First- or Second Trimester SARS-CoV-2 Infection and Subsequent Pregnancy Outcomes

Authors

Brenna L Hughes
Grecio J Sandoval
Torri D Metz
Rebecca G Clifton
William A Grobman
George R Saade
Tracy A Manuck
Monica Longo
Amber Sowles
Kelly Clark
Hyagriv N Simhan
Dwight J Rouse
Hector Mendez-Figueroa
Cynthia Gyamfi-Bannerman
Jennifer Bailit
Maged M Costantine
Harish M Sehdev
Alan T N Tita
George A Macones

Publication Date

2-1-2023

Journal

American Journal of Obstetrics & Gynecology

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 atdeath, preterm birth atgestation, hypertensive disorders of pregnancy (HDP), any major congenital malformation, and size for gestational age offeatures, both overall and with delivery atgestation.

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(19.6% vs 13.8%; adjusted relative risk, 1.29; 95% confidence interval, 1.02-1.63), and HDP with delivery at(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 atgestation, any major congenital malformation, and size for gestational age ofaddition, 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.

Keywords

COVID-19, fetal or neonatal death, hypertensive disorders of pregnancy, pregnancy, preterm birth, SARS-CoV-2 infection