This cohort study estimates associations between mode of delivery (vaginal vs cesarean delivery) and maternal and neonatal birth outcomes among SARS-CoV-2–infected women giving birth in Spain. In this cohort, severe adverse maternal outcomes occurred in 11% (9/82), 4 of whom presented with severe and 5 with mild COVID-19 symptoms

The authors examined 82 women with singleton pregnancies and a positive reverse transcriptase–polymerase chain reaction (RT-PCR) test result for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) between March 12 and April 6, 2020, and who delivered within the next 14 days at 96 level 2 or level 3 maternity hospitals throughout Spain.

Of these pregnant women:

• 4 presented with severe COVID-19 symptoms, including 1 with concomitant preeclampsia; all 4 underwent cesarean delivery and required ICU admission
• 78 presented with no or mild COVID-19 symptoms, including 11 patients requiring oxygen supplementation
• 41 (53%) delivered vaginally and 37 (47%) by cesarean delivery, 29 for obstetrical indications and 8 for COVID-19 symptoms without other obstetrical indications
• No patients with a vaginal delivery developed severe adverse outcomes, while 5 (13.5%) with cesarean delivery required ICU admission
• 2 patients (4.9%) with a vaginal delivery had clinical deterioration after birth vs 8 (21.6%) with cesarean delivery
• 8 newborns (19.5%) delivered vaginally and 11 (29.7%) born by cesarean delivery were admitted to the NICU
• 3 (4.2%) of 72 newborns tested within 6 hours after birth had a positive SARS-CoV-2 RT-PCR result. Repeat testing at 48 hours was negative. None developed COVID-19 symptoms within 10 days
• 2 other newborns, both cesarean deliveries at term, developed COVID-19 symptoms within 10 days. Though initial testing at birth was negative, repeat testing was positive. Both newborns were in contact with their parents immediately after birth. Symptoms resolved within 48 hours.

After adjustment for potential confounding factors, cesarean birth was significantly associated with clinical deterioration (adjusted odds ratio, 13.4; 95% CI, 1.5-121.9; P = .02) and increased risk of NICU admission (adjusted odds ratio, 6.9; 95% CI, 1.3-37.1; P = .02).