Association of SARS-CoV-2 Infection With Serious Maternal Morbidity and Mortality From Obstetric Complications

Metz, Torri D.; Clifton, Rebecca G.; Hughes, Brenna L.; Sandoval, Grecio; Grobman, William A.; Saade, George R.; Manuck, Tracy A.; Longo, Monica; Sowles, Amber; Clark, Kelly; Simhan, Hyagriv N.; Rouse, Dwight J.; Mendez‐Figueroa, Hector; Gyamfi-Bannerman, Cynthia; Bailit, Jennifer L.; Costantine, Maged M.; Sehdev, Harish M.; Tita, Alan T.N.; Macones, George A.; Bickus, M.; Facco, Francesca; Grant, Janatha S.; Leath, Amy M.; Bartholomew, Anna; Landon, Mark B.; Rood, Kara M.; Schneider, Patrick; Frey, Heather A.; Nelson, Amanda L.; Esplin, Sean; Varner, Michael W.; Allard, Donna; Rousseau, Janet; Milano, J.; Early, Lisa; Bousleiman, Sabine; Wapner, Ronald J.; Sutton, Desmond; Manchon, Haley; Salazar, Ashley H.; Pacheco, Luis D.; Clark, Shannon; Harirah, Hassan; Jain, Sangeeta; Olson, Gayle; Saad, Antonio F.; Allen, Lindsey; Carrington, Guillermina; Cornwell, Jennifer; DeVolder, Jennifer; Dalton, Wendy; Tyhulski, Amanda; Mayle, Ashley; Chauhan, Suneet P.; Ortiz, Felecia; Thorp, John M.; Timlin, S.; Fried, Lena; Byers, Hannah; Ferrara, Jennifer; Williams, Aimee; Mallett, Gail; Ramos-Brinson, M.; Parry, Samuel; McCabe, Meaghan; Fazio, Christina; Filipczak, Anna; Craig, Jennifer; Muzzarelli, Lucia; Roche, Abigail; Thom, Elizabeth; Nwachuku, Crystal; Flowers-Fanomezantsoa, V. Lynn; Miodovnik, Menachem; Archer, Stephanie Wilson

doi:10.1001/jama.2022.1190

Cited by 195 publications

(195 citation statements)

References 26 publications

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“…Apgar score < 7 at 5' Recent studies have shown that pregnant women are more likely to develop asymptomatic SARS-COV-2 infections than non-pregnant women, but this does not exempt them from experiencing obstetric and neonatal complications due to this infection [5,6,14]. The most frequent symptoms reported in this study were coryza, cough, loss of smell and taste, headache, and fever, corroborating the findings of Allotey et al, who reported fever and cough [7].…”

Section: Discussionsupporting

confidence: 87%

“…It is important to note that the frequency of unfavorable outcomes was higher in the group of patients exposed to the virus, who showed a higher incidence of cesarean section, premature delivery, admission to NICU, need for resuscitation, neonatal jaundice, and need for phototherapy, which despite not being statistically significant, corroborates the literature, similar to the results of Metz et al, Chmielewska et al, Litman et al, and Chinn et al, which showed higher rates of maternal death, clinical complications, fetal loss, ectopic pregnancy, maternal depression and premature birth associated to SARS-CoV-2 infection [4,5,8,19].…”

Section: Plos Onesupporting

confidence: 88%

“…Data on SARS-CoV-2 infection during pregnancy have been extensively studied, but scientific consensus has yet to be achieved [4]. Different findings regarding obstetric and neonatal consequences of this infection during various phases of pregnancy highlight the need to better understand this specific population [5][6][7]. An observational cohort study including 683,905 women from 2022 showed that SARS-CoV-2 infection during pregnancy was associated with preterm birth, preeclampsia, and several other clinical complications, but was not associated with a higher incidence of stillbirths [4].…”

Section: Introductionmentioning

confidence: 99%

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SARS-CoV-2 infection in pregnant women assisted in a high-risk maternity hospital in Brazil: Clinical aspects and obstetric outcomes

et al. 2022

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Background The spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, the possible development of serious illness, and the possibility of severe obstetric outcomes highlight the importance of addressing SARS-CoV-2 infection in obstetric management. Methods and findings A cross-sectional study of pregnant women assisted in a high-risk maternity hospital in Brazil in 2020. All patients admitted for delivery or miscarriage care were tested for SARS-CoV-2 using polymerase chain reaction (PCR) and for immunoglobulin (I)gM, and/or IgG by immunochromatography. Clinical aspects and obstetric outcomes were analyzed. A total of 265 pregnant women were included in the study. There were 38 (14.4%) PCR positive cases during pregnancy, 12 (31.6%) on admission screening, and 71(27.2%) patients were IgM- and/or IgG-positive. Among the participants, 86 (32.4%) had at least one positive test during pregnancy. SARS-CoV-2 positive patients had greater contact with known positive patients (p = 0.005). The most frequently reported symptoms were runny nose, cough, loss of smell and taste, headache, and fever. There was also a 35% rate of asymptomatic infections and a 4.6% rate of severe or critical infections. Patients exposed or infected with SARS-CoV-2 had a higher incidence of preterm delivery, cesarean section, need for resuscitation in the delivery room, Apgar score <7 at 5 min, admission to the neonatal intensive care unit, and jaundice. Newborns with at least one positive test had a significantly greater need for phototherapy after delivery (p = 0.05). The results showed a high rate of positive tests among newborns (37.5%), which seems to be compatible with both neonatal and perinatal infection. Conclusions It is important to further investigate SARS-CoV-2 infection during pregnancy, including the clinical course and the possibility of adverse outcomes with impact on maternal and fetal health, regardless of the development of symptoms.

