Maternal and Perinatal Outcomes Associated With the Omicron Variant of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection

Seasely, Angela R.; Blanchard, Christina T.; Arora, Nitin; Battarbee, Ashley N.; Casey, Brian M.; Dionne-Odom, Jodie; Leal, Sixto M.; Moates, Derek; Sinkey, Rachel G.; Szychowski, Jeff M.; Tita, Alan; Subramaniam, Akila

doi:10.1097/aog.0000000000004849

Cited by 30 publications

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“… [7] , [21] , [50] Pregnant people likely infected with Delta had 1.8-2.9 fold increased odds of developing severe illness compared to previous variants, whereas those likely infected with Omicron had 0.1-0.2 the odds of developing a severe illness compared to those with Delta. [23] , [49] There was an overall increase in severe maternal morbidities associated with SARS-CoV-2 infections during Delta dominance, which decreased substantially during Omicron dominance. [51] Maternal mortality was also substantially higher (3.5 fold increase) during Delta dominance [22] , [50] as well as stillbirth rates (2.7 fold increase) following a maternal SARS-CoV-2 infection compared to a pre-Delta infection.…”

Section: Maternal Sars-cov-2 Infection Impact On Maternal-fetal Outcomesmentioning

confidence: 99%

“… [46] , [47] , [48] This variability in variant transmissibility and disease severity led to differences in the number of cases and hospitalizations during each variant wave, and these trends hold true in the pregnant population. [7] , [19] , [20] , [21] , [49] There were lower COVID-19 case numbers in pregnant people during Alpha dominance in the US and UK compared to the wild-type dominance. [19] , [21] , [22] The lower case numbers during the Alpha wave may have been impacted due to the onset of vaccination programs in the US and UK shortly before the start of the Alpha wave in these countries.…”

Section: Maternal Sars-cov-2 Infection Impact On Maternal-fetal Outcomesmentioning

confidence: 99%

“…[19] , [21] , [22] The lower case numbers during the Alpha wave may have been impacted due to the onset of vaccination programs in the US and UK shortly before the start of the Alpha wave in these countries. There was a noticeable increase in cases following Delta achieving dominance [19] , [21] , [23] , [49] with one report of 3.1 greater odds of becoming infected during the Delta wave, [23] although cases were primarily observed in unvaccinated pregnant people. [20] , [24] .…”

Section: Maternal Sars-cov-2 Infection Impact On Maternal-fetal Outcomesmentioning

confidence: 99%

“…There were substantially higher number of cases during the Omicron wave compared to the Delta wave (OR: 10.09) [23] with a spike in cases observed in both vaccinated and unvaccinated individuals. [20] , [22] , [23] , [49] …”

Section: Maternal Sars-cov-2 Infection Impact On Maternal-fetal Outcomesmentioning

confidence: 99%

“…Furthermore, the COVID-19 pandemic has been a rapidly evolving situation with differences in transmissibility and severity observed between variants complicating our understanding of the impact of COVID-19 on maternal-fetal outcomes. [7] , [19] , [20] , [21] , [22] , [23] , [24] , [49] All this combines underlines the necessity to ensure the risk of COVID-19 is reduced in this population. Pregnant people should be encouraged to become vaccinated and stay current with their COVID-19 vaccination schedule as part of routine prenatal care to reduce their risk of infection.…”

Section: Maternal Sars-cov-2 Infection Impact On Maternal-fetal Outcomesmentioning

confidence: 99%

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The impact of maternal SARS-CoV-2 infection and COVID-19 vaccination on maternal-fetal outcomes

