Coronavirus and birth in Italy: results of a national population-based cohort study

Maraschini, Alice; Corsi, Edoardo; Salvatore, Michele Antonio; Donati, Serena

doi:10.1101/2020.06.11.20128652

Cited by 47 publications

(74 citation statements)

References 10 publications

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“…We noted a higher rate of symptomatic mothers than has been reported in some other studies, 23,24 likely because of selfselection. Our proportion of symptomatic SARS-CoV-2+ mothers in the perinatal period, 62%, is much higher than the 23% reported by the AAP in their registry as of October 3, 2020, 23 but similar to that seen in the Italian Obstetric Surveillance System, 72% on admission, 33 and in one New York hospital system (Presbyterian), 74%, 25 nearly half of whose mothers had their symptoms >2 weeks before delivery. Our rate of SARS-CoV-2+ infants in the first 3 days of life, 7.4%, is higher than the AAP reported rate of 1.7%, 23 the United Kingdom Obstetric Surveillance System, 5%, 34 in the Spanish data, 5.2%, 27 and that seen in the worldwide review of infants of over 660 pregnant women with COVID-19, 4%, 35 but it is consistent with that seen in the Italian data, 6.1%, 33 and in another New York hospital (Elmhurst), 6.7%.…”

Section: Discussionsupporting

confidence: 38%

Maternal and Infant Outcomes Associated with Maternity Practices Related to COVID-19: The COVID Mothers Study

Bartick

Valdés

Giusti

et al. 2021

Breastfeeding Medicine

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Background: Maternity care practices such as skin-to-skin care, rooming-in, and direct breastfeeding are recommended, but it is unclear if these practices increase the risk of clinically significant COVID-19 in newborns, and if disruption of these practices adversely affects breastfeeding. Methods: We performed a retrospective cohort study of 357 mothers and their infants <12 months who had confirmed or suspected COVID-19. Subjects came from an anonymous worldwide online survey between May 4 and September 30, 2020, who were recruited through social media, support groups, and health care providers. Using multivariable logistic regression, Fisher's exact test, and summary statistics, we assessed the association of skin-to-skin care, feeding, and rooming-in with SARS-CoV-2 outcomes, breastfeeding outcomes, and maternal distress. Results: Responses came from 31 countries. Among SARS-CoV-2+ mothers whose infection was £3 days of birth, 7.4% of their infants tested positive. We found a nonsignificant decrease in risk of hospitalization among neonates who roomed-in, directly breastfed, or experienced uninterrupted skin-to-skin care (p > 0.2 for each). Infants who did not directly breastfeed, experience skin-to-skin care, or who did not room-in within arms' reach, were significantly less likely to be exclusively breastfed in the first 3 months, adjusting for maternal symptoms (p £ 0.02 for each). Nearly 60% of mothers who experienced separation reported feeling ''very distressed,'' and 29% who tried to breastfeed were unable. Presence of maternal symptoms predicted infant transmission or symptoms (adjusted odds ratio = 4.50, 95% confidence interval = 1.52-13.26, p = 0.006). Conclusion: Disruption of evidence-based quality standards of maternity care is associated with harm and may be unnecessary.

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Section: Discussionsupporting

confidence: 38%

Maternal and Infant Outcomes Associated with Maternity Practices Related to COVID-19: The COVID Mothers Study

Bartick

Valdés

Giusti

et al. 2021

Breastfeeding Medicine

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“…The reason for the increasing proportion of severe SARS-CoV-2 in pregnancy compared to the general population is not known and further research is required. In this study we have identified that very few pregnant women (2%) were treated with anti-viral medications, much lower than in some other high resource countries such as Italy where nearly a quarter of women (23%) received treatment with anti-viral agents [22]. Evidence about pharmacological management in the general population is improving [15].…”

Section: Discussionmentioning

confidence: 99%

The incidence, characteristics and outcomes of pregnant women hospitalized with symptomatic and asymptomatic SARS-CoV-2 infection in the UK from March to September 2020: a national cohort study using the UK Obstetric Surveillance System (UKOSS)

