Skip to main content
SpringerLink
Log in

Cesarean Delivery Outcomes for Patients with Coronavirus Disease-2019 in the USA

  • Published:
Journal of Racial and Ethnic Health Disparities Aims and scope Submit manuscript

Abstract

Introduction

Coronavirus disease-2019 (COVID-19) may have increased morbidity and mortality in patients having Cesarean delivery (CD) in the USA.

Methods

We performed a retrospective cohort study of patients who had CD in 2020 using the national inpatient sample. After stratification by COVID-19 status, demographics, comorbidities, complications, mortality, and costs were compared.

Results

There were 31,444,222 hospitalizations in the USA in 2020 with a mortality rate of 2.8%. Among these, 1,453,945 patients had COVID-19 and mortality was 13.2%. There were 1,108,755 patients who had CD and 15,550 had COVID-19. Patients with COVID-19 more frequently had Medicaid and were Hispanic. Patients with COVID-19 had more comorbidities including chronic hypertension, diabetes mellitus, pre-eclampsia, and eclampsia. Mortality in CD patients with COVID-19 was 30 in 10,000 patients, while for non-COVID-19 patients, it was 1 in 10,000 patients, P < 0.001. The crude odds ratio for mortality in COVID-19 patients was 32.1 (95% confidence interval = 22.9 to 44.7), P < 0.001 and the adjusted odds ratio was 29.3 (95% confidence interval = 20.7 to 41.4), P < 0.001.

Conclusions

CD patients with COVID-19 had 30-fold higher mortality before widespread vaccination was available with Hispanic and Medicaid patients disproportionately impacted. Potential explanations for this disparity include reduced access to personal protective equipment (e.g., masks) and testing, as well as socio-economic factors. Further research is needed to understand the factors that contributed to disparities in infection and clinical outcomes among obstetric patients during the COVID-19 pandemic. In future pandemics, enhanced efforts will be needed to protect economically disadvantaged women who are pregnant.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Availability of Data and Material

The data used in the study are publicly available in the 2020 National Inpatient Sample. All necessary training must be completed before the dataset can be accessed.

Code Availability

The code used for the study is available from the first author Michael Mazzeffi upon request, he can be emailed at syy4wa@uvahealth.org.

References

  1. Korb D, Goffinet F, Seco A, Chevret S, Deneux-Tharaux C, Group ES. Risk of severe maternal morbidity associated with cesarean delivery and the role of maternal age: a population-based propensity score analysis. CMAJ. 2019;191:E352–60. https://doi.org/10.1503/cmaj.181067.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Lim MJ, Lakshminrusimha S, Hedriana H, Albertson T. Pregnancy and severe ARDS with COVID-19: epidemiology, diagnosis, outcomes and treatment. Semin Fetal Neonatal Med. 2023;28: 101426. https://doi.org/10.1016/j.siny.2023.101426.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Torres Acosta MA, Singer BD. Pathogenesis of COVID-19-induced ARDS: implications for an ageing population. Eur Respir J. 2020;56:2002049. https://doi.org/10.1183/13993003.02049-2020.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. LoMauro A, Aliverti A. Respiratory physiology of pregnancy: physiology masterclass. Breathe (Sheff). 2015;11:297–301. https://doi.org/10.1183/20734735.008615.

    Article  PubMed  Google Scholar 

  5. Kuriloff M, Patel E, Mueller A, Dada T, Duncan C, Arnolds D, Rana S. COVID-19 and obstetric outcomes: a single-center retrospective experience in a predominantly Black population. J Matern Fetal Neonatal Med. 2023;36:2196364. https://doi.org/10.1080/14767058.2023.2196364.

