Management and outcomes of pregnant women admitted to intensive care unit for severe pneumonia related to SARS-CoV-2 infection: the multicenter and international COVIDPREG study

Edwige Péju; Félicie Belicard; Stein Silva; Sami Hraiech; Benoît Painvin; Toufik Kamel; Arnaud W Thille; Antoine Goury; David Grimaldi; Boris Jung; Michael Piagnerelli; Hadrien Winiszewski; Merce Jourdain; Mathieu Jozwiak; COVIDPREG Study Group

doi:10.1007/s00134-022-06833-8

Management and outcomes of pregnant women admitted to intensive care unit for severe pneumonia related to SARS-CoV-2 infection: the multicenter and international COVIDPREG study

Intensive Care Med. 2022 Sep;48(9):1185-1196. doi: 10.1007/s00134-022-06833-8. Epub 2022 Aug 17.

Authors

Edwige Péju^{1

2

3}, Félicie Belicard¹, Stein Silva⁴, Sami Hraiech^{5

6}, Benoît Painvin⁷, Toufik Kamel⁸, Arnaud W Thille⁹, Antoine Goury¹⁰, David Grimaldi¹¹, Boris Jung^{12

13}, Michael Piagnerelli¹⁴, Hadrien Winiszewski¹⁵, Merce Jourdain^{16

17}, Mathieu Jozwiak^{18

19}; COVIDPREG Study Group

Collaborators

COVIDPREG Study Group:
Laurent Argaud, Cécile Aubron, Nicolas Bèle, François Beloncle, Pierre-Marie Bertrand, Laetitia Bodenes, Filippo Boroli, Belaid Bouhemad, Lucie Braconnier, William Buffieres, Cédric Darreau, Jean Dellamonica, Stephan Ehrmann, Mélanie Faure, Sébastien Gibot, Claudine Gniadek, Marine Goudelin, Pierre-Alban Guenier, Christophe Guitton, Etienne Haussaire, Julie Helms, Matthieu Jamme, Michel Kaidomar, Jean-Baptiste Lascarrou, Christophe Le Terrier, Julien Maizel, Ferhat Meziani, Jean-Paul Mira, Lucas Morand, Grégoire Muller, Benjamin Pequignot, Gaël Piton, Jérôme Pugin, Alexandre Robert, Michael Siino, Bertrand Souweine, Mattieu Stanowski, Fabienne Tamion, Nicolas Terzi, Guillaume Thiery

Affiliations

¹ Service de Médecine Intensive et Réanimation, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 27 rue du faubourg Saint Jacques, 75014, Paris, France.
² Université de Paris, Paris, France.
³ Institut Cochin, INSERM U1016, CNRS UMR8104, 75006, Paris, France.
⁴ Service de Médecine Intensive et Réanimation, Centre Hospitalier Universitaire Purpan, 31300, Toulouse, France.
⁵ Service de Médecine Intensive et Réanimation, AP-HM, Hôpital Nord, Marseille, France.
⁶ Aix-Marseille Université, Health Service Research and Quality of Life Center (CEReSS), Marseille, France.
⁷ Service de réanimation médicale, service des maladies infectieuses et réanimation médicale, Centre Hospitalier Universitaire de Rennes, Hôpital Pontchaillou, 2 rue Henri le Guilloux, 35033, Rennes Cedex 9, France.
⁸ Service de Médecine Intensive et Réanimation, Centre Hospitalier Régional d'Orléans, Orléans, France.
⁹ Service de Médecine Intensive et Réanimation, CHU de Poitiers, Poitiers, France.
¹⁰ Service de Médecine Intensive et Réanimation, Centre Hospitalier Universitaire de Reims, Reims, France.
¹¹ Service de soins intensifs CUB-Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium.
¹² Service de Médecine Intensive et Réanimation, CHU de Lapeyronie, Montpellier, France.
¹³ PhyMedExp, Université de Montpellier, Montpellier, France.
¹⁴ Intensive Care, CHU-Charleroi, Université Libre de Bruxelles, 140, chaussée de Bruxelles, 6042, Charleroi, Belgium.
¹⁵ Service de Médecine Intensive et Réanimation, Centre Hospitalier Universitaire de Besançon, Besançon, France.
¹⁶ Pôle de Médecine Intensive et Réanimation, Hôpital Roger Salengro, CHU Lille, Lille, France.
¹⁷ Inserm U1190, Université de Lille, 59000, Lille, France.
¹⁸ Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nice, Hôpital l'Archet 1, 151 rue saint Antoine de Ginestière, 06200, Nice, France. jozwiak.m@chu-nice.fr.
¹⁹ Équipe 2 CARRES, UR2CA-Unité de Recherche Clinique Côte d'Azur, Université Côte d'Azur, Nice, France. jozwiak.m@chu-nice.fr.

Abstract

Purpose: Management and outcomes of pregnant women with coronavirus disease 2019 (COVID-19) admitted to intensive care unit (ICU) remain to be investigated.

Methods: A retrospective multicenter study conducted in 32 ICUs in France, Belgium and Switzerland. Maternal management as well as maternal and neonatal outcomes were reported.

Results: Among the 187 pregnant women with COVID-19 (33 ± 6 years old and 28 ± 7 weeks' gestation), 76 (41%) were obese, 12 (6%) had diabetes mellitus and 66 (35%) had pregnancy-related complications. Standard oxygenation, high-flow nasal oxygen therapy (HFNO) and non-invasive ventilation (NIV) were used as the only oxygenation technique in 41 (22%), 55 (29%) and 18 (10%) patients, respectively, and 73 (39%) were intubated. Overall, 72 (39%) patients required several oxygenation techniques and 15 (8%) required venovenous extracorporeal membrane oxygenation. Corticosteroids and tocilizumab were administered in 157 (84%) and 25 (13%) patients, respectively. Awake prone positioning or prone positioning was performed in 49 (26%) patients. In multivariate analysis, risk factors for intubation were obesity (cause-specific hazard ratio (CSH) 2.00, 95% CI (1.05-3.80), p = 0.03), term of pregnancy (CSH 1.07, 95% CI (1.02-1.10), per + 1 week gestation, p = 0.01), extent of computed tomography (CT) scan abnormalities > 50% (CSH 2.69, 95% CI (1.30-5.60), p < 0.01) and NIV use (CSH 2.06, 95% CI (1.09-3.90), p = 0.03). Delivery was required during ICU stay in 70 (37%) patients, mainly due to maternal respiratory worsening, and improved the driving pressure and oxygenation. Maternal and fetal/neonatal mortality rates were 1% and 4%, respectively. The rate of maternal and/or neonatal complications increased with the invasiveness of maternal respiratory support.

Conclusion: In ICU, corticosteroids, tocilizumab and prone positioning were used in few pregnant women with COVID-19. Over a third of patients were intubated and delivery improved the driving pressure.

Keywords: Acute respiratory distress syndrome; COVID-19; Mechanical ventilation; Neonates; Oxygenation; Pregnancy; Prognosis; Prone positioning.

Publication types

Multicenter Study

MeSH terms

Adult
COVID-19* / complications
COVID-19* / therapy
Female
Humans
Infant, Newborn
Intensive Care Units
Pregnancy
Pregnancy Complications, Infectious* / epidemiology
Pregnancy Complications, Infectious* / therapy
Pregnant Women
SARS-CoV-2