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Section: Maternal Sars-cov-2 Infection Impact On Maternal-fetal Outcomesmentioning

confidence: 99%

Section: Maternal Sars-cov-2 Infection Impact On Maternal-fetal Outcomesmentioning

confidence: 99%

Section: Maternal Sars-cov-2 Infection Impact On Maternal-fetal Outcomesmentioning

confidence: 99%

Section: Maternal Sars-cov-2 Infection Impact On Maternal-fetal Outcomesmentioning

confidence: 99%

Section: Maternal Sars-cov-2 Infection Impact On Maternal-fetal Outcomesmentioning

confidence: 99%

See 3 more Smart Citations

The impact of maternal SARS-CoV-2 infection and COVID-19 vaccination on maternal-fetal outcomes

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Perinatal Complications in Individuals in California With or Without SARS-CoV-2 Infection During Pregnancy

et al. 2022

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population-based studies is needed to inform the treatment of SARS-CoV-2 infection during pregnancy and to provide health risk information to pregnant individuals. OBJECTIVE To assess the risk of perinatal complications associated with SARS-CoV-2 infection and to describe factors associated with hospitalizations. DESIGN, SETTING, AND PARTICIPANTSThis population-based cohort study included 43 886 pregnant individuals with longitudinal electronic health record data from preconception to delivery who delivered at Kaiser Permanente Northern California between March 1, 2020, and March 16, 2021. Individuals with diagnostic codes for COVID-19 that did not have a confirmatory polymerase chain reaction test for SARS-CoV-2 were excluded.EXPOSURES SARS-CoV-2 infection detected by polymerase chain reaction test (from 30 days before conception to 7 days after delivery) as a time varying exposure. MAIN OUTCOMES AND MEASURESSevere maternal morbidity including 21 conditions (eg, acute myocardial infarction, acute renal failure, acute respiratory distress syndrome, and sepsis) that occurred at any time during pregnancy or delivery; preterm birth; pregnancy hypertensive disorders; gestational diabetes; venous thromboembolism (VTE); stillbirth; cesarean delivery; and newborn birth weight and respiratory conditions. Standardized mean differences between individuals with and without SARS-CoV-2 were calculated. Cox proportional hazards regression was used to estimate the hazard ratios (HRs) and 95% CIs for the association between SARS-CoV-2 infection and perinatal complications and hospitalization and to consider the timing of SARS-CoV-2 infection relative to outcomes. RESULTSIn this study of 43 886 pregnant individuals (mean [SD] age, 30.7 [5.2] years), individuals with a SARS-CoV-2 infection (1332 [3.0%]) were more likely to be younger, Hispanic, multiparous individuals with a higher neighborhood deprivation index and obesity or chronic hypertension. After adjusting for demographic characteristics, comorbidities, and smoking status, individuals with SARS-CoV-2 infection had higher risk for severe maternal morbidity (HR, 2.45; 95% CI, 1.91-3.13), preterm birth (<37 weeks; HR, 2.08; 95% CI, 1.75-2.47), and VTE (HR, 3.08; 95% CI, 1.09-8.74) than individuals without SARS-CoV-2. SARS-CoV-2 infection was also associated with increased risk of medically indicated preterm birth (HR, 2.56; 95% CI, 2.06-3.19); spontaneous preterm birth (HR, 1.61; 95% CI, 1.22-2.13); and early (HR, 2.52; 95% CI, 1.49-4.24), moderate (HR, 2.18; 95% CI, 1.25-3.80), and late (HR, 1.95; 95% CI, 1.61-2.37) preterm birth. Among individuals with SARS-CoV-2 infection, 76 (5.7%) had a hospitalization; pregestational diabetes (HR, 7.03; 95% CI, 2.22-22.2) and Asian or Pacific Islander (HR, 2.33; 95% CI, 1.06-5.11) and Black (HR, 3.14; 95% CI, 1.24-7.93) race and ethnicity were associated with an increased risk of hospitalization. CONCLUSIONS AND RELEVANCEIn this cohort study, SARS-CoV-2 infection was associated with increased risk of severe maternal morbidity, preterm b...

