Global variations in the burden of SARS-CoV-2 infection and its outcomes in pregnant women by geographical region and country’s income status: a meta-analysis

Sheikh, Jameela; Lawson, Heidi; Allotey, John; Yap, Magnus; Balaji, Rishab; Kew, Tania; Stallings, Elena; Coomar, Dyuti; Gaetano-Gil, Andrea; Zamora, Javier; Thangaratinam, Shakila

doi:10.1136/bmjgh-2022-010060

Cited by 9 publications

(6 citation statements)

References 38 publications

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“…The immune system's overreaction to the viral infection (“the cytokine storm”) may thus exacerbate the known increase of cytokines already reported for other pregnancy-related complications such as preeclampsia, early IUGR, and gestational diabetes 5 , 6 . Previous studies have indicated a 3-to-tenfold prevalence of severe COVID-19 during pregnancy 7 .…”

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confidence: 95%

Vaccination in twin pregnancies: comparison between immunization before conception and during pregnancy

Svirsky,

Rabbi,

Hamad

et al. 2024

Sci Rep

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To evaluate the development of neutralizing Anti-Spike Protein IgG (Anti-S-IgG) during twin pregnancies before conception vs. during pregnancy. In this prospective study, three blood samples were collected from pregnant women and subjected to anti-S-IgG immunodiagnostics. The patient’s medical records, including vaccination and PCR test results, were collected from the hospital’s electronic database. Age-matched non-pregnant women were used as a control group. We enrolled 83 women with twin pregnancies. 49 women were vaccinated before conception, 21 women were vaccinated during pregnancy, and 13 were not vaccinated. Of the 13 women who weren’t vaccinated, three became positive during pregnancy, and all three were severely ill. By contrast, in women who were vaccinated during or before pregnancy, COVID-19 infection during pregnancy caused only mild symptoms. A ten-fold lower level of neutralizing Anti-S-IgG in the 3rd trimester was observed in healthy women who were vaccinated before conception and remained healthy until discharge from the hospital after delivery 1605 (IQR: 763–2410) compared to the healthy women who were vaccinated during pregnancy 152 AU/mL (IQR: 54–360). This difference was higher among women who were infected by COVID-19 (as verified by a positive PCR test). The third-trimester level of neutralizing Ant-S-IgG in the infected group was 4770 AU/mL (4760–6100) in infected women vaccinated before conception compared to those vaccinated during pregnancy who had 70 AU/mL (IQR: 20–170) (p < 0.001). In women vaccinated at 13–16 weeks gestation, neutralizing Anti-S-IgG at 20–22 weeks went up to 372 AU/mL (IQR: 120–1598) but rapidly dropped to 112 AU/mL (IQR: 54–357) at 28–30 weeks, (p < 0.001), a faster decline than in women vaccinated at a median 22 weeks before conception. Being infected by COVID-19 before conception was linked to having low Anti-S-IgG levels during pregnancy, whereas being infected by COVID-19 during pregnancy led to a very high response in the 3rd trimester. In twin pregnancies, significantly lower neutralizing Anti-S-IgG levels were observed in women vaccinated during pregnancy compared to those vaccinated before conception, whether infected or not infected by COVID-19. A full course of vaccination before conception is recommended.Trial registration. ClinicalTrials.gov Protocol Registration and Results System (PRS) Receipt Release Date: October 4, 2021. https://clinicaltrials.gov/ ID: NCT04595214.

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confidence: 95%

Vaccination in twin pregnancies: comparison between immunization before conception and during pregnancy

Svirsky,

Rabbi,

Hamad

et al. 2024

Sci Rep

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“…The immune system's overreaction to COVID-19 ("the cytokine storm") may thus exacerbate the known increase of cytokines already reported for other pregnancyrelated complications such as preeclampsia, early IUGR, and gestational diabetes [5,6]. Previous studies have indicated a 3-to-10-fold prevalence of severe COVID-19 during pregnancy [7].…”

Section: Introductionmentioning

confidence: 99%

Serological responses to the BNT-162b2 Pfizer/BioNTech vaccination in twin pregnancies- Comparison between immunization before conception and during pregnancy.

