CDC Report: Risk for Stillbirth among Women with and without Covid-19 at Delivery Hospitalization – United States, March 2020–September 2021

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Risk for Stillbirth Among Women With and Without COVID-19 at Delivery Hospitalization — United States, March 2020–September 2021

Early Release / November 19, 2021 / 70

Carla L. DeSisto, PhD1; Bailey Wallace, MPH1; Regina M. Simeone, PhD1; Kara Polen, MPH1; Jean Y. Ko, PhD1; Dana Meaney-Delman, MD1; Sascha R. Ellington, PhD1 (View author affiliations)View suggested citation

Summary

What is already known about this topic?

Pregnant women are at increased risk for severe disease from COVID-19, and COVID-19 is associated with an increased risk for adverse perinatal outcomes.

What is added by this report?

Among 1,249,634 delivery hospitalizations during March 2020–September 2021, U.S. women with COVID-19 were at increased risk for stillbirth compared with women without COVID-19 (adjusted relative risk [aRR] = 1.90; 95% CI = 1.69–2.15). The magnitude of association was higher during the period of SARS-CoV-2 B.1.617.2 (Delta) variant predominance than during the pre-Delta period.

What are the implications for public health practice?

Implementing evidence-based COVID-19 prevention strategies, including vaccination before or during pregnancy, is critical to reduce the impact of COVID-19 on stillbirths.

Pregnant women are at increased risk for severe COVID-19–related illness, and COVID-19 is associated with an increased risk for adverse pregnancy outcomes and maternal and neonatal complications (13). To date, studies assessing whether COVID-19 during pregnancy is associated with increased risk for stillbirth have yielded mixed results (24). Since the B.1.617.2 (Delta) variant of SARS-CoV-2 (the virus that causes COVID-19) became the predominant circulating variant,* there have been anecdotal reports of increasing rates of stillbirths in women with COVID-19. CDC used the Premier Healthcare Database Special COVID-19 Release (PHD-SR), a large hospital-based administrative database,§ to assess whether a maternal COVID-19 diagnosis documented at delivery hospitalization was associated with stillbirth during March 2020September 2021 as well as before and during the period of Delta variant predominance in the United States (March 2020June 2021 and July–September 2021, respectively). Among 1,249,634 deliveries during March 2020–September 2021, stillbirths were rare (8,154; 0.65%): 273 (1.26%) occurred among 21,653 deliveries to women with COVID-19 documented at the delivery hospitalization, and 7,881 (0.64%) occurred among 1,227,981 deliveries without COVID-19. The adjusted risk for stillbirth was higher in deliveries with COVID-19 compared with deliveries without COVID-19 during March 2020–September 2021 (adjusted relative risk [aRR] = 1.90; 95% CI = 1.69–2.15), including during the pre-Delta (aRR = 1.47; 95% CI = 1.27–1.71) and Delta periods (aRR = 4.04; 95% CI = 3.28–4.97). COVID-19 documented at delivery was associated with increased risk for stillbirth, with a stronger association during the period of Delta variant predominance. Implementing evidence-based COVID-19 prevention strategies, including vaccination before or during pregnancy, is critical to reducing the impact of COVID-19 on stillbirths.

Delivery hospitalizations were identified from PHD-SR using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnostic and procedure codes pertaining to obstetric delivery and diagnosis-related group delivery codes. Deliveries with discharge dates during March 2020–September 2021 were included. Stillbirths, defined as fetal deaths at ≥20 weeks’ gestation, were identified using maternal ICD-10-CM diagnosis codes.** Hospitalizations without ICD-10-CM codes indicating gestational age or with ICD-10-CM codes indicating gestational age <20 weeks were excluded to reduce misclassification of fetal deaths at <20 weeks’ gestation as stillbirths (1.5% of the overall sample).

Read the rest here:

https://www.cdc.gov/mmwr/volumes/70/wr/mm7047e1.htm#:~:text=Among%201%2C249%2C634%20delivery%20hospitalizations%20during,CI%20%3D%201.69%E2%80%932.15

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