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Assessment of Adverse Reactions, Antibody Patterns, and 12-month Outcomes in the Mother-Infant Dyad After COVID-19 mRNA Vaccination in Pregnancy

et al. 2023

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ImportanceLongitudinal data on COVID-19 messenger RNA (mRNA) vaccine reactogenicity and immunogenicity in pregnancy and for the mother-infant dyad are needed.ObjectiveTo examine COVID-19 mRNA vaccine reactogenicity and immunogenicity in pregnancy and observe longitudinal maternal and infant outcomes.Design, Setting, and ParticipantsThis prospective cohort study of pregnant individuals enrolled in the COVID-19 Vaccination in Pregnancy and Lactation study from December 1, 2020, through December 31, 2021, with follow-up through March 31, 2022, was conducted at a large academic medical center in an urban metropolitan area in California. Pregnant individuals receiving COVID-19 mRNA vaccines (mRNA-1273 [Moderna] and BNT162b2 [Pfizer-BioNTech]) were eligible. Of 81 participants enrolled, 5 were excluded after enrollment: 1 terminated pregnancy, 1 received the third vaccine dose prior to delivery, and 3 delivered prior to completing the initial vaccine series.ExposureCOVID-19 mRNA vaccination at any time during pregnancy.Main Outcomes and MeasuresThe primary outcomes were vaccine response as measured by blood Immunoglobulin G (IgG) titers after each vaccine dose and self-reported postvaccination symptoms. Patients’ IgG titers were measured in cord blood and in infant blood at intervals up to 1 year of life; IgG and IgA titers were measured in maternal milk. Clinical outcomes were collected from medical records.ResultsOf 76 pregnant individuals included in final analyses (median [IQR] maternal age, 35 [29-41] years; 51 [67.1%] White; 28 [36.8%] primigravid; 37 [48.7%] nulliparous), 42 (55.3%) received BNT162b2 and 34 (44.7%) received mRNA-1237. There were no significant differences in maternal characteristics between the 2 vaccine groups. Systemic symptoms were more common after receipt of the second vaccine dose than after the first dose (42 of 59 [71.2%] vs 26 of 59 [44.1%]; P = .007) and after mRNA-1237 than after BNT162b2 (25 of 27 [92.6%] vs 17 of 32 53.1%; P = .001). Systemic symptoms were associated with 65.6% higher median IgG titers than no symptoms after the second vaccine dose (median [IQR], 2596 [1840-4455] vs 1568 [1114-4518] RFU; P = .007); mean cord titers in individuals with local or systemic symptoms were 6.3-fold higher than in individuals without symptoms. Vaccination in all trimesters elicited a robust maternal IgG response. The IgG transfer ratio was highest among individuals vaccinated in the second trimester. Anti-SARS-CoV-2 IgG was detectable in cord blood regardless of vaccination trimester. In milk, IgG and IgA titers remained above the positive cutoff for at least 5-6 months after birth, and infants of mothers vaccinated in the second and third trimesters had positive IgG titers for at least 5 to 6 months of life. There were no vaccine-attributable adverse perinatal outcomes.Conclusions and RelevanceThe findings of this cohort study suggest that mRNA COVID-19 vaccination in pregnancy provokes a robust IgG response for the mother-infant dyad for approximately 6 months after birth. Postvaccination symptoms may indicate a more robust immune response, without adverse maternal, fetal, or neonatal outcomes.

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Maternal and Perinatal Outcomes Associated With the Omicron Variant of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection

Cited by 30 publications

References 2 publications

The impact of maternal SARS-CoV-2 infection and COVID-19 vaccination on maternal-fetal outcomes

The impact of maternal SARS-CoV-2 infection and COVID-19 vaccination on maternal-fetal outcomes

Perinatal Complications in Individuals in California With or Without SARS-CoV-2 Infection During Pregnancy

Assessment of Adverse Reactions, Antibody Patterns, and 12-month Outcomes in the Mother-Infant Dyad After COVID-19 mRNA Vaccination in Pregnancy

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