First or second trimester SARS-CoV-2 infection and subsequent pregnancy outcomes

Brenna L. Hughes, Departments of Obstetrics and Gynecology of the University of North Carolina at Chapel Hill, Chapel Hill, NC.
Grecio J. Sandoval, the George Washington University Biostatistics Center, Washington, DC.
Torri D. Metz, University of Utah Health, Salt Lake City, UT.
Rebecca G. Clifton, the George Washington University Biostatistics Center, Washington, DC.
William A. Grobman, Northwestern University, Chicago, IL.
George R. Saade, University of Texas Medical Branch, Galveston, TX.
Tracy A. Manuck, Departments of Obstetrics and Gynecology of the University of North Carolina at Chapel Hill, Chapel Hill, NC.
Monica Longo, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD.
Amber Sowles, University of Utah Health, Salt Lake City, UT.
Kelly Clark, Departments of Obstetrics and Gynecology of the University of North Carolina at Chapel Hill, Chapel Hill, NC.
Hyagriv N. Simhan, University of Pittsburgh, Pittsburgh, PA.
Dwight J. Rouse, Brown University, Providence, RI.
Hector Mendez-Figueroa, University of Texas Health Science Center at Houston, Children's Memorial Hermann Hospital, Houston, TX.
Cynthia Gyamfi-Bannerman, Columbia University, New York, NY.
Jennifer Bailit, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH.
Maged M. Costantine, Ohio State University, Columbus, OH.
Harish M. Sehdev, University of Pennsylvania, Philadelphia, PA.
Alan T. Tita, University of Alabama at Birmingham, Birmingham, AL.
George A. Macones, University of Texas at Austin, Austin, TX.

Document Type

Journal Article

Publication Date

8-12-2022

Journal

American journal of obstetrics and gynecology

DOI

10.1016/j.ajog.2022.08.009

Keywords

COVID-19; SARS-CoV-2 infection; fetal/neonatal death; hypertensive disorder of pregnancy; pregnancy; preterm birth

Abstract

BACKGROUND: SARS-CoV2 infection during pregnancy is associated with adverse pregnancy outcomes including fetal death and preterm birth. It is not known whether that risk occurs only during the time of acute infection or whether risk persists later in pregnancy. OBJECTIVE: The goal of this analysis was to evaluate whether the risk of SARS-CoV-2 infection during pregnancy persists after acute maternal illness. STUDY DESIGN: A retrospective cohort study of pregnant patients with and without SARS-CoV2 infection delivering at 17 hospitals in the United States between March and December 2020. Patients experiencing a SARS-CoV-2 positive test at or prior to 28 weeks' gestation with a subsequent delivery hospitalization were compared with those without a positive SAR-CoV-2 test at the same hospitals with randomly selected delivery days during the same period. Deliveries occurring <20 weeks' gestation in both groups were excluded. Study outcomes included fetal or neonatal death, preterm birth less than 37 weeks' gestation and less than 34 weeks' gestation, hypertensive disorders of pregnancy, any major congenital malformation, and size for gestational age less than 5 or 10 percentiles at birth based on published standards. Hypertensive disorders of pregnancy that were collected included hypertensive disorders of pregnancy and preeclampsia with severe features, both overall and with delivery <37 weeks' gestation. RESULTS: Of 2,326 patients who tested positive for SARS-CoV-2 during pregnancy and were at least 20 weeks' gestation at delivery from March through December 2020, 402 patients (delivering 414 fetuses/neonates) were SARS-CoV-2 positive before 28 weeks' gestation and prior to their admission for delivery; they were compared to 11,705 patients without a positive SARS-CoV-2 test. In adjusted analyses, those with SARS-CoV-2 prior to 28 weeks' had a subsequent increased risk of fetal/neonatal death [2·9% vs 1·5%, adjusted relative risk (aRR) 1·97, 95% confidence interval (CI),1·01 - 3·85], preterm birth <37 weeks' (19·6% vs 13·8%, aRR, 1·29; 95%CI, 1·02 - 1·63) and hypertensive disorders of pregnancy with delivery less than 37 weeks' gestation (7·2% vs 4·1%, aRR 1·74, 95% CI 1·19-2·55). There were no significant differences in the rates of preterm birth <34 weeks', any major congenital malformation, size for gestational age less than the 5 or 10 percentiles. There were also no significant differences in the rate of gestational hypertension overall or in preeclampsia with severe features. CONCLUSION: There is a modest increase in risk of adverse pregnancy outcomes subsequent to SARS-CoV-2 infection.

Department

Biostatistics and Bioinformatics

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