Does being infected with SARS-CoV-2 in the first-trimester increase the risk of miscarriage?

Kiremitli, Sevil; Kiremitli, Tunay; Ulug, Pasa; Kirkinci, Ahmet; Kurnuc, Fatma Zehra; Yılmaz, Nesrin Helvacı; Dinç, Kemal; Yilmaz, Betul; Gül, Özlem; Uzel, Kemine

doi:10.1590/0001-3765202220211283

Cited by 4 publications

(2 citation statements)

References 33 publications

(26 reference statements)

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“…included women infected before gestational week 20. 20 , 22 Eleven articles focused on maternal and obstetric outcomes, 2 , 19 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 whereas seven focused on neonatal outcomes only. 16 , 20 , 21 , 22 , 32 , 33 , 34 For the diagnosis of SARS‐CoV‐2 infection, all but six studies relied exclusively on clinically confirmed reverse transcription polymerase chain reaction, whereas two relied on self‐reported data on infection and four studies also included pregnant women with positive antibody serology (Table 1 ).…”

Section: Resultsmentioning

confidence: 99%

“…Of the 18 studies included in this review, 12 were retrospective, including 10 cohort studies and two case-control studies, and six were prospective cohort studies, including a total of 10 147 COVID- fore gestational week 20. 20,22 Eleven articles focused on maternal and obstetric outcomes, 2,19,[23][24][25][26][27][28][29][30][31] whereas seven focused on neonatal outcomes only. 16,[20][21][22][32][33][34] For the diagnosis of SARS-CoV-2 infection, all but six studies relied exclusively on clinically confirmed reverse transcription polymerase chain reaction, whereas two relied on self-reported data on infection and four studies also included pregnant women with positive antibody serology (Table 1).…”

Section: General Characteristics Of the Studiesmentioning

confidence: 99%

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Outcomes of SARS‐CoV‐2 infection in early pregnancy—A systematic review and meta‐analysis

Rodriguez‐Wallberg,

Nilsson,

Røthe

et al. 2024

Acta Obstet Gynecol Scand

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IntroductionAvailable data on severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection and pregnancy outcomes mostly refer to women contracting the infection during advanced pregnancy or close to delivery. There is limited information on the association between SARS‐CoV‐2 infection in early pregnancy and outcomes thereof.Material and methodsWe aimed to systematically review the maternal, fetal and neonatal outcomes following SARS‐CoV‐2 infection in early pregnancy, defined as <20 weeks of gestation (PROSPERO Registration 2020 CRD42020177673). Searches were carried out in PubMed, Medline, EMBASE, and Scopus databases from January 2020 until April 2023 and the WHO database of publications on coronavirus disease 2019 (COVID‐19) from December 2019 to April 2023. Cohort and case–control studies on COVID‐19 occurring in early pregnancy that reported data on maternal, fetal, and neonatal outcomes were included. Case reports and studies reporting only exposure to SARS‐CoV‐2 or not stratifying outcomes based on gestational age were excluded. Data were extracted in duplicate. Meta‐analyses were conducted when appropriate, using R meta (R version 4.0.5).ResultsA total of 18 studies, 12 retrospective and six prospective, were included in this review, reporting on 10 147 SARS‐CoV‐2‐positive women infected in early pregnancy, 9533 neonates, and 180 882 SARS‐CoV‐2 negative women. The studies had low to moderate risk of bias according to the Newcastle–Ottawa quality assessment Scale. The studies showed significant clinical and methodological heterogeneity. A meta‐analysis could be performed only on the outcome miscarriage rate, with a pooled random effect odds ratio of 1.44 (95% confidence interval 0.96–2.18), showing no statistical difference in miscarriage in SARS‐CoV‐2‐infected women. Individual studies reported increased incidences of stillbirth, low birthweight and preterm birth among neonates born to mothers affected by COVID‐19 in early pregnancy; however, these results were not consistent among all studies.ConclusionsIn this comprehensive systematic review of available evidence, we identified no statistically significant adverse association between SARS‐CoV‐2 infection in early pregnancy (before 20 weeks of gestation) and fetal, neonatal, or maternal outcomes. However, a 44% increase in miscarriage rate is concerning and further studies of larger sample size are needed to confirm or refute our findings.

