (4–19) |
Duration of treatment (days), median (IQR) | - | - | 4 (3–6) | 10 (3–16) | 25 (12–41) | - |
Horowitz Index (mmHg), median (IQR) | - | - | 180 (136–233) | 85 (68–176) | 60 (50–67) | 120 (67–184) |
Prone position a | - | - | 4 (18) | 13 (57) | 9 (60) | 26 (30) |
Circulatory support a | 0 (0) | 0 (0) | 4 (18) | 16 (70) | 13 (87) | 33 (41) |
Renal Replacement Therapy a | 0 (0) | 0 (0) | 0 (0) | 2 (9) | 3 (20) | 5 (6) |
Thromboembolic event | 1 (17) | 1 (3) | 0 (0) | 3 (13) | 6 (40) | 11 (13) |
Anticoagulation a | ||||||
Prophylactic | 1 (17) | 13 (62) | 14 (64) | 12 (52) | 6 (40) | 46 (53) |
Therapeutic | 0 (0) | 7 (33) | 3 (14) | 7 (30) | 3 (20) | 20 (23) |
Antiviral medication a | 0 (0) | 2 (10) | 3 (14) | 5 (22) | 5 (33) | 15 (17) |
Steroids a | 0 (0) | 8 (38) | 14 (64) | 17 (74) | 7 (47) | 46 (53) |
Treatment for COVID-19 | All N = 101 a | |||||
---|---|---|---|---|---|---|
Monitoring n = 6 | O2 n = 30 | NIV n = 22 | ITN n = 28 | ECMO n = 15 | ||
Maternal outcome | ||||||
Recovery | 5 (83) | 20 (67) | 16 (73) | 19 (68) | 6 (40) | 66 (65) |
Death | 0 (0) | 0 (0) | 0 (0) | 1 (4) | 3 (20) | 5 (5) |
Unknown/open | 1 (17) | 10 (33) | 6 (27) | 8 (35) | 7 (47) | 32 (32) |
Neonatal outcome | ||||||
Preterm labour b | 3 (50) | 8 (33) | 3 (18) | 23 (79) | 11 (73) | 48 (48) |
Livebirth | 5 (83) | 22 (73) | 15 (68) | 23 (82) | 11 (73) | 77 (76) |
Stillbirth | 1 (17) | 0 (0) | 0 (0) | 2 (7) | 3 (20) | 6 (6) |
Unknown/open | 0 (0) | 8 (27) | 7 (32) | 3 (11) | 1 (7) | 19 (19) |
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Sitter, M.; Pecks, U.; Rüdiger, M.; Friedrich, S.; Fill Malfertheiner, S.; Hein, A.; Königbauer, J.T.; Becke-Jakob, K.; Zöllkau, J.; Ramsauer, B.; Rathberger, K.; Pontones, C.A.; Kraft, K.; Meybohm, P.; Härtel, C.; Kranke, P.; CRONOS Network. Pregnant and Postpartum Women Requiring Intensive Care Treatment for COVID-19—First Data from the CRONOS-Registry. J. Clin. Med. 2022, 11, 701. https://doi.org/10.3390/jcm11030701
Sitter M, Pecks U, Rüdiger M, Friedrich S, Fill Malfertheiner S, Hein A, Königbauer JT, Becke-Jakob K, Zöllkau J, Ramsauer B, Rathberger K, Pontones CA, Kraft K, Meybohm P, Härtel C, Kranke P, CRONOS Network. Pregnant and Postpartum Women Requiring Intensive Care Treatment for COVID-19—First Data from the CRONOS-Registry. Journal of Clinical Medicine. 2022; 11(3):701. https://doi.org/10.3390/jcm11030701
Chicago/Turabian StyleSitter, Magdalena, Ulrich Pecks, Mario Rüdiger, Sabine Friedrich, Sara Fill Malfertheiner, Alexander Hein, Josefine T. Königbauer, Karin Becke-Jakob, Janine Zöllkau, Babett Ramsauer, Katharina Rathberger, Constanza A. Pontones, Katrina Kraft, Patrick Meybohm, Christoph Härtel, Peter Kranke, and CRONOS Network. 2022. "Pregnant and Postpartum Women Requiring Intensive Care Treatment for COVID-19—First Data from the CRONOS-Registry" Journal of Clinical Medicine 11, no. 3: 701. https://doi.org/10.3390/jcm11030701