Maternal and Neonatal Morbidity and Mortality Among Pregnant Women With and Without COVID-19 Infection

Abstract

IMPORTANCE Detailed information about the association of COVID-19 with outcomes in pregnant individuals compared with not-infected pregnant individuals is much needed. OBJECTIVE To evaluate the risks associated with COVID-19 in pregnancy on maternal and neonatal outcomes compared with not-infected, concomitant pregnant individuals. DESIGN, SETTING, AND PARTICIPANTSIn this cohort study that took place from March to October 2020, involving 43 institutions in 18 countries, 2 unmatched, consecutive, not-infected women were concomitantly enrolled immediately after each infected woman was identified, at any stage of pregnancy or delivery, and at the same level of care to minimize bias. Women and neonates were followed up until hospital discharge.EXPOSURES COVID-19 in pregnancy determined by laboratory confirmation of COVID-19 and/or radiological pulmonary findings or 2 or more predefined COVID-19 symptoms. MAIN OUTCOMES AND MEASURESThe primary outcome measures were indices of (maternal and severe neonatal/perinatal) morbidity and mortality; the individual components of these indices were secondary outcomes. Models for these outcomes were adjusted for country, month entering study, maternal age, and history of morbidity.RESULTS A total of 706 pregnant women with COVID-19 diagnosis and 1424 pregnant women withoutCOVID-19diagnosiswereenrolled,allwithbroadlysimilardemographiccharacteristics(mean [SD] age, 30.2 [6.1] years). Overweight early in pregnancy occurred in 323 women (48.6%) with

mRNA Covid-19 Vaccines in Pregnant Women

“… 4 Studies also showed an increased risk of pregnancy complications — including preterm birth, cesarean delivery, and preeclampsia — associated with Covid-19 infection during pregnancy. 5 Therefore, clinicians relied on developmental and reproductive animal data from Moderna that showed no safety concerns, and there was no biologically plausible reason that the mRNA technology would be harmful in pregnancy. Pregnant women were counseled to consider the available evidence and make personal decisions about vaccination in the absence of human safety data.…”

Passive and active immunity in infants born to mothers with SARS-CoV-2 infection during pregnancy: prospective cohort study

“…10 An international study collected outcomes of 706 pregnant mothers with SARS-CoV-2 infection during pregnancy and their newborns from 18 developed and developing countries. 11 Results from this large-scale study demonstrated that pregnant women with COVID-19, compared with those without COVID-19, were at a substantially increased risk of severe pregnancy complications and death. Interestingly, several cohort studies conducted in the USA have found that the majority of pregnant women with SARS-CoV-2 infection were either asymptomatic or had mild symptoms.…”

“…20 24 The large-scale international investigation found that infants born to women with COVID-19 during pregnancy had a significantly higher risk of severe perinatal mobility and mortality. 11 These risks remained significant after adjusting for prematurity, indicating a direct effect of COVID-19 on the infants.…”

Role of ACE2 in pregnancy and potential implications for COVID-19 susceptibility

“…There are still conflicting reports; and some methodological limitations have been addressed, such as COVID-19 testing only in symptomatic pregnancies and at delivery time, a lack of control for confounder factors (such as age, comorbidities, multiparity etc. ), limited comparisons with non-pregnant women, and an underrepresentation of pregnancies diagnosed with COVID-19 in early pregnancy [12,142]. Therefore, we here summarize the most concise data reported until June 2021.…”