Maternal and perinatal outcomes of pregnant women with SARS-CoV-2 infection at the time of birth in England: national cohort study

Abstract

BACKGROUND: Some studies have suggested that women with SARS-CoV-2 infection during pregnancy are at increased risk of adverse pregnancy and neonatal outcomes, but these associations are still not clear. OBJECTIVE: This study aimed to determine the association between SARS-CoV-2 infection at the time of birth and maternal and perinatal outcomes. STUDY DESIGN: This is a population-based cohort study in England. The inclusion criteria were women with a recorded singleton birth between May 29, 2020, and January 31, 2021, in a national database of hospital admissions. Maternal and perinatal outcomes were compared between pregnant women with a laboratory-confirmed SARS-CoV-2 infection recorded in the birth episode and those without. Study outcomes were fetal death at or beyond 24 weeks' gestation (stillbirth), preterm birth (<37 weeks' gestation), small for gestational age infant (small for gestational age; birthweight at the <tenth centile), preeclampsia or eclampsia, induction of labor, mode of birth, specialist neonatal care, composite neonatal adverse outcome indicator, maternal and neonatal length of hospital stay after birth (3 days or more), and 28-day neonatal and 42-day maternal hospital readmission. Adjusted odds ratios and their 95% confidence interval for the association between SARS-CoV-2 infection status and outcomes were calculated using logistic regression, adjusting for maternal age, ethnicity, parity, preexisting diabetes mellitus, preexisting hypertension, and socioeconomic deprivation measured using the Index of Multiple Deprivation 2019. Models were fitted with robust standard errors to account for hospital-level clustering. The analysis of the neonatal outcomes was repeated for those born at term (37 weeks' gestation) because preterm birth has been reported to be more common in pregnant women with SARS-CoV-2 infection. RESULTS: The analysis included 342,080 women, of whom 3527 had laboratory-confirmed SARS-CoV-2 infection. Laboratory-confirmed SARS-CoV-2 infection was more common in women who were younger, of non-White ethnicity, primiparous, or residing in the most deprived areas or had comorbidities. Fetal death (adjusted odds ratio, 2.21; 95% confidence interval, 1.58e3.11; P<.001) and preterm birth (adjusted odds ratio, 2.17; 95% confidence interval, 1.96e2.42; P<.001) occurred more frequently in women with SARS-CoV-2 infection than those without. The risk of preeclampsia or eclampsia (adjusted odds ratio, 1.55; 95% confidence interval, 1.29e1.85; P<.001), birth by emergency cesarean delivery (adjusted odds ratio, 1.63; 95% confidence interval, 1.51e1.76; P<.001), and prolonged admission after birth (adjusted odds ratio, 1.57; 95% confidence interval, 1.44e1.72; P<.001) were significantly higher for women with SARS-CoV-2 infection than those without. There were no significant differences (P>.05) in the rate of other maternal outcomes. The risk of neonatal adverse outcome (adjusted odds ratio, 1.45; 95% confidence interval, 1.27e1.66; P<.001), need for specialist neonatal care (adjusted odds r...

Novel Ratio Soluble Fms-like Tyrosine Kinase-1/Angiotensin-II (sFlt-1/ANG-II) in Pregnant Women Is Associated with Critical Illness in COVID-19

“…In relation to preeclampsia, no significant differences in the incidence among patients with severe and non-severe COVID-19 have been observed; this finding is contradictory to previous studies in which higher rates of preeclampsia have been demonstrated in cases of severe COVID-19 [32][33][34].…”

A prospective cohort study of confirmed severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection during pregnancy evaluating SARS‐CoV‐2 antibodies in maternal and umbilical cord blood and SARS‐CoV‐2 in vaginal swabs

“…In large cohort studies, the overall risk of severe neonatal outcomes as well as neonatal infection related to maternal SARS‐CoV‐2 infection seems low, however, a recent paper reports increased rates of fetal death, preterm birth, preeclampsia, emergency cesarean delivery, and other adverse maternal and neonatal outcomes. 33 High‐quality evidence syntheses of comparative studies as well as studies describing detailed clinical observations from cases with adverse outcomes are needed to guide future clinical decisions in pregnancies complicated by COVID‐19. 34 …”

COVID-19 Vaccination in Pregnancy, Paediatrics, Immunocompromised Patients, and Persons with History of Allergy or Prior SARS-CoV-2 Infection: Overview of Current Recommendations and Pre- and Post-Marketing Evidence for Vaccine Efficacy and Safety

“…Regarding perinatal outcomes following SARS-CoV-2 infection, several reports of miscarriage and stillbirth were published [49,50], as well as pathological findings such as placentitis [51] and placenta thrombosis [52]. Premature births have been shown to be more common in SARS-CoV-2-positive mothers and their newborns are more likely to be admitted to the neonatal care unit [45].…”