For a study, researchers sought to assess the relationship between SARS-CoV-2 infection and significant maternal morbidity or death due to frequent obstetric problems. A retrospective cohort study of 14,104 pregnant and postpartum patients born between March 1, 2020, and December 31, 2020 (with a final follow-up date of February 11, 2021) at 17 US hospitals participating in the Eunice Kennedy Shriver National Institute of Child Health and Human Development’s Gestational Research Assessments of COVID-19 (GRAVID) Study. All SARS-CoV-2 patients were included in the study, and their results were compared to those who did not have a positive SARS-CoV-2 test result and gave birth on randomly selected dates over the same time period. The infection of SARS-CoV-2 was determined by a positive nucleic acid or antigen test result. Secondary analysis classified patients infected with SARS-CoV-2 according to the severity of their sickness. The main outcome was a combination of maternal mortality or significant morbidity caused by hypertensive disorders of pregnancy, postpartum hemorrhage, or infection other than SARS-CoV-2. Cesarean birth was the predominant secondary result.

Of the 14,104 individuals included in the study (mean age 29.7), 2,352 had SARS-CoV-2 infection and 11,752 did not. SARS-CoV-2 infection was substantially related with the main outcome when compared to individuals lacking a positive SARS-CoV-2 test result (13.4% vs 9.2%; difference, 4.2% [95% CI, 2.8% -5.6%]; adjusted relative risk [aRR], 1.41 [95% CI, 1.23-1.61]). SARS-CoV-2 was the cause of all five maternal fatalities. SARS-CoV-2 infection was not related with cesarean delivery (34.7% vs 32.4% ; aRR, 1.05 [95% CI, 0.99-1.11]). In comparison to those who did not have a positive SARS-CoV-2 test result, moderate or higher COVID-19 severity (n=586) was significantly associated with the primary outcome (26.1% vs 9.2%; difference, 16.9% [95% CI, 13.3% -20.4%]; aRR, 2.06 [95% CI, 1.73-2.46]) and the major secondary outcome of cesarean birth (45.4% vs 32.4%; difference 12.8% [95% CI, 8.7%-16.8%]; aRR, 1.17 [95% CI, 1.07-1.28]), but mild or asymptomatic infection (n=1766) was not significantly associated with the primary outcome (9.2% vs 9.2%; difference, 0% [95% CI, −1.4% to 1.4%]; aRR, 1.11 [95% CI, 0.94-1.32]) or cesarean birth (31.2% vs 32.4%; difference, −1.4% [95% CI, −3.6% to 0.8%]; aRR, 1.00 [95% CI, 0.93-1.07]).

SARS-CoV-2 infection was linked to an elevated risk of maternal death or significant morbidity from obstetric problems in pregnant and postpartum women at 17 US hospitals.