Top 5 Takeaways

1. Increased Risk for Stillbirth: Women with COVID-19 at delivery hospitalization had a higher risk of stillbirth compared to those without COVID-19 (adjusted relative risk [aRR] = 1.90).
2. Impact of Delta Variant: The association between COVID-19 and stillbirth was stronger during the Delta variant predominance period (aRR = 4.04) compared to the pre-Delta period (aRR = 1.47).
3. Underlying Medical Conditions: Conditions such as chronic hypertension and multiple-gestation pregnancy were associated with higher prevalence of stillbirth among deliveries with COVID-19.
4. Importance of Prevention: Implementing COVID-19 prevention strategies, including vaccination before or during pregnancy, is critical to reduce the impact of COVID-19 on stillbirths.
5. Data Limitations: The study’s reliance on administrative data and lack of information on vaccination status are notable limitations.

Original Article Author and Citation

Corresponding Author

Carla L. DeSisto, eocevent397@cdc.gov

Suggested Citation

DeSisto CL, Wallace B, Simeone RM, et al. Risk for Stillbirth Among Women With and Without COVID-19 at Delivery Hospitalization — United States, March 2020–September 2021. MMWR Morb Mortal Wkly Rep 2021;70:1640–1645. DOI: http://dx.doi.org/10.15585/mmwr.mm7047e1

Summary

This report examines the risk of stillbirth among women with and without COVID-19 at delivery hospitalization in the United States from March 2020 to September 2021. The study found that women with COVID-19 had a higher risk of stillbirth, particularly during the Delta variant predominance period. The findings highlight the importance of COVID-19 prevention strategies, including vaccination, to mitigate the risk of stillbirth.

Methods

The study used data from the Premier Healthcare Database Special COVID-19 Release (PHD-SR) to identify delivery hospitalizations and stillbirths using ICD-10-CM codes. The analysis included deliveries with discharge dates from March 2020 to September 2021. Poisson regression models were used to calculate relative risks for stillbirth among deliveries with COVID-19 versus those without, adjusting for within-hospital and within-woman correlation.

Discussion

The analysis revealed that COVID-19 at delivery hospitalization is associated with an increased risk of stillbirth, with a stronger association during the Delta variant period. The study suggests that placental hypoperfusion and inflammation due to maternal COVID-19 infection might explain this increased risk. The findings underscore the need for further research on the biological mechanisms and the impact of maternal complications from COVID-19 on stillbirth risk.

Conclusion

The study adds to the growing evidence of an association between COVID-19 in pregnancy and stillbirth, emphasizing the importance of COVID-19 prevention strategies, including vaccination, to reduce the risk. Further research is needed to confirm these findings and to understand the biological mechanisms and the role of maternal risk factors in stillbirth associated with COVID-19.

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