Pregnancy and neonatal outcomes of COVID-19 – co-reporting of common outcomes from the PAN-COVID and AAP SONPM registry

Abstract

BackgroundFew large, cohort studies report data on individual’s maternal, fetal, perinatal, and neonatal outcomes associated with SARS-CoV-2 infection in pregnancy. We report outcomes from a collaboration formed early during the pandemic between the investigators of two registries, the UK and global Pregnancy and Neonatal outcomes in COVID-19 (PAN-COVID) study and the US American Academy of Pediatrics Section on Neonatal Perinatal Medicine (AAP SONPM) National Perinatal COVID-19 Registry.MethodsPAN-COVID (suspected or confirmed SARS-CoV-2 infection at any stage in pregnancy) and the AAP SONPM registry (positive maternal testing for SARS-CoV-2 from 14 days before delivery to 3 days after delivery) studies collected data on maternal, fetal, perinatal and neonatal outcomes. PAN-COVID results are presented as all inclusions and those with confirmed SARS-CoV-2 infection only.ResultsWe report 4004 women in pregnancy affected by suspected or confirmed SARS-CoV-2 infection (1606 from PAN-COVID and 2398 from the AAP SONPM) from January 1st 2020 to July 25th 2020 (PAN-COVID) and August 8th (AAP SONPM). For obstetric outcomes in PAN-COVID and AAP SONPM, respectively, maternal death occurred in 0.5% and 0.17%, early neonatal death in 0.2% and 0.3%, and stillbirth in 0.50% and 0.65% of women. Delivery was pre-term (<37 weeks gestation) in 12% of all women in PAN-COVID, in 16.2% of those women with confirmed infection in PAN-COVID and 16.2% of women in AAP SONPM. Very preterm delivery (< 27 weeks’ gestation) occurred in 0.6% in PAN-COVID and 0.7% in AAP SONPM.Neonatal SARS-CoV-2 infection was reported in 0.8% of PAN-COVID all inclusions, 2.0% in PAN-COVID confirmed infections and 1.8% in the AAP SONPM study; the proportions of babies tested were 9.5%, 20.7% and 87.2% respectively.The proportion of SGA babies was 8.2% in PAN-COVID all inclusions, 9.7% in PAN-COVID confirmed infection and 9.6% in AAP SONPM. Gestational age adjusted mean z-scores were −0.03 for PAN-COVID and −0.18 for AAP SONPM.ConclusionsThe findings from the UK and US SARS-CoV-2 in pregnancy registries were remarkably concordant. Pre-term delivery affected a higher proportion of women in pregnancy than expected from historical and contemporaneous national data. The proportions of women affected by stillbirth, small for gestational age infants and early neonatal death were comparable to historical and contemporaneous UK and US data. Although maternal death was uncommon, the proportion was higher than expected from UK and US population data, likely explained by under-ascertainment of women affected by milder and asymptomatic infection in pregnancy. The data presented support strong guidance for enhanced precautions to prevent SARS-COV-2 infection in pregnancy, particularly in the context of increased risks of preterm delivery and maternal mortality, and for priority vaccination of women planning pregnancy.What is known about SARS-COV-2 infection in pregnancy and neonates?Cohort, population surveillance studies and living systematic reviews have included limited numbers of women in pregnancy affected by COVID-19 and report that most women and infants had good outcomes.What this study addsPreterm deliveries occurred in a high proportion of women participating in these two registries in comparison to contemporaneous and historical national data in the UK and US. The majority of preterm deliveries occurred late preterm (between 32+0 and 36+6 weeks’ gestation).SARS-COV-2 infection in pregnancy did not appear to be associated with a clinically significant effect on the rate of stillbirth, fetal growth, or neonatal outcomes.Although maternal death was uncommon, the proportion was higher than expected from UK and US population data, likely explained by under-ascertainment of women affected by milder and asymptomatic infection in pregnancy.

SARS-CoV-2 and Placenta: New Insights and Perspectives

“…Allotey J et al suggest that pregnant women with symptomatic SARS-CoV-2 infection are less likely to present with fever and myalgia, but are more likely to need intensive care, ventilation, and have a higher risk of pre-term delivery [19,20]; moreover, death occurs in a small number of cases that are COVID-related [21][22][23][24]. Among the 71 placentas we analyzed, there were no cases of the maternal-fetal transmission of SARS-CoV-2, and all the newborns were in good health at birth, with similar APGAR scores at 1 minute and 5 minutes to those of the controls (p = 0.83).…”

Prevalence of Maternal Mortality and Clinical Course of Maternal Deaths in COVID-19 Pneumonia-A Cross-Sectional Study

“…Majority of COVID-19 infection in pregnancy will be asymptomatic. Preg COV-19 Living systematic review reporting on universal screening in pregnancy found 74% (95% CI 51-93) of women were asymptomatic [16]. While another study from the USA reported that 86% of women who were admitted in labor and who tested positive for SARS-CoV-2 were asymptomatic.…”

“…Most symptomatic women experience only mild or moderate cold/flu-like symptoms. [18] The PregCOV-19 systematic review has so far included over 64 000 pregnant women worldwide with suspected or confirmed COVID-19 (reported prior to 29 November 2020) [16]. In this review, the most common symptoms of COVID-19 in pregnant women were cough (41%) and fever (40%).…”

Empfehlungen zu SARS-CoV-2/COVID-19 in Schwangerschaft, Geburt und Wochenbett – Update November 2021 (Langfassung)

“…Mütterliche Sterblichkeit war in beiden Registern selten: Sie trat bei 3 von 651 (0,46%) der Frauen mit bestätigter COVID-19 im PAN-COVID-Register und bei 5 von 2398 Frauen mit COVID-19 (0,21%) im AAP SONPM-Register auf. Diese Müttersterblichkeitsraten sind damit als höher einzuschätzen als die zuvor in diesen Bevölkerungsgruppen verzeichneten Müttersterblichkeitsraten (AAP SONPM-Register 167 pro 100 000) für Frauen, die zum Zeitpunkt der Geburt an COVID-19 erkrankt sind), verglichen mit einer Prä-COVID-Rate von 17,3 pro 100 000 in den USA) 169 . Das britische UKOSS-Register berichtet eine Müttersterblichkeitsrate von 2,2 pro 100 000 (95% KI 0,9–4,3) 42 122 .…”