{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T20:12:45Z","timestamp":1791576765617,"version":"4.3.4"},"reference-count":35,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2021,11,30]],"date-time":"2021-11-30T00:00:00Z","timestamp":1638230400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosmedicine.org"],"crossmark-restriction":false},"short-container-title":["PLoS Med"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>To the best of our knowledge, no study has exhaustively evaluated the association between maternal morbidities and Coronavirus Disease 2019 (COVID-19) during the first wave of the pandemic in pregnant women. We investigated, in natural conceptions and assisted reproductive technique (ART) pregnancies, whether maternal morbidities were more frequent in pregnant women with COVID-19 diagnosis compared to pregnant women without COVID-19 diagnosis during the first wave of the COVID-19 pandemic.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods and findings<\/jats:title>\n<jats:p>We conducted a retrospective analysis of prospectively collected data in a national cohort of all hospitalizations for births \u226522 weeks of gestation in France from January to June 2020 using the French national hospitalization database (PMSI). Pregnant women with COVID-19 were identified if they had been recorded in the database using the ICD-10 (International Classification of Disease) code for presence of a hospitalization for COVID-19. A total of 244,645 births were included, of which 874 (0.36%) in the COVID-19 group. Maternal morbidities and adverse obstetrical outcomes among those with or without COVID-19 were analyzed with a multivariable logistic regression model adjusted on patient characteristics. Among pregnant women, older age (31.1 (\u00b15.9) years old versus 30.5 (\u00b15.4) years old, respectively, <jats:italic>p &lt;<\/jats:italic> 0.001), obesity (0.7% versus 0.3%, respectively, <jats:italic>p &lt;<\/jats:italic> 0.001), multiple pregnancy (0.7% versus 0.4%, respectively, <jats:italic>p &lt;<\/jats:italic> 0.001), and history of hypertension (0.9% versus 0.3%, respectively, <jats:italic>p &lt;<\/jats:italic> 0.001) were more frequent with COVID-19 diagnosis. Active smoking (0.2% versus 0.4%, respectively, <jats:italic>p &lt;<\/jats:italic> 0.001) and primiparity (0.3% versus 0.4%, respectively, <jats:italic>p &lt;<\/jats:italic> 0.03) were less frequent with COVID-19 diagnosis. Frequency of ART conception was not different between those with and without COVID-19 diagnosis (<jats:italic>p<\/jats:italic> = 0.28).<\/jats:p>\n<jats:p>When compared to the non-COVID-19 group, women in the COVID-19 group had a higher frequency of admission to ICU (5.9% versus 0.1%, <jats:italic>p<\/jats:italic> &lt; 0.001), mortality (0.2% versus 0.005%, <jats:italic>p &lt;<\/jats:italic> 0.001), preeclampsia\/eclampsia (4.8% versus 2.2%, <jats:italic>p &lt;<\/jats:italic> 0.001), gestational hypertension (2.3% versus 1.3%, <jats:italic>p<\/jats:italic> &lt; 0.03), postpartum hemorrhage (10.0% versus 5.7%, <jats:italic>p &lt;<\/jats:italic> 0.001), preterm birth at &lt;37 weeks of gestation (16.7% versus 7.1%, <jats:italic>p &lt;<\/jats:italic> 0.001), &lt;32 weeks of gestation (2.2% versus 0.8%, <jats:italic>p &lt;<\/jats:italic> 0.001), &lt;28 weeks of gestation (2.4% versus 0.8%, <jats:italic>p &lt;<\/jats:italic> 0.001), induced preterm birth (5.4% versus 1.4%, <jats:italic>p &lt;<\/jats:italic> 0.001), spontaneous preterm birth (11.3% versus 5.7%, <jats:italic>p &lt;<\/jats:italic> 0.001), fetal distress (33.0% versus 26.0%, <jats:italic>p &lt;<\/jats:italic> 0.001), and cesarean section (33.0% versus 20.2%, <jats:italic>p &lt;<\/jats:italic> 0.001). Rates of pregnancy terminations \u226522 weeks of gestation, stillbirths, gestational diabetes, placenta praevia, and placenta abruption were not significantly different between the COVID-19 and non-COVID-19 groups. The number of venous thromboembolic events was too low to perform statistical analysis. A limitation of this study relies in the possibility that asymptomatic infected women were not systematically detected.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>We observed an increased frequency of pregnant women with maternal morbidities and diagnosis of COVID-19 compared to pregnant women without COVID-19. It appears essential to be aware of this, notably in populations at known risk of developing a more severe form of infection or obstetrical morbidities and in order for obstetrical units to better inform pregnant women and provide the best care. Although causality cannot be determined from these associations, these results may be in line with recent recommendations in favor of vaccination for pregnant women.