The Risk of SARS-CoV-2 Infection in Pregnant Women: An Observational Cohort Study Using the BIFAP Database

Abstract

Background: It has been suggested that women experiencing during pregnancy several physiological and immunological changes that might increase the risk of any infection including the SARS-CoV-2. Objective: We aimed to quantify the risk of SARS-CoV-2 infection during pregnancy compared with women with no pregnancies. Methods: We used data from the BIFAP database and a published algorithm to identify all pregnancies during 2020. Pregnancies were matched (1:4) by age region, and length of pregnancy with a cohort of women of childbearing age. All women with SARS-CoV-2 infection before entering the study were discarded. We estimated incidence rates of SARS-CoV-2 with 95% confidence intervals (CIs) expressed by 1000 person-months as well as Kaplan–Meier figures overall and also stratified according to pregnancy period: during pregnancy, at puerperium (from end of pregnancy up to 42 days) and after pregnancy. (from 43 days after pregnancy up to end pf study period (i.e., June 2021). We conducted a Cox regression to assess risk factors for SARS-COV infection. The incidence rate of SARS-CoV-2 infection expressed by 1000 person-months were. Results: There was a total of 103,185 pregnancies and 412,740 matched women at childbearing, with a mean age of 32.3 years. The corresponding incidence rates of SARS-CoV-2 infection according to cohorts were: 2.44 cases per 1000 person-months (confidence interval (CI) 95%: 2.40–2.50) and 4.29 (95% CI: 4.15–4.43) for comparison cohort. The incidence rate ratio (IRR) of SARS-CoV-2 was 1.76 (95% CI: 1.69–1.83). When analyzing according to pregnancy period, the IRRs were 1.30 (95% CI: 11.20–1.41) during the puerperium and 1.19 (95% CI: 41.15–1.23) after pregnancy. In addition to pregnancy itself, other important risk factors were obesity (1.33 (95% CI: 1.23–1.44)) and diabetes (1.23 (95% CI: 11.00–1.50). Conclusion: Pregnant women are at increased risk of SARS-CoV-2 infection compared with women of childbearing age not pregnant. Nevertheless, there is a trend towards reverting during puerperium and after pregnancy.

COVID-19 Distribution in Pregnancy, Drug Use Patterns and COVID-19 Medication during the Pandemic in Spain: Data from Real-World Electronic Health Records

“…Once obtaining the cohort of pregnancies, we searched all pregnancies with a recorded diagnosis of COVID-19 during their gestational age, that is, from the last menstrual period up to the end of pregnancy (regardless of the outcome of pregnancy). A patient was classified as a confirmed case if they met one of the following criteria: a confirmed case of SARS-CoV-2 infection from the active surveillance system implemented during the COVID-19 pandemic and from hospital data or from an ICU [ 44 ]. For each pregnant woman with a confirmed diagnosis of COVID-19 (N = 8413), we matched 3 pregnant women without COVID-19 with the same age at the date of SARS-CoV-2 diagnosis (+/2 years), same gestational age (+/− 2 weeks) and length of pregnancy and outcome (N = 24,975).…”

“…At the time of the study, the database included information from nine participating Autonomous Regions (out of seventeen) in Spain. The distributions of age and sex are comparable with the Spanish population [44][45][46]. In terms of drug utilization, prescriptions issued by the PCPs are automatically recorded; prescriptions from specialists, as well as those used during hospitalizations, may not be fully captured.…”

Risk and Protective Factors for COVID‐19 Infection among Pregnant Women with Sickle Cell Trait

“…The incidence of COVID-19 infection in pregnant women was 3.02 times greater than that in the general population [ 6 ]. Pregnancy causes several physiological changes and alters the immune system and its response to viral infection [ 7 , 8 ], which might increase the risk of any infection [ 9 ]. This includes COVID-19, which could lead to more severe symptoms, especially in the third trimester [ 8 , 9 ].…”

“…Pregnancy causes several physiological changes and alters the immune system and its response to viral infection [ 7 , 8 ], which might increase the risk of any infection [ 9 ]. This includes COVID-19, which could lead to more severe symptoms, especially in the third trimester [ 8 , 9 ]. The presence of certain comorbidities further worsens the severity of COVID-19 disease [ 10 ], but there is a paucity of studies available for pregnant individuals with SCT.…”