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Section: Discussionsupporting

confidence: 87%

Section: Plos Onesupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

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SARS-CoV-2 infection in pregnant women assisted in a high-risk maternity hospital in Brazil: Clinical aspects and obstetric outcomes

et al. 2022

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“…An increasing body of evidence demonstrates that pregnant persons with SARS-CoV-2 infection are at higher risk of severe COVID-19 including hospitalization, intensive care, mechanical ventilation, and death 1-3 . Furthermore, adverse perinatal outcomes such as increased risk of preterm birth, preeclampsia, and stillbirth have been observed with SARS-CoV-2 infection in pregnancy, particularly in the setting of moderate-severe disease 1 3-6 . COVID-19 vaccines have been granted Emergency Use Authorization by the U.S. Food and Drug Administration, although pregnant persons were excluded from published phase three vaccine trials.…”

Section: Introductionmentioning

confidence: 99%

Maternal Antibody Response and Transplacental Transfer Following SARS-CoV-2 Infection or Vaccination in Pregnancy

Otero

Sunderraj

Shanes

et al. 2022

Preprint

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Background: Pregnant persons are at increased risk of severe COVID-19 and adverse obstetric outcomes. Understanding maternal antibody response and transplacental transfer after SARS-CoV-2 infection and COVID-19 vaccination is important to inform public health recommendations. Methods: This prospective observational cohort study included 351 birthing individuals who had SARS-CoV-2 infection or COVID-19 vaccination during pregnancy. IgG and IgM to SARS-CoV-2 S1 receptor binding domain were measured in maternal and cord blood. Antibody levels and transplacental transfer ratios were compared across 1) disease severity for those with SARS-CoV-2 infection and 2) infection versus vaccination. Findings: There were 252 individuals with SARS-CoV-2 infection and 99 who received COVID-19 vaccination during pregnancy. Birthing people with more severe SARS-CoV-2 infection category had higher maternal and cord blood IgG levels (p=0.0001, p=0.0001). Median IgG transfer ratio was 0.87-1.2. Maternal and cord blood IgG were higher after vaccination than infection (p=0.001, p=0.001). Transfer ratio was higher after 90 days in the vaccinated group (p<0.001). Modeling showed higher amplitude and half-life of maternal IgG following vaccination (p<0.0001). There were no significant differences by fetal sex. Interpretation: COVID-19 vaccination in pregnancy leads to higher and longer lasting maternal IgG levels, higher cord blood IgG, and higher transfer ratio after 90 days compared to SARS-CoV-2 infection. Greater infection severity leads to higher maternal and cord blood antibodies. Maternal IgG decreases over time following both vaccination and infection, reinforcing the importance of vaccination, even after infection, and vaccine boosters for pregnant patients.

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“…Wir haben in unserem Update wiederholt auf die Gefahren einer COVID-19-Erkrankung in der Schwangerschaft hingewiesen. Eine retrospektive Kohortenstudie erhob mütterliche und neonatale Sterbefälle, die Inzidenz hypertensiver Entgleisungen, postpartale Blutungen, Infektionen während und unmittelbar nach Schwangerschaft bei 14.104 PCR-positiven Patientinnen aus 17 US-Spitälern und verglich diese mit COVID-negativen Schwangeren [ 8 ]. Das Risiko, zu sterben, eine hypertensive Entgleisung zu erfahren, postpartal stärker zu bluten oder eine Infektion zu bekommen, war für infizierte Mütter signifikant erhöht.…”

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Corona-Update: Aktuelle Studien zu SARS-CoV-2

Hasibeder

2022

Anästhesie Nachr

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Association of SARS-CoV-2 Infection With Serious Maternal Morbidity and Mortality From Obstetric Complications

Abstract: IMPORTANCEIt remains unknown whether SARS-CoV-2 infection specifically increases the risk of serious obstetric morbidity.OBJECTIVE To evaluate the association of SARS-CoV-2 infection with serious maternal morbidity or mortality from common obstetric complications.

Cited by 195 publications

References 26 publications

SARS-CoV-2 infection in pregnant women assisted in a high-risk maternity hospital in Brazil: Clinical aspects and obstetric outcomes

SARS-CoV-2 infection in pregnant women assisted in a high-risk maternity hospital in Brazil: Clinical aspects and obstetric outcomes

Maternal Antibody Response and Transplacental Transfer Following SARS-CoV-2 Infection or Vaccination in Pregnancy

Corona-Update: Aktuelle Studien zu SARS-CoV-2

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