Clinical Implications of SARS-CoV-2 Infection in the Viable Preterm Period

Abstract

<jats:p> Objective This study aimed to determine the rate of preterm birth (PTB) during hospitalization among women diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) between 23 and 37 weeks of gestation and whether this rate differs by gestational age at diagnosis of infection.</jats:p><jats:p> Study Design Retrospective, cross-sectional study of all women diagnosed with SARS-CoV-2 infection between 23 and 37 weeks of gestation within a large integrated health system from March 13 to April 24, 2020. Cases with severe fetal structural malformations detected prior to infection were excluded. Women were stratified into two groups based on gestational age at diagnosis: early preterm (230/7 to 336/7 weeks) versus late preterm (34 to 366/7 weeks). We compared the rate of PTB during hospitalization with infection between the two groups. Statistical analysis included use of Wilcoxon rank sum and Fisher exact tests, as well as a multivariable logistic regression. Statistical significance was defined as a p-value &lt;0.05.</jats:p><jats:p> Results Of the 65 patients included, 36 (53.7%) were diagnosed in the early preterm period and 29 (46.3%) were diagnosed in the late preterm period. Baseline demographics were similar between groups. The rate of PTB during hospitalization with infection was significantly lower among women diagnosed in the early preterm period compared with late preterm (7/36 [19.4%] vs. 18/29 [62%], p-value = 0.001). Of the 25 patients who delivered during hospitalization with infection, the majority were indicated deliveries (64%, 16/25). There were no deliveries &lt;33 weeks of gestation for worsening coronavirus disease 2019 and severity of disease did not alter the likelihood of delivery during hospitalization with SARS-CoV-2 infection (adjusted odds ratio [aOR]: 0.64; 95% confidence interval [CI]: 0.24–1.59). Increased maternal age was associated with a lower likelihood of delivery during hospitalization with SARS-CoV-2 infection (aOR: 0.77; 95% CI: 0.58–0.96), while later gestational age at diagnosis of infection was associated with a higher likelihood of delivery during hospitalization (aOR: 2.9; 95% CI: 1.67–8.09).</jats:p><jats:p> Conclusion The likelihood of PTB during hospitalization with SARS-CoV-2 infection is significantly lower among women diagnosed in the early preterm period compared with late preterm. Most women with SARS-CoV-2 infection in the early preterm period recovered and were discharged home. The majority of PTB were indicated and not due to spontaneous preterm labor.</jats:p><jats:p> Key Points </jats:p>

The Profile of the Obstetric Patients with SARS-CoV-2 Infection According to Country of Origin of the Publication: A Systematic Review of the Literature

“…Figure 1 presents the flow chart of the SR. Of the articles identified in the 2 databases, a total of 38 articles [ 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 ] were included in this systematic review with 2670 patients proceeding from 7 countries (China, United States of America (USA), France, United Kingdom (UK), Spain, Italy, and Portugal).…”

“…All of them were published in 2020, with a maximum recruitment period of 3 months [ 21 ]. The first patient recruited in China was on 8 December 2019 [ 21 ] and the last on 24 March 2020 [ 22 ], while in the USA, the first patient was recruited on 21 January 2020 [ 45 ] and the last was on 24 April 2020 [ 43 ]. From the total articles, 34 (89.5%) were a case series and 20 (52.6%) were conducted in a single center.…”

“…UK, similar to Italy and Spain, only provides 2 works (5.6%), within a total of 450 patients (16.9% of the total series), collecting the last patient recruited on 30 April of 2020 [ 43 ]. Although the median maternal age in this country is the lowest (29.8 years), it is the second country following Italy (14.6%) with the highest maternal admission in the ICU, and after China (83.9%) in the proportion of C-sections (71.9%).…”

“…In addition, the publications included in this review come mainly from the cities or geographic areas most affected by the pandemic within each of the countries, such as is the case of Wuhan, China, the east coast of the USA, or Madrid in Spain. Furthermore, data collected in this systematic review guide us in noticing that patients have been recruited during the first wave in these 7 countries, firstly because of the short recruitment period (maximum 3 months in the work conducted by Chen et al [ 21 ] and the final date of the collection period, at the end of April in the work conducted by Antoun et al [ 43 ].…”

Pregnancy and Breastfeeding During COVID-19 Pandemic: A Systematic Review of Published Pregnancy Cases

“…From the 161 studies included, 66 were case series reports (48% from China and 23% from USA) (11-76), 59 case reports (27% from China and 25% from USA) (77-135), 20 cohort studies (30% from China, 30% from USA, 15% from Spain) (136-155), 13 cross-sectional (62% China and 15% USA) (156)(157)(158)(159)(160)(161)(162)(163)(164)(165)(166)(167)(168), and 3 case-control studies (2 from China and 1 from Italy) (169)(170)(171). Table 2 shows the distribution of studies according to the study design.…”