Pregnancy and neonatal outcomes of COVID‐19: coreporting of common outcomes from PAN‐COVID and AAP‐SONPM registries

Abstract

What are the novel findings of this work? Preterm delivery occurred in a higher proportion of women with SARS-CoV-2 infection in the PAN-COVID and AAP-SONPM registries compared to contemporaneous and historical national data from uninfected women in the UK and USA. The majority of preterm deliveries occurred between 32 + 0 and 36 + 6 weeks' gestation. SARS-CoV-2 infection in pregnancy did not appear to be associated with a clinically significant effect on fetal growth, adverse neonatal outcome or the rate of stillbirth. Although maternal death was uncommon, the rate was higher than expected based on UK and USA population data, which is likely explained by underascertainment of women affected by milder or asymptomatic infection in pregnancy in the PAN-COVID study, although not in the AAP-SONPM study. What are the clinical implications of this work? Pregnant women should be counseled that SARS-CoV-2 infection increases the risk of preterm delivery but not stillbirth, early neonatal death or a small baby. Healthcare providers should recommend SARS-CoV-2 vaccination in pregnant women and women planning pregnancy, alongside enhanced social distancing.

Placental expression of ACE2 and TMPRSS2 in maternal SARS-CoV-2 infection: are placental defenses mediated by fetal sex?

“…is not yet known, given the relative rarity of placental infection and in utero transmission of SARS-CoV-2 and lack of reported sex disaggregated data in these areas [2][3][4]. Reporting the sex differences described here represents the first essential step toward a more nuanced understanding of how fetal sex may influence vulnerability or resilience to placental and fetal infection with SARS-CoV-2.…”

“…More than 82,000 pregnant women in the United States have tested positive for SARS-CoV-2 [1], with numbers rising daily. Reported rates of vertical transmission of SARS-CoV-2the passage of SARS-CoV-2 from mother to baby during pregnancy or childbirthrange from 1-3% [2][3][4]. Case reports and case series documenting placental SARS-CoV-2 infection in the second and third trimesters suggest that SARS-CoV-2 infection of the placenta may be an intermediate step in vertical transmission [5][6][7][8][9][10][11].…”

Pregnancy and COVID: what the data say

“…Pregnant women with COVID-19 had higher rates of preterm delivery than did those without the disease, according to data from two registries that tracked more than 4,000 women with confirmed or suspected COVID-19 in the United States and the United Kingdom 6 . Twelve per cent of participants in the UK registry delivered before 37 weeks, compared with the rate for 2020 of 7.5% across England and Wales; in the United States, 15.7% of women with COVID-19 experienced preterm birth (the expected national rate is 10%).…”

COVID-19 during pregnancy one year on – what lessons did we learn?

“…Only those women with specific chronic diseases should be considered on a case-by-case basis [35,36]. The most recent data presented by Mullins et al, based on a group of 4,005 pregnant women with either suspected or confirmed SARS-CoV-2 infection, has indicated the need for enhanced precautions to prevent SARS-CoV-2 infection in pregnancy, particularly in the context of the increased risks of preterm delivery and maternal mortality, and the need for priority vaccination of women planning pregnancy [37].…”