792 - Association of Maternal Illness Severity for COVID-19 with Maternal and Neonatal Health Outcomes

Poster Number: 792
Publication Number: 792.249

Julide Sisman, University of Texas Southwestern Medical Center, DALLAS, TX, United States; Lauren F. Black, University of Texas Southwestern Medical School, Dallas, TX, United States; Ariana Weiss, University of Texas Southwestern Medical School, Dallas, TX, United States; Larry S. Brown, Parkland Health, Dallas, TX, United States; Luc P. Brion, UT Southwestern Medical Center, Dallas, TX, United States

Background: Several reports consistently demonstrated that perinatal SARS-CoV-2 infection has significant impact on maternal and neonatal health outcomes. However, the relationship of the degree of maternal severity with outcomes remain unclear.

Objective: To evaluate whether maternal and neonatal characteristics and outcomes are associated with the severity of maternal SARS-CoV-2 infection at the time of the delivery

Design/Methods: This is a retrospective observational study of 543 mother/infant dyads with positive maternal SARS-CoV-2 reverse transcriptase-polymerase chain reaction (RT-PCR) testing between 14 days prior and 3 days after delivery from 3/30/2020 to 12/28/2021 at Parkland Hospital in Dallas, Texas. The severity of the maternal illness was assigned using Society for Fetal Maternal Medicine severity scale for COVID-19. Neonatal infection was defined based on at least one positive result of RT-PCR tests administered at 24 and 48 hours of life. Statistical analyses included Wilcoxon rank sum test, chi-square analysis or Fisher's exact test followed by pair-wise analysis at the < 0.05 level using Bonferroni correction.

Results: Among 543 mothers who tested positive for SARS-CoV-2, those with moderate/severe/critical illness (6%) were more likely to be hospitalized and undergo induction for worsening COVID-19 than those asymptomatic (64%) or mild illness (30%) (P< 0.05). Mothers with moderate/severe/critical illness were more likely to receive medical treatment, oxygen, mechanical ventilation or ECMO (P< 0.05), and had longer hospital stay and higher mortality (P< 0.05) [Table 1].
Neonates who were born to mothers with moderate/severe/critical illness were more likely to be born prematurely with lower birth weight, to receive resuscitation in the delivery room and to be admitted to the NICU (P< 0.05) but not be small for gestational age. They were more likely to be symptomatic with respiratory distress, to have hypoglycemia and to have longer hospital stay but were less likely to receive breastmilk and to be breastfeeding at discharge (P< 0.05). Neonates born to mothers with mild illness were similar to those asymptomatic ones for all the variables studied except for more frequent NICU admission and less breastfeeding. The rate of SARS-CoV-2 transmission was low and did not differ by maternal illness severity (P=0.86) [Table 2].

Conclusion(s): In this cohort, maternal illness severity was significantly associated with several maternal and neonatal health outcomes. Mild maternal illness was only associated with NICU admission for isolation precaution and less frequent breastfeeding.