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Section: Resultsmentioning

confidence: 99%

Section: General Characteristics Of the Studiesmentioning

confidence: 99%

Outcomes of SARS‐CoV‐2 infection in early pregnancy—A systematic review and meta‐analysis

Rodriguez‐Wallberg,

Nilsson,

Røthe

et al. 2024

Acta Obstet Gynecol Scand

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Bioinformatics-based analysis of the dialog between COVID-19 and RSA

Bi,

Li,

Zhang

et al. 2024

Heliyon

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COVID-19 in pregnant women: a systematic review and meta-analysis on the risk and prevalence of pregnancy loss

van Baar,

Kostova,

Allotey

et al. 2023

Human Reproduction Update

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BACKGROUND Pregnant women infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are more likely to experience preterm birth and their neonates are more likely to be stillborn or admitted to a neonatal unit. The World Health Organization declared in May 2023 an end to the coronavirus disease 2019 (COVID-19) pandemic as a global health emergency. However, pregnant women are still becoming infected with SARS-CoV-2 and there is limited information available regarding the effect of SARS-CoV-2 infection in early pregnancy on pregnancy outcomes. OBJECTIVE AND RATIONALE We conducted this systematic review to determine the prevalence of early pregnancy loss in women with SARS-Cov-2 infection and compare the risk to pregnant women without SARS-CoV-2 infection. SEARCH METHODS Our systematic review is based on a prospectively registered protocol. The search of PregCov19 consortium was supplemented with an extra electronic search specifically on pregnancy loss in pregnant women infected with SARS-CoV-2 up to 10 March 2023 in PubMed, Google Scholar, and LitCovid. We included retrospective and prospective studies of pregnant women with SARS-CoV-2 infection, provided that they contained information on pregnancy losses in the first and/or second trimester. Primary outcome was miscarriage defined as a pregnancy loss before 20 weeks of gestation, however, studies that reported loss up to 22 or 24 weeks were also included. Additionally, we report on studies that defined the pregnancy loss to occur at the first and/or second trimester of pregnancy without specifying gestational age, and for second trimester miscarriage only when the study presented stillbirths and/or foetal losses separately from miscarriages. Data were stratified into first and second trimester. Secondary outcomes were ectopic pregnancy (any extra-uterine pregnancy), and termination of pregnancy. At least three researchers independently extracted the data and assessed study quality. We calculated odds ratios (OR) and risk differences (RDs) with corresponding 95% CI and pooled the data using random effects meta-analysis. To estimate risk prevalence, we performed meta-analysis on proportions. Heterogeneity was assessed by I2. OUTCOMES We included 120 studies comprising a total of 168 444 pregnant women with SARS-CoV-2 infection; of which 18 233 women were in their first or second trimester of pregnancy. Evidence level was considered to be of low to moderate certainty, mostly owing to selection bias. We did not find evidence of an association between SARS-CoV-2 infection and miscarriage (OR 1.10, 95% CI 0.81–1.48; I2 = 0.0%; RD 0.0012, 95% CI −0.0103 to 0.0127; I2 = 0%; 9 studies, 4439 women). Miscarriage occurred in 9.9% (95% CI 6.2–14.0%; I2 = 68%; 46 studies, 1797 women) of the women with SARS CoV-2 infection in their first trimester and in 1.2% (95% CI 0.3–2.4%; I2 = 34%; 33 studies; 3159 women) in the second trimester. The proportion of ectopic pregnancies in women with SARS-CoV-2 infection was 1.4% (95% CI 0.02–4.2%; I2 = 66%; 14 studies, 950 women). Termination of pregnancy occurred in 0.6% of the women (95% CI 0.01–1.6%; I2 = 79%; 39 studies; 1166 women). WIDER IMPLICATIONS Our study found no indication that SARS-CoV-2 infection in the first or second trimester increases the risk of miscarriages. To provide better risk estimates, well-designed studies are needed that include pregnant women with and without SARS-CoV-2 infection at conception and early pregnancy and consider the association of clinical manifestation and severity of SARS-CoV-2 infection with pregnancy loss, as well as potential confounding factors such as previous pregnancy loss. For clinical practice, pregnant women should still be advised to take precautions to avoid risk of SARS-CoV-2 exposure and receive SARS-CoV-2 vaccination.

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Does being infected with SARS-CoV-2 in the first-trimester increase the risk of miscarriage?

Cited by 4 publications

References 33 publications

Outcomes of SARS‐CoV‐2 infection in early pregnancy—A systematic review and meta‐analysis

Outcomes of SARS‐CoV‐2 infection in early pregnancy—A systematic review and meta‐analysis

Bioinformatics-based analysis of the dialog between COVID-19 and RSA

COVID-19 in pregnant women: a systematic review and meta-analysis on the risk and prevalence of pregnancy loss

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