Svirsky

Rabbi

Hamad³

et al. 2023

Preprint

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Objectives Compare the levels of neutralizing Anti-Spike Protein IgG (Anti-S-IgG) during twin pregnancies in women who were immunized by the BNT-62b2-Pfizer/BioNTech vaccine for COVID-19 before conception vs. during pregnancy. Methods In this prospective study, three blood samples were collected from 83 pregnant and 200 age-matched non-pregnant women and subjected to Anti-S-IgG immunodiagnostics. Patient’s medical records were collected from the hospital’s electronic database, including vaccination and PCR test results. Results Of the 83 women with twin pregnancies, 74 were dichorionic diamniotic (DCDA) and 9 were monochorionic diamniotic (MCDA), 49 were vaccinated before conception, 21 were vaccinated during pregnancy, and 13 were non-vaccinated. Nine non-vaccinated women experienced an uneventful pregnancy, one contracted COVID-19 before conception, three became positive during pregnancy, and all three were severely ill and required hospitalization in the 3rd trimester. By contrast, in two (9.5%) of the 21 women who were vaccinated during pregnancy and 7 (14.3%) of the 46 women vaccinated before conception COVID-19 infection during pregnancy caused only mild symptoms. The levels of neutralizing Anti-S-IgG in the 3rd trimester in the women vaccinated before conception were 1,475 Au/mL [IQR 392-3,020] vs. 112 [54–357] (ten-fold lower) in women vaccinated during pregnancy (p < 0.001)). No difference was found between DCDA and MCDA. Third-trimester Anti-S-IgG levels in twin pregnancies were higher compared to non-pregnant women and to gravid women with singletons (according to reported levels). In women vaccinated at 13–16 weeks gestation, neutralizing Anti-S-IgG at 20–22 weeks went up to 372 Au/mL[120–1598], but rapidly dropped to 112[54–357) at 28–30 weeks, (p < 0.001), a faster decline than in women vaccinated before conception, or women with singleton pregnancies, or non-pregnant women (p < 0.001). Infection before conception was associated with having low Anti-S-IgG levels during pregnancy, whereas COVID-19 during pregnancy led to a very high response in the 3rd trimester, as previously reported for singleton pregnancies. Conclusion Lower neutralizing Anti-S-IgG levels were observed in women who were vaccinated during pregnancy compared to those who were vaccinated before conception, and they also declined faster. Vaccinated women who came down with COVID-19 had milder symptoms than unvaccinated women. Thus, a full course of vaccination before conception is recommended. ClinicalTrials.gov Protocol Registration and Results System (PRS) Receipt Release Date: October 4, 2021 ClinicalTrials.gov ID: NCT04595214

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“…An individual participant data meta‐analysis indicated that SARS‐CoV‐2 infection at any time during pregnancy increases the risk of maternal death, severe maternal morbidities and neonatal morbidity, but not stillbirth or intrauterine growth restriction 2 . Another meta‐analysis of cohort studies reported higher rates of maternal mortality and stillbirth due to SARS‐CoV‐2 infection during pregnancy among lower‐/middle‐income countries 3 . A retrospective cohort study in the USA found increased odds of stillbirth among pregnant women with SARS‐CoV‐2 infection only in early pregnancy and midpregnancy 4 .…”

Section: Introductionmentioning

confidence: 99%

“… 2 Another meta‐analysis of cohort studies reported higher rates of maternal mortality and stillbirth due to SARS‐CoV‐2 infection during pregnancy among lower‐/middle‐income countries. 3 A retrospective cohort study in the USA found increased odds of stillbirth among pregnant women with SARS‐CoV‐2 infection only in early pregnancy and midpregnancy. 4 A meta‐analysis of observational studies showed higher odds for preeclampsia/hypertensive disorders of pregnancy, neonatal intensive care unit admissions, stillbirths and perinatal mortality among SARS‐CoV‐2‐positive women.…”

Section: Introductionmentioning

confidence: 99%

SARS‐CoV‐2 infection during pregnancy and perinatal outcomes in Estonia in 2020 and 2021: A register‐based study

Veerus,

Nõmm,

Innos

et al. 2023

Acta Obstet Gynecol Scand

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IntroductionData from different countries show partly controversial impact of SARS‐CoV‐2 infection on pregnancy outcomes. A nationwide register‐based study was conducted in Estonia to assess the impact of SARS‐CoV‐2 infection at any time during pregnancy on stillbirth, perinatal mortality, Apgar score at 5 minutes, cesarean section rates, rates of preterm birth and preeclampsia.Material and methodsData on all newborns and their mothers were obtained from the Estonian Medical Birth Registry, and data on SARS‐CoV‐2 testing dates, test results and vaccination dates against SARS‐CoV‐2 from the Estonian Health Information System. Altogether, 26 211 births in 2020 and 2021 in Estonia were included. All analyses were performed per newborn. Odds ratios with 95% confidence intervals (CI) were analyzed for all outcomes, adjusted for mother's place of residence, body mass index, age of mother at delivery and hypertension and for all the aforementioned variables together with mother's vaccination status using data from 2021 when vaccinations against SARS‐CoV‐2 became available. For studying the effect of a positive SARS‐CoV‐2 test during pregnancy on preeclampsia, hypertension was omitted from the models to avoid overadjustment.ResultsSARS‐CoV‐2 infection during pregnancy was associated with an increased risk of stillbirth (adjusted odds ratio [aOR] 2.81; 95% CI 1.37–5.74) and perinatal mortality (aOR 2.34; 95% CI 1.20–4.56) but not with a lower Apgar score at 5 minutes, higher risk of cesarean section, preeclampsia or preterm birth. Vaccination slightly decreased the impact of SARS‐CoV‐2 infection during pregnancy on perinatal mortality.ConclusionsA positive SARS‐CoV‐2 test during pregnancy was associated with higher rates of stillbirth and perinatal mortality in Estonia but was not associated with change in preeclampsia, cesarean section or preterm birth rates.

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Global variations in the burden of SARS-CoV-2 infection and its outcomes in pregnant women by geographical region and country’s income status: a meta-analysis

Cited by 9 publications

References 38 publications

Vaccination in twin pregnancies: comparison between immunization before conception and during pregnancy

Vaccination in twin pregnancies: comparison between immunization before conception and during pregnancy

Serological responses to the BNT-162b2 Pfizer/BioNTech vaccination in twin pregnancies- Comparison between immunization before conception and during pregnancy.

SARS‐CoV‐2 infection during pregnancy and perinatal outcomes in Estonia in 2020 and 2021: A register‐based study

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