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pmed.1003857","type":"journal-article","created":{"date-parts":[[2021,11,30]],"date-time":"2021-11-30T18:43:50Z","timestamp":1638297830000},"page":"e1003857","update-policy":"https:\/\/doi.org\/10.1371\/journal.pmed.corrections_policy","source":"Crossref","is-referenced-by-count":75,"title":["Obstetrical outcomes and maternal morbidities associated with COVID-19 in pregnant women in France: A national retrospective cohort study"],"prefix":"10.1371","volume":"18","author":[{"given":"Sylvie","family":"Epelboin","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9416-5601","authenticated-orcid":true,"given":"Julie","family":"Labrosse","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9465-3488","authenticated-orcid":true,"given":"Jacques","family":"De Mouzon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9708-1710","authenticated-orcid":true,"given":"Patricia","family":"Fauque","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7837-094X","authenticated-orcid":true,"given":"Marie-Jos\u00e9","family":"Gervoise-Boyer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Levy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7044-6935","authenticated-orcid":true,"given":"Nathalie","family":"Sermondade","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laetitia","family":"Hesters","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marianne","family":"Berg\u00e8re","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire","family":"Devienne","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philippe","family":"Jonveaux","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2914-959X","authenticated-orcid":true,"given":"Jade","family":"Ghosn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabienne","family":"Pessione","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,11,30]]},"reference":[{"key":"pmed.1003857.ref001","author":"WHO"},{"issue":"2","key":"pmed.1003857.ref002","first-page":"145","article-title":"[The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China].","volume":"41","author":"Epidemiology Working Group for NCIP Epidemic Response, Chinese Center for Disease Control and Prevention","year":"2020","journal-title":"Zhonghua Liu Xing Bing Xue Za Zhi"},{"issue":"9","key":"pmed.1003857.ref003","doi-asserted-by":"crossref","first-page":"1511","DOI":"10.1002\/jmv.26035","article-title":"Increase in COVID-19 cases and case-fatality and case-recovery rates in Europe: A cross-temporal meta-analysis","volume":"92","author":"E Karadag","year":"2020","journal-title":"J Med Virol"},{"issue":"12","key":"pmed.1003857.ref004","doi-asserted-by":"crossref","first-page":"2282","DOI":"10.1002\/oby.23014","article-title":"Obesity Doubles Mortality in Patients Hospitalized for Severe Acute Respiratory Syndrome Coronavirus 2 in Paris Hospitals, France: A Cohort Study on 5,795 Patients","volume":"28","author":"S Czernichow","year":"2020","journal-title":"Obesity (Silver Spring)."},{"issue":"12","key":"pmed.1003857.ref005","doi-asserted-by":"crossref","first-page":"2265","DOI":"10.1002\/oby.23027","article-title":"COVID-19 and Obesity: The Intersection Between a Pandemic and an Epidemic in a Developing Country","volume":"28","author":"MJ Concepci\u00f3n-Zavaleta","year":"2020","journal-title":"Obesity (Silver Spring)."},{"issue":"4","key":"pmed.1003857.ref006","doi-asserted-by":"crossref","first-page":"2149","DOI":"10.1002\/jmv.26601","article-title":"Impact on disease mortality of clinical, biological, and virological characteristics at hospital admission and overtime in COVID-19 patients","volume":"93","author":"Y Yazdanpanah","year":"2021","journal-title":"J Med Virol"},{"issue":"2","key":"pmed.1003857.ref007","doi-asserted-by":"crossref","first-page":"100107","DOI":"10.1016\/j.ajogmf.2020.100107","article-title":"Outcome of coronavirus spectrum infections (SARS, MERS, COVID-19) during pregnancy: a systematic review and meta-analysis","volume":"2","author":"D Di Mascio","year":"2020","journal-title":"Am J Obstet Gynecol MFM"},{"issue":"10226","key":"pmed.1003857.ref008","doi-asserted-by":"crossref","first-page":"760","DOI":"10.1016\/S0140-6736(20)30365-2","article-title":"What are the risks of COVID-19 infection in pregnant women?","volume":"395","author":"J Qiao","year":"2020","journal-title":"Lancet"},{"issue":"2","key":"pmed.1003857.ref009","doi-asserted-by":"crossref","first-page":"194","DOI":"10.3390\/v12020194","article-title":"Potential Maternal and Infant Outcomes from Coronavirus 2019-nCoV (SARS-CoV-2) Infecting Pregnant Women: Lessons from SARS, MERS, and Other Human Coronavirus Infections","volume":"12","author":"DA Schwartz","year":"2020","journal-title":"Viruses."