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Am J Perinatol 2022; 39(09): 0909-0914
DOI: 10.1055/s-0041-1740017
SMFM Fellowship Series Article

Comparing Two Testing Strategies: Universal versus Symptomatic SARS-CoV-2 Testing in Obstetric Patients

Oluyemi A. Aderibigbe
1   Division of Maternal-Fetal Medicine, Department of Reproductive Biology, MetroHealth, Case Western Reserve University, Cleveland, Ohio
2   Division of Maternal-Fetal Medicine, Department of Reproductive Biology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
,
Justin R. Lappen
2   Division of Maternal-Fetal Medicine, Department of Reproductive Biology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
3   Division of Maternal-Fetal Medicine, Department of Reproductive Biology, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio
,
Megan Albertini
2   Division of Maternal-Fetal Medicine, Department of Reproductive Biology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
,
Kelly S. Gibson
1   Division of Maternal-Fetal Medicine, Department of Reproductive Biology, MetroHealth, Case Western Reserve University, Cleveland, Ohio
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Abstract

Objective To compare universal severe acute respiratory syndrome coronvirus-2 (SARS-CoV-2) testing to symptomatic testing at two large academic centers.

Study Design We performed a retrospective cohort study comparing the approach to testing at two academic centers in Northeast Ohio. The study period started with the inception of symptomatic testing for SARS-CoV-2 at both institutions in March 2020. Women younger than 18 years were excluded. The primary outcome was the SARS-CoV-2 positivity rate in symptomatic pregnant patients at both institutions. Our coprimary outcome was the additional positivity rate obtained from universal testing at the University Hospitals. The secondary outcome of interest was the percentage of SARS-CoV-2 screen positive mothers with screen positive neonates. Data were analyzed using Mann–Whitney U test for continuous variables with chi-square and Fisher's exact tests for proportions.

Results During the study period, 144 pregnant women with symptoms of coronavirus disease 2019 (COVID-19) were tested at MetroHealth of which 27 resulted as positive for SARS-CoV-2 (18.7% positivity rate). University Hospitals tested 392 pregnant women with symptoms of COVID-19 of which 67 resulted as positive for SARS-CoV-2 (positivity rate 17.0%). In the universal testing program at University Hospitals, an additional 2,870 tests were performed on asymptomatic pregnant women of which 30 were positive for SARS-CoV-2 (1.0% positivity rate).There were no SARS-CoV-2 positive infants in our cohort, and all cases of maternal critical illness occurred in symptomatic patients.

Conclusion Universal and symptomatic testing approaches demonstrated similar clinical performance within a single geographic region in obstetric patients.

Key Points

  • There is a lack of data to recommend an optimal approach to SARS-CoV-2 testing in obstetric patients.

  • Universal testing detected few additional cases of SARS-CoV-2.

  • Maternal and neonatal outcomes were unaffected by testing strategy.

Keywords

SARS-CoV-2 - COVID-19 testing - pregnancy - universal testing - symptomatic testing


Publication History

Received: 17 March 2021

Accepted: 04 October 2021

Article published online:
28 November 2021

© 2021. Thieme. All rights reserved.

