Author: Denise Baez
Coronavirus disease 2019 (COVID-19) has a prolonged and nonspecific disease course during pregnancy and in the 6 weeks after pregnancy, according to a study published in Obstetrics & Gynecology.
Although the majority of the symptomatic women in the study who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) had mild disease and were not hospitalised, the median time to symptom resolution was 37 days, and for some, even longer.
The findings come from the Pregnancy Coronavirus Outcomes Registry (PRIORITY), an ongoing nationwide prospective cohort study of women in the United States who are pregnant or up to 6 weeks post-pregnancy with known or suspected SARS-CoV-2 infection.
“Despite the potential increased risks of COVID-19 for pregnant patients and their newborns, there remain significant gaps in knowledge on the clinical course of disease and the overall prognosis in this population,” wrote Yalda Afshar, MD, University of California Los Angeles, Los Angeles, California, and colleagues. “To date, studies of SARS-CoV-2 infection in pregnancy have primarily focused on hospitalised patients. Currently, there are limited data on longitudinal changes in symptoms over time and total duration of disease among the pregnant outpatient population, which includes the majority of patients with COVID-19.”
The researchers analysed the clinical presentation and disease course in 594 women (mean age, 31.3 years) who tested positive for SARS-CoV-2 infection and reported symptoms at the time of testing, between March 22, 2020, and July 10, 2020. The average gestational age at enrolment was 24.1 weeks, and 13% of participants were enrolled after pregnancy.
The most prevalent symptoms that led the women to go get tested for SARS-CoV-2 were cough (61%), fatigue (51%), body aches (51%), headache (46%), fever (44%), shortness of breath (40%), sore throat (39%), runny nose (34%), and anosmia or ageusia or both (32%).
Cough (46%), fatigue (38%), and headache (25%) were the most prevalent symptoms in the first week after diagnosis. Symptoms usually resolved within 1 month. By week 3, 52% of participants had become asymptomatic and by week 4, 60% were asymptomatic. However, symptoms persisted in 25% of women 8 weeks on. The median time from any symptom onset to complete resolution of symptoms was 37 days.
“The prevalence of symptoms among participants who tested positive for SARS-CoV-2 infection was different than that in non-pregnant populations in prior publications,” the authors wrote, noting the lower prevalence of fever and higher rates of fatigue, body aches, and headaches. They also noted that most studies have only included hospitalised patients, whereas 95% of PRIORITY participants are outpatients.
“To our knowledge, this is the largest longitudinal cohort of ambulatory patients in the United States,” the authors wrote.
Limitations of the study include changes in testing availability over time based on participants’ location and access during the study period, timing of testing relative to symptoms, and accuracy of testing. The study also had a high rate of healthcare workers (30%) with high education levels and income, which may not be generalizable. In addition, most (60%) women in the study were white; 31% were Latina and 9% were Black.
“We are actively working with the PRIORITY Community Advisory Council and community-based organisations to increase enrolment of Latina, Black, and Native American patients,” the authors stated.