• Ursula Trovato Gomez, FranciscoRossana Pulcineli VieiraRPVDisciplina de Obstetrícia, Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil; Hospital Universitário da Universidade de São Paulo (USP), São Pau, Fernanda Spadotto Baptista, Maria Augusta B C Gibelli, Silvia Maria Ibidi, CarvalhoWerther Brunow deWBHospital Universitário da Universidade de São Paulo (USP), São Paulo, SP, Brazil; Disciplina de Neonatologia, Departamento de Pediatria, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil., Cristiane de Freitas Paganoti, Ester Cerdeira Sabino, Lea Campos de Oliveira da Silva, Thomas Jaenisch, Philippe Mayaud, Maria de Lourdes Brizot, and HC-FMUSP-Obstetric COVID-19 Study Group.
• Disciplina de Obstetrícia, Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil. Electronic address: ursula.gomez@hc.fm.usp.br.
• Clinics (Sao Paulo). 2022 Jan 1; 77: 100073.

ObjectivesTo determine the incidence and risk of adverse obstetric and neonatal outcomes according to SARS-CoV-2 infection severity in pregnant women.MethodOpen prospective study of pregnant women tested for SARS-CoV-2 by serological and molecular assays during pregnancy or delivery in two hospitals in Sao Paulo, Brazil from April 12, 2020, to February 28, 2021. Five groups were considered for analysis: C0, negative COVID-19 results and no COVID-19 symptoms; C1, positive COVID-19 results, and no symptoms; C2, positive COVID-19 results with mild symptoms; C3, positive COVID-19 results with moderate symptoms; and C4, positive COVID-19 results with severe symptoms. The association between obstetric and neonatal outcomes and COVID-19 severity was determined using multivariate analysis.Results734 eligible pregnant women were enrolled as follows: C0 (n = 357), C1 (n = 127), C2 (n = 174), C3 (n = 37), and C4 (n = 39). The following pregnancy and neonatal outcomes were associated with severe COVID-19: oligohydramnios (adjusted Odds Ratio [aOR] = 6.18; 95% CI 1.87‒20.39), fetal distress (aOR = 4.01; 95% Confidence Interval [CI] 1.84‒8.75), preterm birth (aOR = 5.51; 95% CI 1.47‒20.61), longer hospital stay (aOR = 1.66; 95% CI 1.36‒2.02), and admission to the neonatal intensive care unit (aOR = 19.36; 95% CI, 5.86‒63.99). All maternal (n = 6, 15.4%, p < 0.001) and neonatal (n = 5, 12.5%, p < 0.001) deaths and most fetal deaths (n = 4, 9.8%, p < 0.001) occurred in C4 group. Moderate COVID-19 was associated with oligohydramnios (aOR = 6.23; 95% CI 1.93‒20.13) and preterm birth (aOR = 3.60; 95% CI 1.45‒9.27). Mild COVID-19 was associated with oligohydramnios (aOR = 3.77; 95% CI 1.56‒9.07).ConclusionAdverse pregnancy and neonatal outcomes were associated with maternal symptomatic COVID-19 status, and risk increased with disease severity.Copyright © 2022 HCFMUSP. Published by Elsevier España, S.L.U. All rights reserved.

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