• Francesco D'Antonio, Cihat Sen, MascioDaniele DiDDDepartment of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy (Dr Mascio)., Alberto Galindo, Cecilia Villalain, Ignacio Herraiz, Resul Arisoy, Ali Ovayolu, Hasan Eroğlu, Manuel Guerra Canales, Subhashini Ladella, Liviu Cojocaru, Ozhan Turan, Sifa Turan, Eran Hadar, Noa A Brzezinski-Sinai, Sarah Dollinger, Ozlem Uyaniklar, Sakine Rahimli Ocakouglu, Zeliha Atak, Tanja Premru-Srsen, Lilijana Kornhauser-Cerar, Mirjam Druškovič, Liana Ples, Reyhan Gündüz, Elif Ağaçayak, Javier Alfonso Schvartzman, Mercedes Negri Malbran, Marco Liberati, Francesca Di Sebastiano, Ludovica Oronzi, Chiara Cerra, Danilo Buca, Angelo Cagnacci, Arianna Ramone, Fabio Barra, Andrea Carosso, Chiara Benedetto, Stefano Cosma, Axelle Pintiaux, Caroline Daelemans, Elena Costa, Ayşegül Özel, Murat Muhçu, Jesús S Jimenez Lopez, Clara Alvarado, Anna Luengo Piqueras, Dolores Esteban Oliva, Giovanni Battista Luca Schera, Nicola Volpe, Tiziana Frusca, Igor Samardjiski, Slagjana Simeonova, Irena Aleksioska Papestiev, Javier Hojman, Ilgin Turkcuoglu, Antonella Cromi, Antonio Simone Laganà, Fabio Ghezzi, Angelo Sirico, Alessandra Familiari, Giovanni Scambia, Zulfiya Khodjaeva Gennady T Sukhikh, Ksenia A Gorina, Renato Augusto Moreira de Sa, Mariana Vaz, Otto Henrique May Feuerschuette, GattaAnna Nunzia DellaANDDepartment of Obstetrics and Gynecology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy (Dr Gatta, Dr Youssef, and Dr Donna)., Aly Youssef, Gaetana Di Donna, Alicia Martinez-Varea, Gabriela Loscalzo, José Morales Roselló, Vedran Stefanovic, Irmeli Nupponen, Kaisa Nelskylä, Rodrigo Ayala, MolpeceresRebeca GarroteRGUniversity Clinic Hospital of Valladolid, Valladolid, Spain (Dr Molpeceres and Dr Vázquez)., VázquezAsunción PinoAPUniversity Clinic Hospital of Valladolid, Valladolid, Spain (Dr Molpeceres and Dr Vázquez)., Fabrizio Sandri, Ilaria Cataneo, Marinella Lenzi, Esra Tustas Haberal, Erasmo Huertas, Amadeo Sanchez, Pedro Arango, Amanda Bermejo, María Monica Gonzalez Alcantara, Gökhan Göynümer, Erhan Okuyan, Ciuhodaru Madalina, Ana Concheiro Guisan, Alejandra Martínez Schulte, Valentina Esposito, Valentina De Robertis, Snezana Zdjelar, Milan Lackovic, Sladjana Mihajlovic, Nelly Jekova, Gabriele Saccone, Mehmet Musa Aslan, Maria Carmela Di Dedda, Maisuri Chalid, Jose Enrique Moros Canache, George Daskalakis, Panos Antsaklis, Enrique Criado Vega, Elisa Cueto, Chiara Taccaliti, Yeliz Aykanat, Şerife Özlem Genç, Bernd Froessler, Petya Angelova Radulova, Danila Morano, Beatrice Bianchi, Maria Giulia Lombana Marino, Gabriella Meccariello, Bindu Rohatgi, Antonio Schiattarella, Maddalena Morlando, Nicola Colacurci, Andrea Villasco, Nicoletta Biglia, Ana Luiza Santos Marques, Alessandra Gatti, Daniela Luvero, Roberto Angioli, Alejandro Pittaro, Albert Lila, Blanka Zlatohlávková, and On the behalf of the World Association of Perinatal Medicine working group on coronavirus disease 2019.
• Centre for High-Risk Pregnancy and Fetal Care, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy (Dr D'Antonio). Electronic address: francesco.dantonio@unich.it.
• Am J Obstet Gynecol MFM. 2021 Feb 20; 3 (4): 100329.

BackgroundIt has still to be ascertained whether severe acute respiratory syndrome coronavirus 2 infection in pregnancy is associated with worse maternal and fetal outcomes compared to low risk gestations.ObjectiveThis study aimed to evaluate maternal and perinatal outcomes in high- and low-risk pregnancies complicated by severe acute respiratory syndrome coronavirus 2 infection.Study DesignThis was a multinational retrospective cohort study involving women with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection from 76 centers from 25 countries in Europe, the United States, South America, Asia, and Australia from April 4, 2020, to October 28, 2020. The primary outcome was a composite measure of maternal mortality and morbidity, including admission to the intensive care unit, use of mechanical ventilation, or death. The secondary outcome was a composite measure of adverse perinatal outcome, including miscarriage, fetal loss, neonatal and perinatal death, and admission to the neonatal intensive care unit. All outcomes were assessed in high- and low-risk pregnancies. Pregnancies were considered high risk in case of either preexisting chronic medical conditions in pregnancy or obstetrical disorders occurring in pregnancy. The Fisher exact test and logistic regression analysis were used to analyze the data.ResultsA total of 887 singleton pregnancies who tested positive for severe acute respiratory syndrome coronavirus 2 infection using reverse transcription-polymerase chain reaction of nasal and pharyngeal swab specimens were included in the study. The risk of composite adverse maternal outcomes was higher in high-risk pregnancies than in low-risk pregnancies (odds ratio, 1.52; 95% confidence interval, 1.03-2.24; P=.035). In addition, women carrying high-risk pregnancies were at higher risk of hospital admission (odds ratio, 1.48; 95% confidence interval, 1.07-2.04; P=.002), presence of severe respiratory symptoms (odds ratio, 2.13; 95% confidence interval, 0.41-3.21; P=.001), admission to the intensive care unit (odds ratio, 2.63; 95% confidence interval, 1.42-4.88), and invasive mechanical ventilation (odds ratio, 2.65; 95% confidence interval, 1.19-5.94; P=.002). When exploring perinatal outcomes, high-risk pregnancies were at high risk of adverse perinatal outcomes (odds ratio, 1.78; 95% confidence interval, 0.15-2.72; P=.009). However, such association was mainly because of the higher incidence of miscarriage in high-risk pregnancies compared with that in low-risk pregnancies (5.3% vs 1.6%, P=.008); furthermore, there was no difference in other explored outcomes between the 2 study groups. At logistic regression analysis, maternal age (odds ratio, 1.12; 95% confidence interval, 1.02-1.22; P=.023) and high-risk pregnancy (odds ratio, 4.21; 95% confidence interval, 3.90-5.11; P<.001) were independently associated with adverse maternal outcomes.ConclusionHigh-risk pregnancies complicated by severe acute respiratory syndrome coronavirus 2 infection were at higher risk of adverse maternal outcomes than low-risk pregnancies complicated by severe acute respiratory syndrome coronavirus 2 infection.Copyright © 2021. Published by Elsevier Inc.

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