Outcomes of pregnant ICU patients with severe COVID-19 pneumonia in Qatar during the three waves of the COVID-19 pandemic: A retrospective cohort study.

Abstract

Introduction: Pregnant women are considered a high-risk group for COVID-19 infection/pneumonia as they are known to be more vulnerable to viral infections. They require close monitoring and appropriate timely intervention to minimize the impact on both the mother and the fetus. Although the more prevalent Omicron variant led to fewer severe infections and fewer intensive care unit (ICU) admissions globally during the third wave, the effect on pregnant women and pregnancy outcomes was unknown. The vaccination campaign was thoroughly established by the third wave of the pandemic in Qatar. This retrospective descriptive cohort study investigates the characteristics, hospital stay, interventions, vaccination status, and fetal and maternal outcomes of patients admitted to the ICU with severe COVID-19 pneumonia during each of the three COVID-19 waves in Qatar.

Methods: The inclusion criteria were all pregnant patients with a positive polymerase chain reaction antigen test result and/or defined radiological changes at the time of admission that subsequently required admission to the ICU for 24 hours or more. Data were collected from the medical records and chart reviews of patients admitted to Hamad Medical Corporation with COVID-19 pneumonia from March 1, 2020 to February 28, 2022.

Results: The study included a total of 54 pregnant women. In contrast, during the third wave, the number of patients admitted to the ICU was significantly less than in the first wave. The mean gestational age at presentation for each of the three waves was 213.5, 212, and 245 days, respectively. No pregnant women were vaccinated during the first two waves. However, during the third wave, 90.9% of patients admitted to the ICU were vaccinated. The average length of stay in hospital was (mean ± standard deviation) 22.0 ± 27.6, 15.5 ± 7.8, and 5.0 ± 6.3 days for each of the waves, respectively, and the average length of ICU stay was 13.4 ± 20.9, 6.3 ± 5.5, and 3 ± 2.5 days, respectively. The most common chest X-ray finding on admission was bilateral infiltrates. During the third wave, only one patient required a high-flow nasal cannula. As the severity of the disease increased, the patients received more invasive respiratory support and had a higher likelihood of a preterm delivery. Vaccination status correlated with a significantly higher birth weight (mean weight 3.14 kg). However, it was not associated with better maternal outcome.

Conclusion: This extension study of the COVID-19 patients admitted to the ICU in Qatar during all three waves suggests that those admitted to the ICU with COVID-19 pneumonia are more likely to require close monitoring and appropriate interventions to minimize adverse outcomes for both the mother and the fetus. Our data may suggest that vaccination in these patients may contribute to reducing the use of respiratory support modalities for those admitted to the ICU and shortening the length of hospital stay. Overall, there was no statistical significance between vaccination and maternal outcome.