Fetal and Perinatal Outcome Following First and Second Trimester COVID-19 Infection: Evidence from a Prospective Cohort Study

Abstract

A novel coronavirus termed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a new strain of coronavirus causing coronavirus disease 2019 (COVID-19) disease, which emerged as a global pandemic. Data regarding the implications of COVID-19 disease at early gestation on fetal and obstetric outcomes is scarce. Thus, our aim was to investigate the effect of first and second trimester maternal COVID-19 disease on fetal and perinatal outcomes. This was a prospective cohort study of pregnant women with a laboratory-proven SARS-COV-2 infection contracted prior to 26 weeks gestation. Women were followed at a single tertiary medical center by serial sonographic examinations every 4–6 weeks to assess fetal well-being, growth, placental function, anatomic evaluation and signs of fetal infection. Amniocentesis was offered to assess amniotic fluid SARS-COV-2-PCR (polymerase chain reaction) and fetal brain magnetic resonance imaging (MRI) was offered at 30–32 weeks gestation. Demographic, obstetric and neonatal data were collected from history intake, medical charts or by telephone survey. Perinatal outcomes were compared between women infected at first vs. second trimester. 55 women with documented COVID-19 disease at early gestation were included and followed at our center. The mean maternal age was 29.6 ± 6.2 years and the mean gestational age at viral infection was 14.2 ± 6.7 weeks with 28 (51%) women infected at the first trimester and 27 (49%) at the second trimester. All patients but one experienced asymptomatic to mild symptoms. Of 22 patients who underwent amniocentesis, none had evidence of vertical transmission. None of the fetuses exhibited signs of central nervous system (CNS) disease, growth restriction and placental dysfunction on serial ultrasound examinations and fetal MRI. Pregnancies resulted in perinatal survival of 100% to date with mean gestational age at delivery of 38.6 ± 3.0 weeks and preterm birth <37 weeks rate of 3.4%. The mean birthweight was 3260 ± 411 g with no cases of small for gestational age infants. The obstetric and neonatal outcomes were similar among first vs. second trimester infection groups. We conclude SARS-CoV-2 infection at early gestation was not associated with vertical transmission and resulted in favorable obstetric and neonatal outcomes.

Assessment of fetal growth and anomalies in the era of COVID-19 pandemic: an Egyptian pilot study

“…Another case in group B was diagnosed with cleft lip and cleft palate without any other gross anomalies, which is the most common fetal craniofacial malformation that is screened during prenatal ultrasonographic examination [ 19 ]. Cosma’s research group found that asymptomatic or mildly symptomatic SARS-CoV-2 infection during the first trimester of pregnancy did not predispose affected women to more fetal anomalies than unaffected women [ 20 ], and Rosen and his coworkers also confirmed the same results on the first and second trimester with no significant adverse neonatal outcome [ 21 ].…”

Transmitted Fetal Immune Response in Cases of SARS-CoV-2 Infections during Pregnancy

“…However, little is known of the effects of SARS-CoV-2 on the placenta [ 11 , 12 , 13 , 14 ]. Moreover, the possible transplacental transfer of the virus has not been fully clarified [ 22 , 23 ], although vertical transmission has been reported in some cases of COVID-19, complicating gestation [ 20 , 24 , 25 ]. Additionally, it is not clear whether the maternal inflammatory response to infection can be transmitted to the fetus through the placental pathway, inducing changes in the fetal immune system [ 26 ].…”

Mother to Newborn Transmission of SARS-CoV-2 Infection: Evolution of Evidence in 1.5 Years of COVID-19 Pandemic

“…10 Elevated C-reactive protein and lymphopenia are the most common abnormal laboratory indices. 2 11 12 13 14 15 A large cohort from Premier Healthcare Database compared outcomes in 6,380 mothers with COVID-19 to 400,066 mothers without COVID-19. The authors observed increased risk of ICU admission (adjusted odds ratio [aOR], 6.47; 95% CI, 5.55–7.55), pre-eclampsia (aOR, 1.21; 95% CI, 1.11–1.33), venous thromboembolism (aOR, 3.43; 95% CI, 2.01–5.82), and preterm birth (aOR, 1.17; 95% CI, 1.06–1.29).…”

“…In a recent prospective cohort study from Israel, Rosen et al reported fetal and perinatal outcomes in 55 mothers with early (<26 weeks) confirmed COVID-19 infection. 15 They followed mothers every 4 to 6 weeks to assess fetal wellbeing, growth scans, and signs of fetal infections. Amniocentesis was conducted to assess amniotic fluid infection, and fetal brain magnetic resonance imaging was conducted at 30 to 32 weeks of gestation.…”