    Article  PubMed  Google Scholar 

  6. Molina RL, Tsai TC, Dai D, Soto M, Rosenthal N, Orav EJ, Figueroa JF. Comparison of pregnancy and birth outcomes before vs during the COVID-19 pandemic. JAMA Netw Open. 2022;5: e2226531. https://doi.org/10.1001/jamanetworkopen.2022.26531.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Epelboin S, Labrosse J, De Mouzon J, Fauque P, Gervoise-Boyer MJ, Levy R, Sermondade N, Hesters L, Bergere M, Devienne C, Jonveaux P, Ghosn J, Pessione F. Obstetrical outcomes and maternal morbidities associated with COVID-19 in pregnant women in France: a national retrospective cohort study. PLoS Med. 2021;18: e1003857. https://doi.org/10.1371/journal.pmed.1003857.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Lankford A, Berger J, Benjenk I, Jackson A, Ahmadzia H, Mazzeffi M. Outcomes of cesarean delivery in obstetric patients with SARS-CoV-2 infection. Int J Gynaecol Obstet. 2021;155:547–8. https://doi.org/10.1002/ijgo.13927.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Aydin Guzey N, Uyar TE. Evaluation of 254 cesarean sections with COVID-19 in terms of anesthesia and clinical course: 1-year experience. J Anesth. 2022;36:514–23. https://doi.org/10.1007/s00540-022-03086-z.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Wei SQ, Bilodeau-Bertrand M, Liu S, Auger N. The impact of COVID-19 on pregnancy outcomes: a systematic review and meta-analysis. CMAJ. 2021;193:E540–8. https://doi.org/10.1503/cmaj.202604.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Villar J, Ariff S, Gunier RB, Thiruvengadam R, Rauch S, Kholin A, Roggero P, Prefumo F, do Vale MS, Cardona-Perez JA, Maiz N, Cetin I, Savasi V, Deruelle P, Easter SR, Sichitiu J, Soto Conti CP, Ernawati E, Mhatre M, Teji JS, Liu B, Capelli C, Oberto M, Salazar L, Gravett MG, Cavoretto PI, Nachinab VB, Galadanci H, Oros D, Ayede AI, Sentilhes L, Bako B, Savorani M, Cena H, Garcia-May PK, Etuk S, Casale R, Abd-Elsalam S, Ikenoue S, Aminu MB, Vecciarelli C, Duro EA, Usman MA, John-Akinola Y, Nieto R, Ferrazi E, Bhutta ZA, Langer A, Kennedy SH, Papageorghiou AT. Maternal and neonatal morbidity and mortality among pregnant women with and without COVID-19 infection: the INTERCOVID multinational cohort study. JAMA Pediatr. 2021;175:817–26. https://doi.org/10.1001/jamapediatrics.2021.1050.

    Article  PubMed  Google Scholar 

  12. Razzaghi H, Meghani M, Pingali C, Crane B, Naleway A, Weintraub E, Kenigsberg TA, Lamias MJ, Irving SA, Kauffman TL, Vesco KK, Daley MF, DeSilva M, Donahue J, Getahun D, Glenn S, Hambidge SJ, Jackson L, Lipkind HS, Nelson J, Zerbo O, Oduyebo T, Singleton JA, Patel SA. COVID-19 vaccination coverage among pregnant women during pregnancy - eight integrated health care organizations. MMWR Morb Mortal Wkly Rep. 2021, 70:895–899. https://doi.org/10.15585/mmwr.mm7024e2

  13. Khera R, Krumholz HM. With great power comes great responsibility: big data research from the national inpatient sample. Circ Cardiovasc Qual Outcomes. 2017;10. https://doi.org/10.1161/CIRCOUTCOMES.117.003846.

  14. Smith LH, Dollinger CY, VanderWeele TJ, Wyszynski DF, Hernandez-Diaz S. Timing and severity of COVID-19 during pregnancy and risk of preterm birth in the International Registry of Coronavirus Exposure in Pregnancy. BMC Pregnancy Childbirth. 2022;22:775. https://doi.org/10.1186/s12884-022-05101-3.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Riley AR, Chen YH, Matthay EC, Glymour MM, Torres JM, Fernandez A, Bibbins-Domingo K. Excess mortality among Latino people in California during the COVID-19 pandemic. SSM Popul Health. 2021;15: 100860. https://doi.org/10.1016/j.ssmph.2021.100860.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Aburto JM, Tilstra AM, Floridi G, Dowd JB. Significant impacts of the COVID-19 pandemic on race/ethnic differences in US mortality. Proc Natl Acad Sci U S A. 2022;119: e2205813119. https://doi.org/10.1073/pnas.2205813119.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Williams MS, Cigaran E, Martinez S, Marino J, Barbero P, Myers AK, DiClemente RJ, Goris N, Gomez VC, Granville D, Guzman J, Harris YT, Kline M, Lesser ML, Makaryus AN, Murray LM, McFarlane SI, Patel VH, Polo J, Zeltser R, Pekmezaris R. COVID-19 stressors for Hispanic/Latino patients living with type 2 diabetes: a qualitative study. Front Clin Diabetes Healthc. 2023;4:1070547. https://doi.org/10.3389/fcdhc.2023.1070547.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Piedra LM, Howe MJK, Francis J, Montoya Y, Gutwein M. Latinos and the pandemic: results from the National Social Life, Health, and Aging Project-COVID-19 study. J Appl Gerontol. 2022;41:1465–72. https://doi.org/10.1177/07334648211066920.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Pedraza L, Villela R, Kamatgi V, Cocuzzo K, Correa R, Lisigurski MZ. The Impact of COVID-19 in the Latinx community. HCA Healthc J Med. 2022;3:97–104. https://doi.org/10.36518/2689-0216.1387.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Banaei M, Ghasemi V, Saei Ghare Naz M, Kiani Z, Rashidi-Fakari F, Banaei S, Mohammad Souri B, Rokni M. Obstetrics and neonatal outcomes in pregnant women with COVID-19: a systematic review. Iran J Public Health. 2020;49:38–47. https://doi.org/10.18502/ijph.v49iS1.3668.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Metz TD, Clifton RG, Hughes BL, Sandoval GJ, Grobman WA, Saade GR, Manuck TA, Longo M, Sowles A, Clark K, Simhan HN, Rouse DJ, Mendez-Figueroa H, Gyamfi-Bannerman C, Bailit JL, Costantine MM, Sehdev HM, Tita ATN, Macones GA, National Institute of Child H, Human Development Maternal-Fetal Medicine Units N. Association of SARS-CoV-2 infection with serious maternal morbidity and mortality from obstetric complications. JAMA. 2022;327:748–59. https://doi.org/10.1001/jama.2022.1190.