},{"issue":"10226","key":"pmed.1003857.ref010","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1016\/S0140-6736(20)30360-3","article-title":"Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records","volume":"395","author":"H Chen","year":"2020","journal-title":"Lancet"},{"issue":"5","key":"pmed.1003857.ref011","doi-asserted-by":"crossref","first-page":"510.e1","DOI":"10.1016\/j.ajog.2020.11.022","article-title":"Pregnant women with severe or critical coronavirus disease 2019 have increased composite morbidity compared with nonpregnant matched controls","volume":"224","author":"CA DeBolt","year":"2021","journal-title":"Am J Obstet Gynecol"},{"issue":"5","key":"pmed.1003857.ref012","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1016\/j.ajog.2020.02.017","article-title":"Coronavirus Disease 2019 (COVID-19) and pregnancy: what obstetricians need to know","volume":"222","author":"SA Rasmussen","year":"2020","journal-title":"Am J Obstet Gynecol"},{"key":"pmed.1003857.ref013","doi-asserted-by":"crossref","first-page":"m2107","DOI":"10.1136\/bmj.m2107","article-title":"Characteristics and outcomes of pregnant women admitted to hospital with confirmed SARS-CoV-2 infection in UK: national population based cohort study","volume":"369","author":"M Knight","year":"2020","journal-title":"BMJ"},{"key":"pmed.1003857.ref014","first-page":"370","article-title":"Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis","author":"J Allotey","year":"2020","journal-title":"BMJ"},{"issue":"3","key":"pmed.1003857.ref015","doi-asserted-by":"crossref","first-page":"e06393","DOI":"10.1016\/j.heliyon.2021.e06393","article-title":"Impact of SARS-CoV-2 on the clinical outcomes and placental pathology of pregnant women and their infants: A systematic review","volume":"7","author":"I Oltean","year":"2021","journal-title":"Heliyon"},{"key":"pmed.1003857.ref016","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1016\/j.ejogrb.2020.07.008","article-title":"Maternal COVID-19 infection, clinical characteristics, pregnancy, and neonatal outcome: A prospective cohort study.","volume":"252","author":"L Antoun","year":"2020","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"issue":"7","key":"pmed.1003857.ref017","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1001\/jama.2020.12746","article-title":"Change in the Incidence of Stillbirth and Preterm Delivery During the COVID-19 Pandemic.","volume":"324","author":"A Khalil","year":"2020","journal-title":"JAMA"},{"key":"pmed.1003857.ref018","article-title":"Is there a smoker\u2019s paradox in COVID-19?","author":"MS Usman","year":"2020","journal-title":"BMJ Evid Based Med"},{"key":"pmed.1003857.ref019","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1016\/j.ejogrb.2020.11.038","article-title":"Maternal and perinatal outcomes in pregnant women infected by SARS-CoV-2: A meta-analysis","volume":"256","author":"I Bellos","year":"2021","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"issue":"7","key":"pmed.1003857.ref020","doi-asserted-by":"crossref","first-page":"101826","DOI":"10.1016\/j.jogoh.2020.101826","article-title":"A snapshot of the Covid-19 pandemic among pregnant women in France.","volume":"49","author":"G Kayem","year":"2020","journal-title":"J Gynecol Obstet Hum Reprod"},{"issue":"1","key":"pmed.1003857.ref021","doi-asserted-by":"crossref","first-page":"18126","DOI":"10.1038\/s41598-020-75096-4","article-title":"Clinical manifestations and perinatal outcomes of pregnant women with COVID-19: a systematic review and meta-analysis.","volume":"10","author":"J Yee","year":"2020","journal-title":"Sci Rep."},{"key":"pmed.1003857.ref022","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1016\/j.ejogrb.2020.07.006","article-title":"COVID-19 in pregnant women: A systematic review and meta-analysis","volume":"252","author":"G Capobianco","year":"2020","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"issue":"9","key":"pmed.1003857.ref023","doi-asserted-by":"crossref","first-page":"912","DOI":"10.1515\/jpm-2020-0431","article-title":"Clinical manifestation, outcomes in pregnant women with COVID-19 and the possibility of vertical transmission: a systematic review of the current data","volume":"48","author":"Y Han","year":"2020","journal-title":"J Perinat Med."