First- or second-trimester SARS-CoV-2 infection and subsequent pregnancy outcomes - 24/01/23
, Grecio J. Sandoval, PhD n, Torri D. Metz, MD b, Rebecca G. Clifton, PhD n, William A. Grobman, MD c, George R. Saade, MD d, Tracy A. Manuck, MD, MS a, Monica Longo, MD o, Amber Sowles, BSN b, Kelly Clark, BSN a, Hyagriv N. Simhan, MD e, Dwight J. Rouse, MD f, Hector Mendez-Figueroa, MD g, Cynthia Gyamfi-Bannerman, MD h, Jennifer Bailit, MD i, Maged M. Costantine, MD j, Harish M. Sehdev, MD k, Alan T.N. Tita, MD l, George A. Macones, MD mOn behalf of the
Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network
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Abstract |
Background |
SARS-CoV-2 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 the risk persists later in pregnancy.
Objective |
This study aimed to evaluate whether the risk of SARS-CoV-2 infection during pregnancy persists after an acute maternal illness.
Study Design |
A retrospective cohort study of pregnant patients with and without SARS-CoV-2 infection delivering at 17 hospitals in the United States between March 2020 and December 2020. Patients experiencing a SARS-CoV-2–positive test at or before 28 weeks of 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 at <20 weeks of gestation in both groups were excluded. The study outcomes included fetal or neonatal death, preterm birth at <37 weeks of gestation and <34 weeks of gestation, hypertensive disorders of pregnancy (HDP), any major congenital malformation, and size for gestational age of <5th or <10th percentiles at birth based on published standards. HDP that were collected included HDP and preeclampsia with severe features, both overall and with delivery at <37 weeks of gestation.
Results |
Of 2326 patients who tested positive for SARS-CoV-2 during pregnancy and were at least 20 weeks of gestation at delivery from March 2020 to December 2020, 402 patients (delivering 414 fetuses or neonates) were SARS-CoV-2 positive before 28 weeks of gestation and before their admission for delivery; they were compared with 11,705 patients without a positive SARS-CoV-2 test. In adjusted analyses, those with SARS-CoV-2 before 28 weeks of gestation had a subsequent increased risk of fetal or neonatal death (2.9% vs 1.5%; adjusted relative risk, 1.97; 95% confidence interval, 1.01–3.85), preterm birth at <37 weeks of gestation (19.6% vs 13.8%; adjusted relative risk, 1.29; 95% confidence interval, 1.02–1.63), and HDP with delivery at <37 weeks of gestation (7.2% vs 4.1%; adjusted relative risk, 1.74; 95% confidence interval, 1.19–2.55). There was no difference in the rates of preterm birth at <34 weeks of gestation, any major congenital malformation, and size for gestational age of <5th or <10th percentiles. In addition, there was no significant difference in the rate of gestational hypertension overall or preeclampsia with severe features.
Conclusion |
There was a modest increase in the risk of adverse pregnancy outcomes after SARS-CoV-2 infection.
Le texte complet de cet article est disponible en PDF.Key words : COVID-19, fetal or neonatal death, hypertensive disorders of pregnancy, pregnancy, preterm birth, SARS-CoV-2 infection
Plan
| A list of the full members of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network is available in the Acknowledgments. |
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| This study was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (grant numbers UG1HD087230, UG1HD027869, UG1HD027915, UG1HD034208, UG1HD040500, UG1HD040485, UG1HD053097, UG1HD040544, UG1HD040545, UG1HD040560, UG1HD040512, UG1HD087192, and U10HD036801) and the National Center for Advancing Translational Sciences (grant number UL1TR001873). |
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| The authors report no conflict of interest. |
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| Deidentified data and a data dictionary will be available to others through the NICHD Data and Specimen Hub (DASH) within 1 year of publication. Access to data will follow requirements in place through DASH. |
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| Cite this article as: Hughes BL, Sandoval GJ, Metz TD, et al. First- or second-trimester SARS-CoV-2 infection and subsequent pregnancy outcomes. Am J Obstet Gynecol 2023;228:226.e1-9. |
Vol 228 - N° 2
P. 226.e1-226.e9 - février 2023 Retour au numéro
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