BACKGROUND: It 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. OBJECTIVE: This study aimed to evaluate maternal and perinatal outcomes in high- and low-risk pregnancies complicated by severe acute respiratory syndrome coronavirus 2 infection. STUDY DESIGN: This 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. RESULTS: A 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. CONCLUSION: High-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.

ABC Medical Center Mexico City Mexico

Academic Division of Obstetrics and Gynecology Mauriziano Umberto 1 Hospital University of Turin Turin Italy

Academic Unit of Obstetrics and Gynaecology Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Policlinico San Martino Genova Italy

Alexandra Hospital National and Kapodistrian University of Athens Athens Greece

Alvaro Cunqueiro University Hospital of Vigo Vigo Spain

Assistência Obstétrica do Grupo Perinatal Rio de Janeiro Brazil

Batman Maternity and Child Health Hospital Batman Turkey

Bursa City Hospital Bursa Turkey

Campus Bio Medico University of Rome Rome Italy

Cengiz Gokcek Women's and Children's Hospital Gaziantep Turkey

Centre for High Risk Pregnancy and Fetal Care Department of Obstetrics and Gynecology University of Chieti Chieti Italy

Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno Buenos Aires Argentina

Clínica del Country Bogotá Colombia

Community Medical Centers University of California San Francisco Fresno Fresno CA

Departamento de Ginecologia e Obstetrícia Hospital Universitário Polydoro Ernani Santiago Brazil

Departamento De Ginecologia Y Obstetricia Centro Medico La Paz De Bata Bata Guinea Ecuatorial

Department Gynecology and Obstetrics Fornaroli Hospital Magenta Italy

Department of Anaesthesia Lyell McEwin Hospital Adelaide Australia

Department of Maternal and Child Health and Urological Sciences Sapienza University of Rome Rome Italy

Department of Neonatology Obstetrics and Gynecology University Hospital Sofia Bulgaria

Department of Neuroscience Reproductive Sciences and Dentistry School of Medicine University of Naples Federico 2 Naples Italy

Department of Obstetrics and Gynaecology Fondazione Policlinico Universitario A Gemelli IRCCS Università Cattolica del Sacro Cuore Rome Italy

Department of Obstetrics and Gynecology Centre for High Risk Pregnancy and Fetal Care University of Chieti Chieti Italy

Department of Obstetrics and Gynecology Filippo Del Ponte Hospital University of Insubria Varese Italy

Department of Obstetrics and Gynecology Hasanuddin University Makassar Indonesia

Department of Obstetrics and Gynecology Hospital Erasme Cliniques Universitaires de Bruxells Brussels Belgium

Department of Obstetrics and Gynecology Istanbul University Cerrahpasa Medical School Istanbul Turkey

Department of Obstetrics and Gynecology Neonatology and Intensive Care Helsinki University Hospital and University of Helsinki Helsinki Finland

Department of Obstetrics and Gynecology Saint John Hospital Carol Davila University of Medicine and Pharmacy Romania

Department of Obstetrics and Gynecology Sanko University School of Medicine Gaziantep Turkey

Department of Obstetrics and Gynecology Sant'Anna Hospital University of Turin Turin Italy

Department of Obstetrics and Gynecology Sant'Orsola Malpighi University Hospital University of Bologna Bologna Italy

Department of Obstetrics and Gynecology University of Dicle Diyarbakır Turkey

Department of Obstetrics and Gynecology University of Parma Parma Italy

Department of Obstetrics Gynecology and Reproductive Sciences University of Maryland Medical Center Baltimore MD

Department of Perinatal Medicine Memorial Hospital Istanbul Turkey

Department of Woman Child and General and Specialized Surgery University of Campania Luigi Vanvitelli Naples Italy

División Obstetricia Hospital de Clínicas José de San Martín Buenos Aires Argentina

Division of Neonatology Department of Obstetrics and Gynecology General Hospital Prague and 1st Faculty of Medicine Charles University Prague Czech Republic

Division of Neonatology Hospital Clínico San Carlos Madrid Spain

Düzce University Medicine Faculty Department of Perinatology Düzce Turkey

Fetal Medicine Unit Di Venere Hospital Bari Italy

Fetal Medicine Unit Maternal and Child Health and Development Network Department of Obstetrics and Gynecology University Hospital 12 de Octubre Complutense University of Madrid Madrid Spain

Hisar Intercontinental Hospital Instanbul Turkey

Hospital Angeles Lomas Mexico City Mexico

Hospital Clinico San Jose Chile Santiago Chile

Hospital Juan A Fernandez Buenos Argentina

Hospital Raul F Larcade Buenos Aires Argentina

Hospital Regional Universitario de Málaga Malaga Spain

Hospital Universitari Germans Trias i Pujol Barcelona Spain

Hospital Universitario de Móstoles Mostoles Spain

Hospital Virgen De La Luz Cuenca Spain

Instituto de MedFetal e Diagnóstico por Imagem do Amazonas Manausi Brazil

Instituto Nacional Materno Perinatal Lima Peru

Karaman Public Hospital Karaman Turkey

KBC Dr Dragisa Misovic Dedinje Belgrade Serbia

Medical Faculty Department of Perinatology University Medical Center University of Ljubljana Ljubljana Slovenia

National Medical Research Center for Obstetrics Gynecology and Perinatology Moscow Russia

Ospedale Generale Regionale F Miulli Acquaviva delle Fonti Italy

Ostetricia e Ginecologia Universitaria Ospedale S Anna e S Sebastiano Caserta Italy

Perinatal Medicine Foundation Department of Perinatal Medicine Memorial Hospital Istanbul Turkey

Petach Tikva and Sackler Faculty of Medicine Rabin Medical Center Helen Schneider Hospital for Women Tel Aviv University Tel Aviv Israel

Regional Hospital Gjakova Kosovo Republic of Kosovo

Sakarya University Education and Research Hospital Sakarya Turkey

Section of Obstetrics and Gynecology Department of Medical Sciences Azienda Ospedaliera Universitaria Sant' Anna University of Ferrara Ferrara Italy

Servicio de Obstetricia y Ginecología Hospital Universitario y Politécnico La Fe Valencia Spain

Sulochana clinic Kolkata India

Unit of Obstetrics and Gynecology Ospedale Maggiore Bologna Italy

Universitatea de Medicină și Farmacie Grigore T Popa Iași Iasi Romania

University Clinic Hospital of Valladolid Valladolid Spain

University Clinic of Obstetrics and Gynecology Skopje North Macedonia

University Hospital of Obstetrics and Gynecology Sofia Bulgaria

University Of Health Sciences Umraniye Training And Research Hospital Turkey Istanbul

University of Milan Milan Italy

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