Study finds hospitalized obstetric patients with cardiovascular disease and COVID-19 are more symptomatic

In a recent study published in PLoS ONE, researchers evaluated the impact of cardiovascular disease (CVD) on the prognosis of maternal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections.

Background

Maternal deaths are sensitive markers of care due to the multiple associated social and economic effects. CVD is a leading indirect cause of maternal deaths globally, and maternal deaths have reportedly increased considerably in the coronavirus disease 2019 (COVID-19) scenario. Studies have documented that cardiovascular diseases enhance the risk of severe COVID-19; however, data on the impact of CVD among birthing and postnatal women and COVID-19 prognosis are limited.

About the study

In the present study, researchers investigated the influence of CVD on the prognosis of maternal COVID-19.

The health ministry’s Sistema de Vigilaˆncia Epidemiolo´gica de Gripe (SIVEP-Gripe) anonymized database was searched on 5 May 2021 for COVID-19 cases documented between week 8 of the pandemic in 2020 (COVID-19 initiation among Brazilians) and week 15 of the following year (between 16 February 2020 and 17 April 2021).

The study comprised expecting and postnatal women, aged between 10 years and 55 years, with COVID-19-associated hospitalizations, and data on their cardiovascular disease status were obtained. Confirmed COVID-19 cases included individuals with SARS-CoV-2-positive laboratory reports, [polymerase chain reaction (PCR), SARS-CoV-2 antigen testing or serological testing), individuals for whom COVID-19 was highly suspected, and individuals with compatible clinic patients who contacted a COVID-19 case.

CVD cases, excluding those caused by nephrological and neurological causes, were considered, based on which the participants were allocated to the cardiovascular disease and non-cardiovascular disease groups. Variables evaluated included the symptom onset date, age, ethnicity, educational level, pregnancy period, risk factors, comorbidities, COVID-19 symptoms, intensive care unit (ICU) admissions, orotracheal intubation, ventilation support, and COVID-19 outcomes.

Comorbidities such as hepatic illness, hemopathy, diabetes, asthma, pneumopathy, neuropathy, nephropathy, obesity, and immunodepression were evaluated. The team performed logistic regression modeling and determined the odds ratios (OR). Propensity score matching was performed using the inverse probability of treatment weighting method to create balanced study groups.

Results

A total of 1,876,953 COVID-19 cases were reported, including 3,562.0 confirmed COVID-19 cases among expecting and postnatal women, among which 17% (n=602) women suffered from cardiovascular disease. In comparison to non-CVD patients, CVD patients were older (35 years versus 30 years) with a greater incidence of obesity (23% versus 9.0%) and diabetes (34% versus 11%).

Systemic symptoms and systemic COVID-19 symptoms such as fever (62% versus 56%), cough (75% versus 66%), ageusia (26% versus 18%), and anosmia (26% versus 19%) showed greater prevalence among CVD patients. In addition, CVD patients showed greater risks of dyspnea (OR 1.6), respiratory discomfort (OR 1.3), and oxygen saturation <95.0% (OR 1.6).

A 22.0% greater risk of ICU admissions was observed among CDV patients (OR 1.2), and the risk was greater during the first trimester (OR 1.9) and second trimester (OR 1.3) of pregnancy and the puerperium (OR 1.3). CVD presence increased the risk of mechanical ventilation and orotracheal intubation requirements during the final trimester of pregnancy (OR 1.3).

CVD patients had greater mortality rates (19% versus 14%), and a 32% greater risk of mortality (OR 1.3), and the risk of death was greater during the second trimester (OR 1.9) and third trimester (OR 1.3) of pregnancy, and during the puerperium period (OR 1.3). The proportion of deaths among CVD patients showed a rising trend from August 2020 onward, stabilizing at greater levels during March 2021 and April of the same year.

The absolute COVID-19 case counts elevated among individuals with and without cardiovascular disease between March and May of 2020, showing elevated levels till July, followed by a drop from August to October followed by a subsequent increase till March of 2021. Considering the initial COVID-19 period between March and October of 2020, mean COVID-19 growth rates of 11% and 23% were observed for CVD patients and non-CVD patients, respectively.

During the subsequent COVID-19 wave, between October of 2020 and April of the following year, the corresponding mean COVID-19 growth rates were 37.0% and 30.0%, respectively. The findings indicated that during the subsequent COVID-19 wave, SARS-CoV-2 transmission was high among cardiovascular and non-cardiovascular patients compared to the initial COVID-19 wave and, particularly, SARS-CoV-2 spread more aggressively among CVD patients, for whom the contamination rates were greater.

Conclusion

Overall, the study findings showed that cardiovascular disease worsened the prognosis of maternal SARS-CoV-2 infections. Obstetric and hospitalized females with cardiovascular disease and SARS-CoV-2 infections presented with more symptoms and required ICU admission and mechanical ventilation. Additionally, CVD patients infected with SARS-CoV-2 had greater mortality rates than non-CVD patients. However, further research is required to identify key risk factors, analyze CVD etiology independently, enable the provision of improved care services, and reduce maternal deaths.