    Article  CAS  PubMed  Google Scholar 

  22. Lamarca B. Endothelial dysfunction. An important mediator in the pathophysiology of hypertension during pre-eclampsia. Minerva Ginecol. 2012;64:309–20.

    CAS  PubMed  PubMed Central  Google Scholar 

  23. Xu SW, Ilyas I, Weng JP. Endothelial dysfunction in COVID-19: an overview of evidence, biomarkers, mechanisms and potential therapies. Acta Pharmacol Sin. 2023;44:695–709. https://doi.org/10.1038/s41401-022-00998-0.

    Article  CAS  PubMed  Google Scholar 

  24. Sathiya R, Rajendran J, Sumathi S. COVID-19 and preeclampsia: overlapping features in pregnancy. Rambam Maimonides Med J. 2022;13:e0007. https://doi.org/10.5041/RMMJ.10464.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Polack FP, Thomas SJ, Kitchin N, Absalon J, Gurtman A, Lockhart S, Perez JL, Perez Marc G, Moreira ED, Zerbini C, Bailey R, Swanson KA, Roychoudhury S, Koury K, Li P, Kalina WV, Cooper D, Frenck RW Jr, Hammitt LL, Tureci O, Nell H, Schaefer A, Unal S, Tresnan DB, Mather S, Dormitzer PR, Sahin U, Jansen KU, Gruber WC, Group CCT. Safety and efficacy of the BNT162b2 mRNA Covid-19 vaccine. N Engl J Med. 2020;383:2603–15. https://doi.org/10.1056/NEJMoa2034577.

    Article  CAS  PubMed  Google Scholar 

  26. Pratama NR, Wafa IA, Budi DS, Putra M, Wardhana MP, Wungu CDK. mRNA Covid-19 vaccines in pregnancy: a systematic review. PLoS ONE. 2022;17: e0261350. https://doi.org/10.1371/journal.pone.0261350.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Karrow NA, Shandilya UK, Pelech S, Wagter-Lesperance L, McLeod D, Bridle B, Mallard BA. Maternal COVID-19 vaccination and its potential impact on fetal and neonatal development. Vaccines (Basel). 2021;9:1351. https://doi.org/10.3390/vaccines9111351.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

HCUP partners can be found via the following hyperlink: https://hcup-us.ahrq.gov/db/hcupdatapartners.jsp

Author information

Authors and Affiliations

  1. Department of Anesthesiology, University of Virginia Health, PO Box 800710, Charlottesville, VA, 22908, USA

    Michael Mazzeffi, Ashley Garneau, Jessica Sheeran, Amanda Kleiman, Sachin H. Mehta & Mohamed Tiouririne

  2. University of Virginia School of Medicine, Charlottesville, VA, USA

    David Miller

Authors
  1. Michael Mazzeffi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David Miller
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ashley Garneau
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jessica Sheeran
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Amanda Kleiman
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sachin H. Mehta
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Mohamed Tiouririne
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Michael Mazzeffi performed data collection and analysis. The first draft of the manuscript was written by Michael Mazzeffi and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Michael Mazzeffi.

Ethics declarations

Ethics Approval

Deemed to be unnecessary by institutional review board since the dataset is publicly available and de-identified.

Consent to Participate

Not-applicable since the study used a de-identified existing dataset.

Consent for Publication

The authors completed all necessary training for use of the National Inpatient Sample. They also completed the data use agreement.

Conflict of Interest

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mazzeffi, M., Miller, D., Garneau, A. et al. Cesarean Delivery Outcomes for Patients with Coronavirus Disease-2019 in the USA. J. Racial and Ethnic Health Disparities (2023). https://doi.org/10.1007/s40615-023-01857-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s40615-023-01857-2

Keywords

Search

Navigation