Increased incidence of first‐trimester miscarriage during the <scp>COVID</scp>‐19 pandemic

Saçıntı, Koray Görkem; Kalafat, Erkan; Şükür, Yavuz Emre; Koç, Acar

doi:10.1002/uog.23655

Cited by 26 publications

(27 citation statements)

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“…This disparity may be because the median GA at registration in our study was 8 weeks, thus pregnancies lost before 8 weeks would have been missed. We are unable to determine the GA at registration in the Sacinti et al (2021) report.…”

Section: Discussionmentioning

confidence: 99%

“…This is the first study to date to investigate the rates of early pregnancy loss during the SARS-CoV-2 outbreak and, to the best of our knowledge, there are no other prospective studies evaluating the impact of SARS-CoV-2 infection on first trimester pregnancy loss in non-hospitalized women. We identified three retrospective studies investigating whether infection in pregnancy is associated with early miscarriage ( la Cour Freiesleben et al , 2021 ; Cosma et al , 2021 ; Sacinti et al , 2021 ). All three studies recruited women attending early pregnancy and antenatal clinic appointments.…”

Section: Discussionmentioning

confidence: 99%

“…In a letter to the Editor, Sacinti et al (2021) compared the incidence of miscarriage between a 13 week period in 2019 and 2020, and found that the incidence of miscarriage was increased by 25% during the SARS-CoV-2 pandemic, reporting an overall rate of 11.8%. This finding is in agreement with our observation that SARS-CoV-2 infection increases the risk of a loss.…”

Section: Discussionmentioning

confidence: 99%

“…Data on the impact of first trimester infection with SARS-CoV-2 on early pregnancy outcomes are scarce. The majority of published studies are retrospective in design with small sample sizes ( Cosma et al , 2021 ; la Cour Freiesleben et al , 2021 ; Sacinti et al , 2021 ). We performed a nationwide prospective cohort study in the United Kingdom (UK) where infection rates are one of the highest in the world and where nasopharyngeal PCR testing was readily available from 28 May 2020 to those with symptoms.…”

Section: Introductionmentioning

confidence: 99%

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SARS-CoV-2 infection in the first trimester and the risk of early miscarriage: a UK population-based prospective cohort study of 3041 pregnancies conceived during the pandemic

et al. 2022

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STUDY QUESTION Does maternal infection with severe acute respiratory syndrome coronavirus (SARS-CoV-2) in the first trimester affect the risk of miscarriage before 13 week’s gestation? SUMMARY ANSWER Pregnant women with self-reported diagnosis of SARS-CoV-2 in the first trimester had a higher risk of early miscarriage. WHAT IS KNOWN ALREADY Viral infections during pregnancy have a broad spectrum of placental and neonatal pathology. Data on the effects of the SARS-CoV-2 infection in pregnancy are still emerging. Two systematic reviews and meta-analyses reported an increased risk of preterm birth, caesarean delivery, maternal morbidity and stillbirth. Data on the impact of first trimester infection on early pregnancy outcomes are scarce. This is the first study, to our knowledge, to investigate the rates of early pregnancy loss during the SARS-CoV-2 outbreak among women with self-reported infection. STUDY DESIGN, SIZE, DURATION This was a nationwide prospective cohort study of pregnant women in the community recruited using social media between 21st May and 31st December, 2020. We recruited 3545 women who conceived during the SARS-CoV-2 pandemic who were less than 13 week’s gestation at the time of recruitment. PARTICIPANTS/MATERIALS, SETTING, METHODS The COVID-19 Contraception and Pregnancy Study (CAP-COVID) was an on-line survey study collecting longitudinal data from pregnant women in the UK aged 18 years or older. Women who were pregnant during the pandemic were asked to complete on-line surveys at the end of each trimester. We collected data on current and past pregnancy complications, their medical history and whether they or anyone in their household had symptoms or been diagnosed with SARS-CoV-2 infection during each trimester of their pregnancy. RT-PCR–based SARS-CoV-2 RNA detection from respiratory samples (e.g., nasopharynx) is the standard practice for diagnosis of SARS-CoV-2 in the UK. We compared rate of self-reported miscarriage in three groups: ‘presumed infected’ i.e those who reported a diagnosis with SARS-CoV-2 infection in the first trimester; ‘uncertain’ i.e those who did not report a diagnosis but had symptoms/household contacts with symptoms/diagnosis; and ‘presumed uninfected’ i.e., those who did not report any symptoms/diagnosis and had no household contacts with symptoms/diagnosis of SARS-CoV-2. MAIN RESULTS AND THE ROLE OF CHANCE A total of 3545 women registered for the CAP-COVID study at less than 13 weeks gestation and were eligible for this analysis. Data for the primary outcome were available from 3041 women (86%). In the overall sample, the rate of self-reported miscarriage was 7.8% (238/3041 [95% CI, 7-9]). The median gestational age at miscarriage was 9 weeks (interquartile range 8-11). Seventy-seven women were in the 'presumed infected’ group (77/3041, 2.5% [95% CI 2 – 3]), 295/3041 were in the uncertain group (9.7%, [95% CI 9-11]) and the rest in the ‘presumed uninfected’ (87.8%, 2669/3041, [95% CI 87-89]). The rate of early miscarriage was 14% in the ‘presumed infected’ group, 5% in the ‘uncertain’ and 8% in the ‘presumed uninfected’ (11/77 [95% CI 6-22] versus15/295, [95% CI 3-8] versus 212/2669 [95% CI 7-9], p = 0.02). After adjusting for age, BMI, ethnicity, smoking status, gestational age at registration and the number of previous miscarriages, the risk of early miscarriage appears to be higher in the ‘presumed infected’ group (relative rate 1.7, 95% CI 1.0-3.0, p = 0.06). LIMITATIONS, REASONS FOR CAUTION We relied on self-reported data on early pregnancy loss and SARS-CoV-2 infection without any means of checking validity. Some women in the ‘presumed uninfected’ and ‘uncertain’ groups may have had asymptomatic infections. The number of ‘presumed infected’ in our study was low and therefore the study was relatively underpowered. WIDER IMPLICATIONS OF THE FINDINGS This was a national study from the UK, where infection rates were one of the highest in the world. Based on the evidence presented here, women who are infected with SARS-CoV-2 in their first trimester may be at an increased risk of a miscarriage. However, the overall rate of miscarriage in our study population was 8%. This is reassuring and suggests that if there is an effect of SARS-CoV-2 on the risk of miscarriage, this may be limited to those with symptoms substantial enough to lead to a diagnostic test. Further studies are warranted to evaluate a causal association between SARS-CoV-2 infection in early pregnancy and miscarriage risk. Although we did not see an overall increase in the risk of miscarriage, the observed comparative increase in the presumed infected group reinforces the message that pregnant women should continue to exercise social distancing measures and good hygiene throughout their pregnancy to limit their risk of infection STUDY FUNDING/COMPETING INTEREST(S) This study was supported by a grant from the Elizabeth Garrett Anderson Hospital Charity, (G13-559194). The funders of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. JAH is supported by an NIHR Advanced Fellowship. ALD is supported by the National Institute for Health Research University College London Hospitals Biomedical Research Centre. All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: support to JAH and ALD as above; no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work. TRIAL REGISTRATION NUMBER n/a

