Impact of Covid-19 on risk of severe maternal morbidity.

Publication date: Sep 05, 2023

We examined the risk of severe life-threatening morbidity in pregnant patients with Covid-19 infection. We conducted a population-based study of 162,576 pregnancies between March 2020 and March 2022 in Quebec, Canada. The main exposure was Covid-19 infection, including the severity, period of infection (antepartum, peripartum), and circulating variant (wildtype, alpha, delta, omicron). The outcome was severe maternal morbidity during pregnancy up to 42 days postpartum. We estimated risk ratios (RR) and 95% confidence intervals (CI) for the association between Covid-19 infection and severe maternal morbidity using adjusted log-binomial regression models. Covid-19 infection was associated with twice the risk of severe maternal morbidity compared with no infection (RR 2. 02, 95% CI 1. 76-2. 31). Risks were elevated for acute renal failure (RR 3. 01, 95% CI 1. 79-5. 06), embolism, shock, sepsis, and disseminated intravascular coagulation (RR 1. 35, 95% CI 0. 95-1. 93), and severe hemorrhage (RR 1. 49, 95% CI 1. 09-2. 04). Severe antepartum (RR 13. 60, 95% CI 10. 72-17. 26) and peripartum infections (RR 20. 93, 95% CI 17. 11-25. 60) were strongly associated with severe maternal morbidity. Mild antepartum infections also increased the risk, but to a lesser magnitude (RR 3. 43, 95% CI 2. 42-4. 86). Risk of severe maternal morbidity was around 3 times greater during circulation of wildtype and the alpha and delta variants, but only 1. 2 times greater during omicron. Covid-19 infection during pregnancy increases risk of life-threatening maternal morbidity, including renal, embolic, and hemorrhagic complications. Severe Covid-19 infection with any variant in the antepartum or peripartum periods all increase the risk of severe maternal morbidity.

Concepts Keywords
42days Covid-19
Canada Hemorrhage
Hemorrhagic Pregnancy
Models Renal failure
Severe maternal morbidity


Type Source Name
disease MESH Covid-19
disease MESH morbidity
disease MESH infection
disease VO population
disease VO Canada
disease MESH acute renal failure
disease MESH embolism
disease MESH shock
disease MESH sepsis
disease MESH disseminated intravascular coagulation
disease MESH hemorrhage
disease MESH complications
disease MESH Long Covid
disease MESH Renal failure

Original Article

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