pregnancy¹,

Vousden

Bunch

et al. 2021

Preprint

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BackgroundEvidence on risk factors, incidence and impact of SARS-CoV-2 infection in pregnant mothers and their babies has rapidly expanded but there is a lack of population level data to inform accurate incidence rates and unbiased descriptions of characteristics and outcomes. The primary aim of this study was to describe the incidence, characteristics and outcomes of hospitalized pregnant women with symptomatic and asymptomatic SARS-CoV-2 in the UK compared to pregnant women without SARS-CoV-2 in order to inform future clinical guidance and management.Methods and FindingsWe conducted a national, prospective cohort study of all hospitalized pregnant women with confirmed SARS-CoV-2 from 1st March 2020 to 31st August 2020 using the UK Obstetric Surveillance System (UKOSS) across all 194 hospitals in the UK with a consultant-led maternity unit. Incidence was estimated using the latest national maternity data. Overall, 1148 hospitalized women had confirmed SARS-CoV-2 in pregnancy, 63% of which were symptomatic. Therefore, the estimated incidence of hospitalization with symptomatic SARS-CoV-2 was 2.0 per 1000 maternities (95% CI 1.9-2.2) and for asymptomatic SARS-CoV-2 was 1.2 per 1000 maternities (95% CI 1.1-1.4). Compared to pregnant women without SARS-CoV-2, women hospitalized with symptomatic SARS-CoV-2 were more likely to be overweight or obese (adjusted OR 1.86, 95% CI 1.39-2.48 and aOR 2.07, 95% CI 1.53-2.29 respectively), to be of Black, Asian or Other minority ethnic group (aOR 6.24, 95% CI 3.93-9.90, aOR 4.36, 95% CI 3.19-5.95 and aOR 12.95, 95% CI 4.93-34.01 respectively), and to have a relevant medical comorbidity (aOR 1.83, 95% CI 1.32-2.54). Compared to pregnant women without SARS-CoV-2, hospitalized pregnant women with symptomatic SARS-CoV-2 were more likely to be admitted to intensive care (aOR 57.67, 95% CI 7.80-426.70) but the absolute risk of poor outcomes was low. Cesarean births and neonatal unit admission were increased regardless of symptom status (symptomatic aOR 2.60, 95% CI 1.97-3.42 and aOR 3.08, 95% CI 1.99-4.77 respectively; asymptomatic aOR 2.02, 95% CI 1.52-2.70 and aOR 1.84, 95% 1.12-3.03 respectively). Iatrogenic preterm births were more common in women with symptomatic SARS-CoV-2 (aOR 11.43, 95% CI 5.07-25.75). The risks of stillbirth or neonatal death were not significantly increased, regardless of symptom status but numbers were small. The limitations of this study include the restriction to women hospitalized with SARS-CoV-2, who may by nature of their admission have been at greater risk of adverse outcome.ConclusionsWe have identified factors that increase the risk of symptomatic and asymptomatic SARS-CoV-2 in pregnancy. The increased risks of cesarean and iatrogenic preterm birth provide clear evidence of the indirect impact of SARS-CoV-2 on mothers and maternity care in high income settings. Clinicians can be reassured that the majority of women do not experience severe complications of SARS-CoV-2 in pregnancy and women with mild disease can be discharged to continue their pregnancy safely.

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“…Induction of labor, preterm delivery, CD and emergency CD were more frequent among women with severe COVID-19 requiring hospital admission compared to the 2018 birth population, which corresponds to previous findings (9,13,23). An increasing risk of preterm delivery and CD with increasing severity of COVID-19 has also been reported (14). A previous study from one of the including SE centers found no increased risk of severe outcomes (25), however, they included COVID-19 positive women independently of severity, which might have biased their results.…”

Section: Characteristics Of Women Admitted For Any Reason Are Shown Inmentioning

confidence: 97%

“…Large population-based cohort studies from the United Kingdom (UK) and Italy found an incidence of hospitalization with COVID-19 of 2/1000 maternities (13)(14)(15), which is much higher than the risk of 0.4/1000 deliveries found in DK, FI, IS and NO. However, these studies included admissions for any reason, such as obstetric care and labour.…”

Section: Characteristics Of Women Admitted For Any Reason Are Shown Inmentioning

confidence: 99%

“…With the on-going pandemic, population-based studies with larger case numbers and lower risk of bias are crucial for guiding disease surveillance and health management (12). A few population-based studies assessing the risk and consequences of COVID-19 infection in pregnancy have been published (13)(14)(15). However, the inclusion criteria comprised all causes of hospital admission which results in heterogenous study populations.…”

Section: Introductionmentioning

confidence: 99%

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COVID-19 in pregnancy – characteristics and outcomes of pregnant women admitted to hospital because of SARS-CoV-2 infection in the Nordic countries

Engjom

Aabakke

Klungsøyr

et al. 2021

Preprint

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Introduction Population-based studies about the consequences of SARS-CoV-2 infection (COVID-19) in pregnancy are few and have limited generalizability to the Nordic population and health care systems. Material and method This study examines pregnant women with COVID-19 in the five Nordic countries. Pregnant women were included if they were admitted to hospital between March 1 and June 30, 2020 and had a positive SARS-CoV-2 PCR test 14 days or fewer prior to the admission. Cause of admission was classified as either obstetric or COVID-19 related. Results In the study areas, 214 pregnant women with a positive test were admitted to hospital, of which 56 women needed hospital care due to COVID-19. The rate of admission due to COVID-19 was 0.4 per 1000 deliveries in Denmark, Finland, and Norway and 3.8 per 1000 deliveries in the Swedish regions. Women hospitalized because of COVID-19 were more frequently obese (P < 0.001) and had migrant background (P < 0.001) compared to the total population of women who delivered in 2018. Twelve women (21.4%) needed intensive care. Preterm delivery (n=12, 25%, P < 0.001) and cesarean delivery (n=21, 43,8%, P < 0.001) were more frequent in women with COVID-19 compared to the women who delivered in 2018. No maternal deaths, stillbirths or neonatal deaths were reported. Conclusion The risk of admission due to severe COVID-19 disease in pregnancy was low in the Nordic countries. A fifth of the women required intensive care and we observed higher rates of preterm and cesarean deliveries. National public health policies appear to have had an impact on the rates of admission due to severe COVID-19 disease in pregnancy. Nordic collaboration is important in collecting robust data and assessing rare outcomes.

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Coronavirus and birth in Italy: results of a national population-based cohort study

Cited by 47 publications

References 10 publications

Maternal and Infant Outcomes Associated with Maternity Practices Related to COVID-19: The COVID Mothers Study

Maternal and Infant Outcomes Associated with Maternity Practices Related to COVID-19: The COVID Mothers Study

The incidence, characteristics and outcomes of pregnant women hospitalized with symptomatic and asymptomatic SARS-CoV-2 infection in the UK from March to September 2020: a national cohort study using the UK Obstetric Surveillance System (UKOSS)

COVID-19 in pregnancy – characteristics and outcomes of pregnant women admitted to hospital because of SARS-CoV-2 infection in the Nordic countries

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