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

SARS-CoV-2 infection in the first trimester and the risk of early miscarriage: a UK population-based prospective cohort study of 3041 pregnancies conceived during the pandemic

et al. 2022

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“…Recent reports show that pregnant individuals with severe SARS-CoV-2 infection are at higher risk of intensive care unit admission, mechanical ventilation, extracorporeal membrane oxygenation, and mortality compared to non-pregnant individuals [8,9]. Other studies show that active SARS-CoV-2 infection at delivery (mainly confirmed through a PCR positive test) is associated with obstetric and neonatal complications including increased risk of preterm birth, stillbirth, miscarriage, preeclampsia, emergency cesarean section and higher neonatal morbidity [8,[10][11][12][13][14][15][16][17][18]. However, in other reports, including ours from New York City and a Denmark study, SARS-CoV-2 IgG seropositivity without RT-PCR positivity at delivery was not associated with adverse pregnancy outcomes [19,20].…”

Section: Introductionmentioning

confidence: 99%

Gestational SARS-CoV-2 infection is associated with placental expression of immune and trophoblast genes

Lesseur

Jessel

Ohrn

et al. 2022

Preprint

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Introduction: Maternal SARS-CoV-2 infection during pregnancy is associated with adverse pregnancy outcomes and can have effects on the placenta, even in the absence of severe disease or vertical transmission to the fetus. This study aimed to evaluate histopathologic and molecular effects in the placenta after SARS-CoV-2 infection during pregnancy. Methods: We performed a study of 45 pregnant participants from the Generation C prospective cohort study at the Mount Sinai Health System in New York City. We compared histologic features and the expression of 48 immune and trophoblast genes in placentas delivered from 15 SARS-CoV-2 IgG antibody positive and 30 IgG SARS-CoV-2 antibody negative mothers. Statistical analyses were performed using Fisher exact tests, Spearman correlations and linear regression models. Results: The median gestational age at the time of SARS-CoV-2 IgG serology test was 35 weeks. Two of the IgG positive participants also had a positive RT-PCR nasal swab at delivery. 82.2% of the infants were delivered at term (≥37 weeks), and gestational age at delivery did not differ between the SARS-CoV-2 antibody positive and negative groups. No significant differences were detected between the groups in placental histopathology features. Differential expression analyses revealed decreased expression of two trophoblast genes (PSG3 and CGB3) and increased expression of three immune genes (CXCL10, TLR3 and DDX58) in placentas delivered from SARS-CoV-2 IgG positive participants. Discussion: SARS-CoV-2 infection during pregnancy is associated with gene expression changes of immune and trophoblast genes in the placenta at birth which could potentially contribute to long-term health effects in the offspring.

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Increased rate of miscarriage during second wave of COVID‐19 pandemic in India

Gajbhiye

Tilve

Kesarwani

et al. 2021

Ultrasound in Obstet & Gyne

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The lack of reliable data on the risk of miscarriage due to coronavirus disease 2019 (COVID-19) is a concern for both patients and obstetricians. A recent meta-analysis demonstrated an increased risk of adverse pregnancy outcome in low-to-middle-income countries (LMICs) when compared with high-income countries 1 . The second wave of the COVID-19 pandemic was reported to be more fatal than the first wave, with increased disease severity and maternal mortality 2 . However, the impact of the second wave of COVID-19 in India on the rate of miscarriage is unknown.

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Increased incidence of first‐trimester miscarriage during the COVID‐19 pandemic

Cited by 26 publications

References 4 publications

SARS-CoV-2 infection in the first trimester and the risk of early miscarriage: a UK population-based prospective cohort study of 3041 pregnancies conceived during the pandemic

SARS-CoV-2 infection in the first trimester and the risk of early miscarriage: a UK population-based prospective cohort study of 3041 pregnancies conceived during the pandemic

Gestational SARS-CoV-2 infection is associated with placental expression of immune and trophoblast genes

Increased rate of miscarriage during second wave of COVID‐19 pandemic in India

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