Dataset Information

SARS-CoV-2 infection during pregnancy and associated perinatal health outcomes: a national US cohort study.

ABSTRACT:

Background

SARS-CoV-2 infection has been associated with increased risk of adverse perinatal health outcomes. However, few large-scale, community-based epidemiological studies have been conducted.

Methods

We conducted a national cohort study using de-identified administrative claims data for 78,283 pregnancies with estimated conception before 30 April 2020 and pregnancy end after 11 March 2020. We identified maternal infections using diagnostic and laboratory testing data. We compared the risk of pregnancy outcomes using Cox proportional hazard models treating COVID-19 as a time-varying exposure and adjusting for baseline covariates.

Results

2,655 (3.4%) pregnancies had a documented SARS-CoV-2 infection; 3.4% required admission to intensive care, invasive mechanical ventilation or ECMO treatment. COVID-19 during pregnancy was not associated with risk of miscarriage, antepartum hemorrhage, or stillbirth, but was associated with 2-3 fold higher risk of induced abortion (adjusted hazard ratio [aHR] 2.60, 95% CI 1.17-5.78), c-section (aHR 1.99, 95% CI 1.71-2.31), clinician-initiated preterm birth (2.88; 95% CI 1.93, 4.30), spontaneous preterm birth (aHR 1.79, 95% CI 1.37-2.34), fetal growth restriction (aHR 2.04, 95% CI 1.72-2.43), and postpartum hemorrhage (aHR 2.03, 95% CI 1.6-2.63).

Conclusions

Prenatal SARS-CoV-2 infection was associated with increased risk of adverse pregnancy outcomes. Prevention could have fetal health benefits.

SUBMITTER: Regan AK

PROVIDER: S-EPMC8755310 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:The aim of this study is to review the currently available data, and to explore the association of infection with different severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants during pregnancy with maternal and perinatal outcomes in the real world. Observational cohort studies were analyzed that described the maternal and perinatal outcomes of infection with different SARS-CoV-2 variants during pregnancy. Random-effects inverse-variance models were used to evaluate the pooled prevalence (PP) and its 95% confidence interval (CI) for maternal and perinatal outcomes. Random effects were used to estimate the pooled odds ratios (OR) and their 95% CI for different outcomes between Delta and pre-Delta periods, and between Omicron and Delta periods. Eighteen studies, involving a total of 133,058 cases of SARS-CoV-2 infection during pregnancy (99,567 cases of SARS-CoV-2 wild type or pre-variant infection and 33,494 cases of SARS-CoV-2 variant infections), were included in this meta-analysis. Among pregnant women with SARS-CoV-2 infections, the PPs for required respiratory support, severe or critical illness, intensive care unit (ICU) admission, maternal death, and preterm birth <37 weeks were, respectively, 27.24% (95%CI, 20.51-33.97%), 24.96% (95%CI, 15.96-33.96%), 11.31% (95%CI, 4.00-18.61%), 4.20% (95%CI, 1.43-6.97%), and 33.85% (95%CI, 21.54-46.17%) in the Delta period, which were higher than those in the pre-Delta period, while the corresponding PPs were, respectively, 10.74% (95%CI, 6.05-15.46%), 11.99% (95%CI, 6.23-17.74%), 4.17% (95%CI, 1.53-6.80%), 0.63% (95%CI, 0.05-1.20%), and 18.58% (95%CI, 9.52-27.65%). The PPs for required respiratory support, severe or critical illness, and ICU admission were, respectively, 2.63% (95%CI, 0.98-4.28%), 1.11% (95%CI, 0.29-1.94%), and 1.83% (95%CI, 0.85-2.81%) in the Omicron period, which were lower than those in the pre-Delta and Delta periods. These results suggest that Omicron infections are associated with less severe maternal and neonatal adverse outcomes, though maternal ICU admission, the need for respiratory support, and preterm birth did also occur with Omicron infections. Since Omicron is currently the predominant strain globally, and has the highest rates of transmission, it is still important to remain vigilant in protecting the vulnerable populations of mothers and infants. In particular, obstetricians and gynecologists should not ignore the adverse risks of maternal ICU admission, respiratory support, and preterm births in pregnant patients with SARS-CoV-2 infections, in order to protect the health of mothers and infants.

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