Introduction
This study analyzed the incidence of hospitalizations due to COVID-19 in pregnant women, as well as the severity of the disease and the medical treatments administered, during the first 10 months of the pandemic (March 1 to December 31, 2020). Conducted in 10 European countries, the research aimed to identify differences between public health systems and highlight lessons for future health emergencies.
Methods
The analysis used data from 1.7 million pregnant women from 10 countries, with surveillance based on national and regional systems. Pregnant women who were admitted to hospitals with a diagnosis of COVID-19 confirmed by PCR were categorized into two groups: hospitalization due to COVID-19 or hospitalization for other obstetric reasons.
The main outcomes included:
• Incidence of hospitalizations due to COVID-19.
• Frequency of moderate to severe COVID-19 (maternal death, ICU admission, or need for respiratory support).
• Specific medical treatment for COVID-19.
Outcomes
1. Incidence of Hospital Admissions:
• Incidence varied between countries, from 0 admissions in Iceland to 1.9 per 1,000 maternity hospital admissions in the UK.
• Nordic countries (Denmark, Finland, Iceland and Norway) had the lowest rates, while France, the UK and Sweden had the highest.
2. Severity of COVID-19:
• Among 2,350 women hospitalized for COVID-19, 13 deaths were recorded, while 294 were admitted to intensive care units.
• The need for respiratory support varied widely, with up to 41% of women in France requiring supplemental oxygen.
• About 39.1% of women hospitalized had moderate to severe conditions.
3. Medical Treatments:
• Only 16.8% of women with moderate to severe COVID-19 received corticosteroids to treat the infection.
• 66.6% received prophylactic anticoagulation, but antiviral treatments were administered in only 14.8% of cases.
4. Maternal and neonatal outcomes:
• Preterm birth (<37 weeks) was more common in women with severe disease, ranging from 26.7% (Netherlands) to 34.5% (UK).
• Admission of newborns to neonatal units was more frequent in mothers with moderate to severe infection (32.8%).
Discussion
Variations in the incidence of hospitalizations and treatments administered reflect differences in public health policies and containment strategies between countries. In settings with higher hospitalization rates, such as France and the UK, the early mitigation approach contrasted with the early suppression adopted in the Nordic countries. Furthermore, the low frequency of specific treatments for COVID-19 in pregnant women, even after evidence on safety became available, highlights an important gap in clinical management during pandemics.
Conclusion
National policies played a significant role in protecting pregnant women during the pandemic, influencing hospitalization and mortality rates. However, the underuse of effective treatments in pregnant women highlights the need for early inclusion of these patients in drug and vaccine development protocols for future public health emergencies.
Reference
Engjom, H. M., de Bruin, O., Ramakrishnan, R., et al. (2024). Pregnant women admitted to hospital with covid-19 in 10 European countries: individual patient data meta-analysis of population based cohorts in International Obstetric Survey Systems. BMJ Medicine, 3(1), e000733. Available from: https://bmjmedicine.bmj.com/content/3/1/e000733