},{"issue":"1","key":"pmed.1003857.ref024","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1186\/s40001-020-00439-w","article-title":"The effect of coronavirus infection (SARS-CoV-2, MERS-CoV, and SARS-CoV) during pregnancy and the possibility of vertical maternal-fetal transmission: a systematic review and meta-analysis.","volume":"25","author":"K Diriba","year":"2020","journal-title":"Eur J Med Res"},{"issue":"4","key":"pmed.1003857.ref025","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1002\/uog.23619","article-title":"Pregnancy and neonatal outcomes of COVID-19: coreporting of common outcomes from PAN-COVID and AAP-SONPM registries","volume":"57","author":"E Mullins","year":"2021","journal-title":"Ultrasound Obstet Gynecol."},{"key":"pmed.1003857.ref026","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.ejogrb.2020.11.068","article-title":"Maternal, fetal and neonatal outcomes of large series of SARS-CoV-2 positive pregnancies in peripartum period: A single-center prospective comparative study","volume":"257","author":"N Hcini","year":"2021","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"issue":"6","key":"pmed.1003857.ref027","first-page":"334","article-title":"How to screen and diagnose deep venous thrombosis (DVT) in patients hospitalized for or suspected of COVID-19 infection, outside the intensive care units","volume":"45","author":"M Sebuhyan","year":"2020","journal-title":"J Med Vasc."},{"key":"pmed.1003857.ref028","article-title":"Venous thrombosis, thromboembolism, biomarkers of inflammation, and coagulation in coronavirus disease 2019","author":"V Thondapu","year":"2020","journal-title":"J Vasc Surg Venous Lymphat Disord"},{"issue":"3","key":"pmed.1003857.ref029","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1016\/j.rbmo.2020.06.013","article-title":"Assisted reproduction and thromboembolic risk in the COVID-19 pandemic","volume":"41","author":"F Fabregues","year":"2020","journal-title":"Reprod Biomed Online"},{"key":"pmed.1003857.ref030","unstructured":"The Moderna COVID-19 (mRNA-1273) vaccine: what you need to know. [cited 2021 Jun 4]. Available from: https:\/\/www.who.int\/news-room\/feature-stories\/detail\/the-moderna-covid-19-mrna-1273-vaccine-what-you-need-to-know."},{"issue":"11","key":"pmed.1003857.ref031","doi-asserted-by":"crossref","first-page":"1099","DOI":"10.1001\/jama.2021.1683","article-title":"Pregnancy, Postpartum Care, and COVID-19 Vaccination in 2021","volume":"325","author":"SA Rasmussen","year":"2021","journal-title":"JAMA"},{"key":"pmed.1003857.ref032","unstructured":"ASRM COVID-19 Task Force Issues Update No. 14 [Internet]. [cited 2021 Jun 4]. Available from: https:\/\/www.asrm.org\/news-and-publications\/news-and-research\/press-releases-and-bulletins\/asrm-covid-19-task-force-issues-update-no.-14new-page\/."},{"key":"pmed.1003857.ref033","unstructured":"Haute Autorit\u00e9 de Sant\u00e9\u2014Strat\u00e9gie de vaccination contre le Sars-Cov-2\u2014Actualisation des facteurs de risque de formes graves de la Covid-19 et des recommandations sur la strat\u00e9gie de priorisation des populations \u00e0 vacciner [Internet]. [cited 2021 Jun 4]. Available from: https:\/\/www.has-sante.fr\/jcms\/p_3240117\/fr\/strategie-de-vaccination-contre-le-sars-cov-2-actualisation-des-facteurs-de-risque-de-formes-graves-de-la-covid-19-et-des-recommandations-sur-la-strategie-de-priorisation-des-populations-a-vacciner."},{"key":"pmed.1003857.ref034","article-title":"COVID-19 vaccine response in pregnant and lactating women: a cohort study","author":"KJ Gray","year":"2021","journal-title":"medRxiv"},{"issue":"4","key":"pmed.1003857.ref035","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1038\/s41577-021-00525-y","article-title":"Are COVID-19 vaccines safe in pregnancy?","volume":"21","author":"V Male","year":"2021","journal-title":"Nat Rev Immunol"}],"container-title":["PLOS Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pmed.1003857","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,11,30]],"date-time":"2021-11-30T18:44:17Z","timestamp":1638297857000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pmed.1003857"}},"subtitle":[],"editor":[{"given":"Sarah J.","family":"Stock","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2021,11,30]]},"references-count":35,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2021,11,30]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pmed.1003857","relation":{},"ISSN":["1549-1676"],"issn-type":[{"value":"1549-1676","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11,30]]}}}