Background To determine whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, the cause of COVID-19 disease) exposure in pregnancy, compared to non-exposure, is associated with infection-related obstetric morbidity. Methods We conducted a multicentre prospective study in pregnancy based on a universal antenatal screening program for SARS-CoV-2 infection. Throughout Spain 45 hospitals tested all women at admission on delivery ward using polymerase-chain-reaction (PCR) for COVID-19 since late March 2020. The cohort of positive mothers and the concurrent sample of negative mothers was followed up until 6-weeks post-partum. Multivariable logistic regression analysis, adjusting for known confounding variables, determined the adjusted odds ratio (aOR) with 95% confidence intervals (95% CI) of the association of SARS-CoV-2 infection and obstetric outcomes. Main outcome measures: Preterm delivery (primary), premature rupture of membranes and neonatal intensive care unit admissions. Results Among 1009 screened pregnancies, 246 were SARS-CoV-2 positive. Compared to negative mothers (763 cases), SARS-CoV-2 infection increased the odds of preterm birth (34 vs 51, 13.8% vs 6.7%, aOR 2.12, 95% CI 1.32–3.36, p = 0.002); iatrogenic preterm delivery was more frequent in infected women (4.9% vs 1.3%, p = 0.001), while the occurrence of spontaneous preterm deliveries was statistically similar (6.1% vs 4.7%). An increased risk of premature rupture of membranes at term (39 vs 75, 15.8% vs 9.8%, aOR 1.70, 95% CI 1.11–2.57, p = 0.013) and neonatal intensive care unit admissions (23 vs 18, 9.3% vs 2.4%, aOR 4.62, 95% CI 2.43–8.94, p <  0.001) was also observed in positive mothers. Conclusion This prospective multicentre study demonstrated that pregnant women infected with SARS-CoV-2 have more infection-related obstetric morbidity. This hypothesis merits evaluation of a causal association in further research.

Research Question: Is there an association between SARS-CoV-2 infection and firsttrimester miscarriage?Design: Multicenter prospective study of a cohort of first-trimester miscarriages registered consecutively by seven Spanish hospitals, where universal PCR screening for SARS-CoV-2 infection was implemented for both, miscarriages and deliveries. The incidence of SARS-CoV-2 infection among first-trimester miscarriages was compared to the one registered in women at admission on delivery ward within the same timeframe using a mixed-effects Poisson regression analysis, considering hospital as random effect. On the other hand, the characteristics of SARS-CoV-2 positive and negative patients who miscarried were compared through two-sided univariable analyses.Results: 301 miscarriages were registered, 11 (3.7%) SARS-CoV-2 infected and 290 non-infected. No differences in terms of SARS-CoV-2 infection incidence were observed between miscarriages and deliveries [1,936 deliveries were registered at the same time of miscarriages and 44 (2.3%) were SARS-CoV-2 infected] (p= 0.233). Regarding the differences observed between SARS-CoV-2 positive and negative patient miscarriages, more inevitable miscarriages occurred in the group of infected women (36.4% vs 16.5% in non-infected, p= 0.004), as well as more surgical management of miscarriages (27.3% vs 8.2% in non-infected, p= 0.036), which is probably in line with the greater number of inevitable miscarriages observed in this group.Conclusions: No association between SARS-CoV-2 infection and risk of first-trimester miscarriage has been observed; however, the type of miscarriage seems to be different between SARS-CoV-2 positive and negative women, with inevitable miscarriage being more frequent among infected women.

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