Coronavirus disease 2019 and first-trimester spontaneous abortion: a case-control study of 225 pregnant patients

Abstract

Background The disease caused by the “severe acute respiratory syndrome coronavirus 2” (SARS-CoV-2) was named Coronavirus Disease 19 (COVID-19) and classified as a global public health emergency. The evidence related to the impact of COVID-19 on pregnancy are limited to the second and the third trimester of pregnancy, while data on the first trimester are scant. Many viral infections can be harmful to the fetus during the first trimester of pregnancy, and whether SARS-CoV-2 is one of them is still unknown. Objective(s) With this study we evaluated SARS-CoV-2 infection as a risk factor for early pregnancy loss in first trimester of pregnancy. Furthermore, COVID-19 course in the first trimester was assessed. Study design Between February 22 and May 21, 2020, we conducted a case-control study at S. Anna Hospital, Turin, among first trimester pregnant women, paired for last menstruation. The cumulative incidence of COVID-19 was compared between women with spontaneous abortion (case group, n=100) and those with ongoing pregnancy (control group, n=125). Current or past infection was determined by detection of SARS-CoV-2 from nasopharingeal swab and SARS-CoV-2 IgG/IgM antibodies in blood sample. Patient demographics, COVID-19-related symptoms, and the main risk factors for abortion were collected. Results Twenty-three of the 225 women (23/225, 10.2%) tested positive for COVID-19 infection. There was no difference in the cumulative incidence of COVID-19 between the cases (11/100, 11%) and the controls (12/125, 9.6%) (p=0.73). Logistic regression analysis confirmed that COVID-19 was not an independent predictor of early pregnancy loss (Odd Ratio 1.28, confidence interval 0.53-3.08). COVID-19 related symptoms in the first trimester were fever, anosmia, ageusia, cough, arthralgia and diarrhea; no pneumonia or Hospital admission due to COVID-19-related symptoms were recorded. No difference in the incidence of symptoms was noted between the two groups. Conclusion(s) SARS-CoV-2 infection during the first trimester of pregnancy does not appear to predispose to early pregnancy loss; its cumulative incidence did not differ between women with spontaneous abortion and women with ongoing pregnancy. COVID-19 appears to have a favorable maternal course at the beginning of pregnancy, consistent with what has been observed during the second and the third trimester.

Are COVID-19 vaccines safe in pregnancy?

“…If such cross-reactivity did occur, vaccines on all platforms, as well as natural infections, would be expected to be associated with placental pathology. A natural experiment assures us that this is unlikely to be the case as people who are infected with SARS-CoV-2 shortly before conceiving or early in pregnancy are no more likely to miscarry than their uninfected peers 2 . Nonetheless, immunologists have also taken formal approaches to address the claim that antibodies to spike protein could cross-react with syncytin 1: there is no significant similarity between the amino acid sequences of SARS-CoV-2 spike protein and syncytin 1 and convalescent serum from patients with COVID-19 does not react with syncytin 1 (ref.…”

COVID-19: angiotensin-converting enzyme 2 (ACE2) expression and tissue susceptibility to SARS-CoV-2 infection

“…Moreover, COVID-19 symptoms in a small cohort of pregnant women did not differ from non-pregnant patients. Additionally, a case–control study of 225 pregnant women not only unveiled that COVID-19-related symptoms were similar to controls but also reported no difference in the cumulative incidence of early pregnancy loss [ 74 ]. However, mothers hospitalized due to COVID-19 pathology had a higher risk of ending their pregnancy via caesarean section, whereas newborns had a higher risk of premature delivery [ 75 ].…”

Prenatal Biochemical and Ultrasound Markers in COVID-19 Pregnant Patients: A Prospective Case-Control Study

“…The primary aim of this study was to determine whether SARS-CoV-2 positive women during the first trimester of pregnancy are at higher risk of noninvasive prenatal screening test alterations and/or of congenital anomalies at the second-trimester fetal anatomic survey (18)(19)(20)(21)(22) weeks) compared to a cohort of healthy pregnant women. The secondary aim was to evaluate maternal symptoms.…”