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Introduction The Coronavirus 2019 Disease (COVID‐19) pandemic reached the Nordic countries in March 2020. Public health interventions to limit viral transmission varied across different countries both in timing and in magnitude. Interventions indicated by an Oxford Stringency Index ≥50 were implemented early (March 13–17, 2020) in Denmark, Finland, Norway and Iceland, and on March 26, 2020 in Sweden. The aim of the current study was to assess the incidence of COVID‐19‐related admissions of pregnant women in the Nordic countries in relation to the different national public health strategies during the first year of the pandemic. Material and methods This is a meta‐analysis of population‐based cohort studies in the five Nordic countries with national or regional surveillance in the Nordic Obstetric Surveillance System (NOSS) collaboration: national data from Denmark, Finland, Iceland and Norway, and regional data covering 31% of births in Sweden. The source population consisted of women giving birth in the included areas March 1–December 31, 2020. Pregnant women with a positive SARS‐CoV‐2 PCR test ≤14 days before hospital admission were included, and admissions were stratified as either COVID‐19‐related or non‐COVID (other obstetric healthcare). Information about public health policies was retrieved retrospectively. Results In total, 392 382 maternities were considered. Of these, 600 women were diagnosed with SARS‐CoV‐2 infection and 137 (22.8%) were admitted for COVID‐19 symptoms. The pooled incidence of COVID‐19 admissions per 1000 maternities was 0.5 (95% confidence interval [CI] 0.2 to 1.2, I2 = 77.6, tau2 = 0.68, P = 0.0), ranging from no admissions in Iceland to 1.9 admissions in the Swedish regions. Interventions to restrict viral transmission were less stringent in Sweden than in the other Nordic countries. Conclusions There was a clear variation in pregnant women's risk of COVID‐19 admission across countries with similar healthcare systems but different public health interventions to limit viral transmission. The meta‐analysis indicates that early suppression policies protected pregnant women from severe COVID‐19 disease prior to the availability of individual protection with vaccines. The Nordic countries adopted different restriction policies to limit viral transmission in the beginning of the COVID‐19 pandemic in 2020. This meta‐analysis indicates that early suppression policies protected pregnant women from severe COVID‐19 disease prior to the availability of individual protection with vaccines.

Introduction The majority of data on COVID‐19 in pregnancy are not from sound population‐based active surveillance systems. Material and methods We conducted a multi‐national study of population‐based national or regional prospective cohorts using standardized definitions within the International Network of Obstetric Survey systems (INOSS). From a source population of women giving birth between March 1 and August 31, 2020, we included pregnant women admitted to hospital with a positive SARS‐CoV‐2 PCR test ≤7 days prior to or during admission and up to 2 days after birth. The admissions were further categorized as COVID‐19‐related or non‐COVID‐19‐related. The primary outcome of interest was incidence of COVID‐19‐related hospital admission. Secondary outcomes included severe maternal disease (ICU admission and mechanical ventilation) and COVID‐19‐directed medical treatment. Results In a source population of 816 628 maternities, a total of 2338 pregnant women were admitted with SARS‐CoV‐2; among them 940 (40%) were COVID‐19‐related admissions. The pooled incidence estimate for COVID‐19‐related admission was 0.59 (95% confidence interval 0.27–1.02) per 1000 maternities, with notable heterogeneity across countries (I2 = 97.3%, P = 0.00). In the COVID‐19 admission group, between 8% and 17% of the women were admitted to intensive care, and 5%–13% needed mechanical ventilation. Thromboprophylaxis was the most frequent treatment given during COVID‐19‐related admission (range 14%–55%). Among 908 infants born to women in the COVID‐19‐related admission group, 5 (0.6%) stillbirths were reported. Conclusions During the initial months of the pandemic, we found substantial variations in incidence of COVID‐19‐related admissions in nine European countries. Few pregnant women received COVID‐19‐directed medical treatment. Several barriers to rapid surveillance were identified. Investment in robust surveillance should be prioritized to prepare for future pandemics. Across Europe, substantial variation in COVID‐19‐related admission and clinical management in pregnant women was observed. This may reflect different national public health strategies early in the pandemic and emphasizes the need for alignment of management and treatment recommendations globally.

ObjectivesTo assess the incidence of hospital admissions for covid-19 disease in pregnant women, severity of covid-19 disease, and medical treatment provided to pregnant women with moderate to severe covid-19 during the first 10 months of the pandemic.DesignIndividual patient data meta-analysis of population based cohorts in International Obstetric Survey Systems.Setting10 European countries with national or regional surveillance within the International Obstetric Survey Systems (INOSS) collaboration using aligned definitions and case report forms: Belgium, France (regional), Italy, the Netherlands, Denmark, Finland, Iceland, Norway, Sweden (regional), and the UK. The dominant variant of the SARS-CoV-2 virus was the wild-type variant in all countries during the study period (1 March 2020 to 31 December 2020).ParticipantsThe source population was 1.7 million women giving birth (maternities) from 1 March 2020 to 31 December 2020; pregnant women were included if they were admitted to hospital and had a positive polymerase chain reaction test for the SARS-CoV-2 virus ≤7 days before hospital admission, during admission, or up to two days after giving birth. We further categorised the hospital admission in two groups; covid-19 admission (hospital admission due to covid-19 or with reported symptoms of covid-19 disease) or non-covid-19 admission (admission to hospital for obstetric healthcare or no symptoms of covid-19 disease).Main outcome measuresIncidence of hospital admissions for covid-19 per 1000 maternities, frequency of moderate to severe covid-19 disease, and number of women who received specific medical treatment for SARS-CoV-2 infection. Moderate to severe covid-19 disease was defined as maternal death, admission to an intensive care unit, or need for respiratory support.ResultsAmong 1.7 million maternities, 9003 women were included in the study: 2350 (26.1%) were admitted to hospital because of covid-19 disease or had symptoms of disease. The pooled incidence of hospital admissions for covid-19 per 1000 maternities was 0.8 (95% confidence interval (CI) 0.5 to 1.2, τ2=0.44), ranging from no hospital admissions in Iceland to 1.7 in France and 1.9 in the UK. 13 women died due to covid-19. Among 2219 women admitted to hospital for covid-19 in countries with complete information on respiratory support, 820 women (39.5%, 95% CI 34.6% to 44.4%, τ2=0.02) had moderate to severe covid-19 disease. At most, 16.8% (95% CI 7.7% to 32.9%, I2=81.8%, τ2=0.7) of women with moderate to severe covid-19 received specific medical treatment for SARS-CoV-2 infection with corticosteroids, although 66.6% (59.4% to 73.2%, I2=50.1, τ2=0.06) were given thromboprophylaxis.ConclusionsPopulation based surveillance in 10 European countries during the first 10 months of the covid-19 pandemic showed variations in the risk of hospital admissions for covid-19 in pregnant women. This finding indicates that national public health policies likely had a substantial and previously unrecognised role in protecting pregnant women. Few pregnant women with moderate to severe covid-19 were given specific medical treatment for SARS-CoV-2 disease, even when there were no or minor safety concerns. Lessons for future pandemics include the importance of rapid, robust surveillance systems for maternal and perinatal health, and of including use for pregnant women early in the development and testing of medicines and vaccines for public health emergencies.