Preterm birth among women with and without severe acute respiratory syndrome coronavirus 2 infection

Abstract

Introduction Studies directly comparing preterm birth rates in women with and without severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection are limited. Our objective was to determine whether preterm birth was affected by SARS‐CoV‐2 infection within a large integrated health system in New York with a universal testing protocol. Material and methods This retrospective cohort study evaluated data from seven hospitals in New York City and Long Island between March 2020 and June 2021, incorporating both the first and second waves of the coronavirus disease 2019 (COVID‐19) pandemic in the USA. All patients with live singleton gestations who had SARS‐CoV‐2 polymerase chain reaction (PCR) testing at delivery were included. Deliveries before 20 weeks of gestation were excluded. The rate of preterm birth (before 37 weeks) was compared between patients with positive and negative SARS‐CoV‐2 test results. This analysis was performed separately for resolved prenatal infections and infections at delivery, with the latter group subdivided by symptom status. Multiple logistic regression analysis was used to examine the association between SARS‐CoV‐2 infection and preterm birth, adjusting for maternal age, race‐ethnicity, parity, history of preterm birth, body mass index, marital status, insurance type, medical co‐morbidities, month of delivery, and wave of pandemic. Results A total of 31 550 patients were included and 2473 (7.8%) had laboratory‐confirmed infection. Patients with symptomatic COVID‐19 at delivery were more likely to deliver preterm (19.0%; adjusted odds ratio 2.76, 95% CI 1.92–3.88) compared with women with asymptomatic infection (8.8%) or without infection (7.1%). Among preterm births associated with symptomatic infection, 72.5% were medically indicated compared with 44.1% among women without infection (p < 0.001). Risk of preterm birth in patients with resolved prenatal infection was unchanged when compared with women without infection. Among women with infection at delivery, preterm birth occurred more frequently during the second wave compared with the first wave (13.6% vs. 8.7%, respectively; p < 0.006). However, this was not significant on multiple regression analysis after adjusting for other explanatory variables. Conclusions Pregnant women with symptomatic COVID‐19 are more than twice as likely to have a preterm delivery than patients without infection. Asymptomatic infection and resolved prenatal infection are not associated with increased risk.

SARS-CoV-2, Placental Histopathology, Gravity of Infection and Immunopathology: Is There an Association?

“…Our data further confirm different previous works that agree in counting preterm birth among the adverse effects of SARS-CoV-2 infection [40,42,43]. Furthermore, Blitz et al, in a recent paper [44], clearly demonstrate that women with severe SARS-CoV-2 symptoms are at greater risk of premature birth of the newborn than cases of asymptomatic infections.…”

Global Perspectives on Immunization Against SARS-CoV-2 During Pregnancy and Priorities for Future Research: An International Consensus Paper From the World Association of Infectious Diseases and Immunological Disorders

“…Those who develop severe disease have increased rates of admission to an intensive care unit (ICU), requiring invasive ventilation and preterm birth. A recently published retrospective cohort study of pregnant women delivering across 7 hospitals in the USA during the first and second COVID-19 waves, women with COVID-19 were 2.8 times more likely to deliver preterm (19.0%; OR 95% CI 1.92-3.88) compared with women with asymptomatic infection (8.8%) or without SARS-CoV-2 infection (7.1%) ( 19 ).…”

Preterm birth and severe maternal morbidity associated with SARS-CoV-2 infection during the Omicron wave

“…Although this risk was not altered by vaccination or SARS-CoV-2 antibody status in our subgroup analyses, these findings should be interpreted with caution owing to our sample size and low prevalence of outcomes, which may have limited the power to detect significant differences between groups. Although the association between SARS-CoV-2 infection and PTB has been well-characterized during the early part of the COVID-19 pandemic, 3 the risk of PTB was also increased during the most recent Omicron wave. These findings confirm that SARS-CoV-2 infection in pregnancy is a risk factor for PTB despite evidence suggesting less virulence with emerging variants and the available interventions aimed at reducing progression to severe disease.…”