In-Hospital Mortality in a Cohort of Hospitalized Pregnant and Nonpregnant Patients With COVID-19
Authors: Beth L. Pineles, Anthony D. Harris
Journal: Annals of Internal Medicine (2021)

LettersDecember 2021In-Hospital Mortality in a Cohort of Hospitalized Pregnant and Nonpregnant Patients With COVID-19FREEBeth L. Pineles, MD, PhD, Anthony D. Harris, MD, MPHBeth L. Pineles, MD, PhDMcGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TexasSearch for more papers by this author, Anthony D. Harris, MD, MPHThe University of Maryland School of Medicine, Baltimore, MarylandSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L21-0634 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE: Dr. Prefumo is correct that the severity of disease is not completely accounted for and is difficult to measure in an administrative data set. We welcome theories about the cause of the difference in in-hospital mortality between the groups in our brief research report. It is certainly likely that severity of disease as well as differential treatment of pregnant women may have contributed to this difference in our study.Because different Spo2 thresholds are used for pregnant patients, we did not choose supplemental oxygen as a grouping variable. However, among patients who received mechanical ventilation—which itself is a strong marker of severity of illness—nonpregnant women were more likely to die (31.4%) than pregnant women (8.6%) despite no difference in the proportion of mechanically ventilated patients between groups. Given the invasive nature of mechanical ventilation and frequent need for sedation and paralysis in this young group of patients, our experience is that physicians are reluctant to place pregnant patients on mechanical ventilation despite the need for higher oxygenation thresholds (that is, an Spo2 of 95% for pregnant women versus 92% for nonpregnant women). We thus do not believe that a less severe spectrum of disease and prioritization of interventions in pregnant women completely explain the better outcomes observed in pregnant women in our study.In response to Dr. Pagliery's comment, the differences in age and comorbidities were statistically significant. Because of the small number of events, we did not adjust for these confounders. However, we plan to provide an adjusted analysis in a future, longer publication. Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAffiliations: McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TexasThe University of Maryland School of Medicine, Baltimore, MarylandDisclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M21-0974. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoIn-Hospital Mortality in a Cohort of Hospitalized Pregnant and Nonpregnant Patients With COVID-19 Beth L. Pineles , Katherine E. Goodman , Lisa Pineles , Lyndsay M. O’Hara , Gita Nadimpalli , Laurence S. Magder , Jonathan D. Baghdadi , Jacqueline G. Parchem , and Anthony D. Harris In-Hospital Mortality in a Cohort of Hospitalized Pregnant and Nonpregnant Patients With COVID-19 José H. Pagliery In-Hospital Mortality in a Cohort of Hospitalized Pregnant and Nonpregnant Patients With COVID-19 Federico Prefumo Metrics Cited byClinical Manifestation and Characteristics of COVID-19 in Pregnants: A Retrospective, Single-Center StudyComparison of in-hospital mortality of COVID-19 between pregnant and non-pregnant women infected with SARS-CoV-2; a historical cohort study December 2021Volume 174, Issue 12Page: 1779-1780KeywordsCOVID-19Cohort studiesEpidemiologyIntensive care unitsInterquartile rangeMortalityPatientsPregnancyPrevention, policy, and public healthViral pneumonia ePublished: 21 December 2021 Issue Published: December 2021 Copyright & PermissionsCopyright © 2021 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...