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  • References

  • 1 Johns Hopkins University of Medicine Coronavirus Resource Center. Accessed March 9, 2021 at: https://coronavirus.jhu.edu/
    PubMed
  • 2 Center for Disease Control and Prevention COVID Data Tracker. Accessed March 9, 2021 at: https://covid.cdc.gov/covid-data-tracker/#pregnant-population
    PubMed
  • 3 Furukawa NW, Brooks JT, Sobel J. Evidence supporting transmission of severe acute respiratory syndrome coronavirus 2 while presymptomatic or asymptomatic. Emerg Infect Dis 2020; 26 (07) e201595
    CrossrefPubMedGoogle Scholar
  • 4 Byambasuren O, Cardona M, Bell K, Clark J, McLaws M-L, Glasziou P. Estimating the extent of asymptomatic COVID-19 and its potential for community transmission: systematic review and meta-analysis. J Assoc Med Microbiol Infect Dis Can 2020; 5 (04) 223-234
    PubMedGoogle Scholar
  • 5 Sutton D, Fuchs K, D'Alton M, Goffman D. Universal screening for SARS-CoV-2 in women admitted for delivery. N Engl J Med 2020; 382 (22) 2163-2164
    CrossrefPubMedGoogle Scholar
  • 6 Naqvi M, Burwick RM, Ozimek JA, Greene NH, Kilpatrick SJ, Wong MS. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) universal testing experience on a Los Angeles labor and delivery unit. Obstet Gynecol 2020; 136 (02) 235-236
    CrossrefPubMedGoogle Scholar
  • 7 Miller ES, Grobman WA, Sakowicz A, Rosati J, Peaceman AM. Clinical implications of universal severe acute respiratory syndrome coronavirus 2, SARS CoV-2 testing in pregnancy. Obstet Gynecol 2020; 136 (02) 232-234
    CrossrefPubMedGoogle Scholar
  • 8 Bianco A, Buckley AB, Overbey J. et al. Testing of patients and support persons for coronavirus disease 2019 (COVID-19) infection before scheduled deliveries. Obstet Gynecol 2020; 136 (02) 283-287
    CrossrefPubMedGoogle Scholar
  • 9 Pluym ID, Rao R, Ballas J. et al. Obstetrical unit response to the COVID-19 pandemic: OUR study. Am J Perinatol 2020; 37 (13) 1301-1309
    Article in Thieme ConnectPubMedGoogle Scholar
  • 10 Johnson JD, Melvin E, Srinivas SK. et al. COVID-19 testing, personal protective equipment, and staffing strategies vary at obstetrics centers across the country. Am J Perinatol 2020; 37 (14) 1482-1484
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 Yanes-Lane M, Winters N, Fregonese F. et al. Proportion of asymptomatic infection among COVID-19 positive persons and their transmission potential: a systematic review and meta-analysis. PLoS One 2020; 15 (11) e0241536
    CrossrefPubMedGoogle Scholar
  • 12 Center for Disease Control and Prevention COVID Data Tracker. Accessed March 9, 2021 at: https://covid.cdc.gov/covid-data-tracker/#cases_casesper100klast7days
    PubMed
  • 13 Wang D, Hu B, Hu C. et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 2020; 323 (11) 1061-1069
    CrossrefPubMedGoogle Scholar
  • 14 Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA 2020; 323 (13) 1239-1242
    CrossrefPubMedGoogle Scholar
  • 15 Delahoy MJ, Whitaker M, O'Halloran A. et al; COVID-NET Surveillance Team. Characteristics and maternal and birth outcomes of hospitalized pregnant women with laboratory-confirmed COVID-19 - COVID-NET, 13 states, March 1-August 22, 2020. MMWR Morb Mortal Wkly Rep 2020; 69 (38) 1347-1354
    CrossrefPubMedGoogle Scholar
  • 16 Jering KS, Claggett BL, Cunningham JW. et al. Clinical characteristics and outcomes of hospitalized women giving birth with and without COVID-19. JAMA Intern Med 2021; 181 (05) 714-717
    CrossrefPubMedGoogle Scholar
  • 17 American College of Obstetricians and Gynecologists Practice Advisory. Novel Coronavirus 2019 (COVID-19). November 2020
    PubMedGoogle Scholar
  • 18 The Society for Maternal-Fetal Medicine (SMFM); Dotters-Katz S, Hughes BL, Miller ES et al. Coronavirus (COVID-19) and Pregnancy: What Maternal-Fetal Sub Specialists Need to Know. November 23 2020
    PubMedGoogle Scholar
  • 19 Kotlyar AM, Grechukhina O, Chen A. et al. Vertical transmission of coronavirus disease 2019: a systematic review and meta-analysis. Am J Obstet Gynecol 2021; 224 (01) 35-53.e3
    CrossrefPubMedGoogle Scholar
  • 20 Zambrano LD, Ellington S, Strid P. et al; CDC COVID-19 Response Pregnancy and Infant Linked Outcomes Team. Update: characteristics of symptomatic women of reproductive age with laboratory-confirmed SARS-CoV-2 infection by pregnancy status - United States, January 22-October 3, 2020. MMWR Morb Mortal Wkly Rep 2020; 69 (44) 1641-1647
    CrossrefPubMedGoogle Scholar
  • 21 Savitsky LM, Albright CM. Preventing COVID-19 transmission on labor and delivery: a decision analysis. Am J Perinatol 2020; 37 (10) 1031-1037
    Article in Thieme ConnectPubMedGoogle Scholar
  • 22 Mei-Dan E, Satkunaratnam A, Cahan T, Leung M, Katz K, Aviram A. Questionnaire-based vs universal PCR testing for SARS-CoV-2 in women admitted for delivery. Birth 2021; 48 (01) 96-103
    CrossrefPubMedGoogle Scholar
  • 23 Ohio Department of health. Accessed March 9, 2021 at: https://coronavirus.ohio.gov/wps/portal/gov/covid-19/dashboards/key-metrics/testing
    PubMed
  • 24 Ellington S, Strid P, Tong VT. et al. Characteristics of women of reproductive age with laboratory-confirmed SARS-CoV-2 infection by pregnancy status - United States, January 22-June 7, 2020. MMWR Morb Mortal Wkly Rep 2020; 69 (25) 769-775
    CrossrefPubMedGoogle Scholar
  • 25 London V, McLaren Jr R, Atallah F. et al. The relationship between status at presentation and outcomes among pregnant women with COVID-19. Am J Perinatol 2020; 37 (10) 991-994
    Article in Thieme ConnectPubMedGoogle Scholar
  • 26 Price-Haywood EG, Burton J, Fort D, Seoane L. Hospitalization and mortality among black patients and white patients with Covid-19. N Engl J Med 2020; 382 (26) 2534-2543
    CrossrefPubMedGoogle Scholar
  • 27 Berchick ER, Barnett JC, Upton RD. Current Population Reports, P60–267(RV), Health Insurance Coverage in the United States: 2018. Washington, DC: U.S. Government Printing Office; 2019
    Google Scholar
  • 28 Center for Disease Control and Prevention. Accessed March 9, 2021 at: https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/race-ethnicity.html#fn5
    PubMed
  • 29 Accessed March 9, 2021 at: https://www.cleveland.com/coronavirus/2020/11/contact-tracing-shows-cleveland-health-care-workers-are-contracting-covid-19-outside-of-work.html
    PubMed