Epidemiologist Optum Epidemiology Boston, United States
Background: The SARS-CoV-2 pandemic may have prompted people to alter a wide range of their health and lifestyle behaviors, including decisions relating to pregnancy and prenatal care. These alterations may have been further modified by contracting COVID-19 prior to or during pregnancy.
Objectives: To describe the occurrence of pregnancy and pregnancy outcomes from March 2020 through February 2021 relative to previous years, and pregnancy outcomes among women with a COVID-19 diagnosis before or during the first trimester of pregnancy.
Methods: Pregnancies beginning January 2016 through February 2021 were identified as part of the Optum Dynamic Assessment of Pregnancies and Infants (DAPI) process. DAPI identifies the majority of pregnancies through use of ICD-10 Z3A codes, which provide gestational age relative to the service date, or codes relating to pregnancy/infant outcomes. In addition to describing pregnancies by year, two 12-month time periods were established to describe pregnancies before and during COVID-19: beginning March 2018 [M18] and March 2020 [M20]. Diagnosis of COVID-19 was identified by the presence of ICD-10 U07.1. Pregnancy characteristics and outcomes were identified through a combination of diagnosis and procedure codes. Outcome analyses were restricted to pregnancies with an observed outcome.
Results: On average, during 2016-2019 there were 200,108 pregnancies per year and 16,676 per month identified by DAPI. The number of pregnancies observed in 2020 (N=181,203) and 2021 (176,089) was lower than previous years; the number per 1,000 women in the Optum Research Database was similar, with 56.6 in 2016 to 55.0 in 2021. Among the 181,263 pregnancies beginning between March 2020 and February 2021 [M20], there were 6,332 (3.5%) pregnancies with a COVID-19 diagnosis prior to or during the first trimester. Among pregnancies identified during the M18 time period, 75.7% were livebirths and 24.3% were pregnancy losses. Further, in M20, 75.8% were live births and 24.2% were pregnancy losses. Among pregnancies in M20 with a COVID-19 diagnosis before or during the first trimester, pregnancy loss was slightly higher (27.9%).
Conclusions: Observed pregnancies per 1,000 women remained stable in the DAPI database during the pandemic. A COVID-19 diagnosis did not appear to have a substantial effect on pregnancy outcomes though further exploration is warranted.
