SARS-CoV-2 in First Trimester Pregnancy: A Cohort Study

Freiesleben, Nina la Cour; Egerup, Pia; Hviid, Kathrine Vauvert Römmelmayer; Severinsen, Elin Rosenbek; Kolte, Astrid Marie; Westergaard, David; Olsen, Line; Prætorius, Lisbeth; Zedeler, Anne; Christiansen, A.-M. H.; Nielsen, Josefine Reinhardt; Bang, Didi; Berntsen, Sine; Ollé-López, Joaquim; Ingham, Andreas; Bello-Rodríguez, Judith; Storm, Ditte Marie; Ethelberg-Findsen, Jeppe; Hoffmann, Eva; Wilken‐Jensen, Charlotte; Jørgensen, Finn Stener; Westh, Henrik; Jørgensen, Henrik L.; Nielsen, Henriette Svarre

doi:10.1097/ogx.0000000000000920

Cited by 7 publications

(7 citation statements)

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“…Miscarriages: Four studies [ 19 , 27 , 37 , 43 ] contained information on miscarriages and were included in the analysis. The risk of miscarriage was unexpectedly reduced in patients compared with controls (OR 0.564; CI 95% 0.364; 0.875; p = 0.0) ( Figure 2 ).…”

Section: Resultsmentioning

confidence: 99%

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Impact of COVID-19 on Fetal Outcomes in Pregnant Women: A Systematic Review and Meta-Analysis

Cannarella,

Kaiyal,

Marino

et al. 2023

JPM

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Background: Coronavirus disease (COVID-19) is a pandemic causing respiratory symptoms, taste alterations, olfactory disturbances, and cutaneous, cardiovascular, and neurological manifestations. Recently, research interest has shifted to reproductive health to understand the factors predisposing to COVID-19 infection in pregnancy, the consequences of the infection on the fetus and on the mother, and possible vertical transmission through the placenta. Pregnancy does not increase the risk of SARS-CoV-2 infection, according to studies. However, contrary to non-pregnant women, pregnancy worsens the clinical outcome of COVID-19. Studies investigating the effects of COVID-19 on pregnancy women are heterogeneous, and the results are often conflicting. Objectives: The goal of the current work was to offer a thorough and up-to-date systematic review of, and meta-analysis on, the impact of COVID-19 on ovarian function, pregnancy, and fetal outcomes. Search strategy: This meta-analysis (PROSPERO n. CRD42023456904) was conducted using the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) protocols. The search for relevant material was conducted using PubMed, Scopus, Cochrane, and Embase databases, through to 15 December 2022. Selection criteria: Original articles on fertile pregnant women or women attempting to become pregnant, with an active case of, or history of, SARS-CoV-2 infection were included, and reproductive function was compared to that of uninfected women. Data collection and analysis: The effects of COVID-19 on female reproductive function, particularly ovarian function, the profile of female sex hormones, pregnancy outcomes and fetal outcomes were the focus of our search. Quantitative analysis was performed with Comprehensive Meta-Analysis Software. The standard difference of the mean was calculated for the statistical comparison between cases and controls. Cochran’s Q test and heterogeneity (I2) indexes were used to assess statistical heterogeneity. Sensitivity analysis and publication bias tests were also performed. Main Results: Twenty-eight articles met our inclusion criteria, for a total of 27,383 patients pregnant or looking to have offspring, with active or anamnestic COVID-19, and 1,583,772 uninfected control women. Our study revealed that there was no significant difference between COVID-19 patients and the control group in terms of maternal characteristics such as age, body mass index (BMI) and comorbidities that could affect pregnancy and fetal outcomes. The risk of a miscarriage or Cesarean delivery was significantly lower, while the risk of fetal death or premature delivery was significantly higher in COVID-19 patients than in the controls. None of the included studies evaluated hormonal profiles or investigated the presence of infertility. Conclusions: Maternal comorbidities, age, and BMI do not raise the risk of COVID-19. However, pregnant women with COVID-19 had a lower risk of miscarriage and Cesarean delivery, possibly because of better prenatal care and high levels of observation during labor. COVID-19 during pregnancy increases the risk of fetal death and premature delivery.

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Section: Resultsmentioning

confidence: 99%

“… Forest plot of the risk for miscarriage in patients and controls. Crovetto et al, 2021 [ 19 ]; Wang et al, 2021 [ 8 ]; Bortoletto et al, 2021 [ 27 ]; la Cour Freiesleben et al, 2021 [ 37 ]. …”

Section: Figurementioning

confidence: 99%

Impact of COVID-19 on Fetal Outcomes in Pregnant Women: A Systematic Review and Meta-Analysis

Cannarella,

Kaiyal,

Marino

et al. 2023

JPM

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“…Moreover, the hypothesis of SARS-CoV-2 infection changing the endometrial gene expression profile of its associated receptors and proteases leading to alteration of the endometrial receptivity status remain under question. Despite of the many issues unresolved to date, clinical data reported no increasing risk of pregnancy loss for patients with SARS-CoV-2 infection during the first pregnancy trimester compared to non-infected patients [26], suggesting no impact of SARS-CoV-2 on the endometrial receptivity status and successful implantation.…”

Section: Discussionmentioning

confidence: 95%

SARS-CoV-2 and Implantation Window: Gene Expression Mapping of Human Endometrium and Preimplantation Embryo

Haouzi

Entezami

Tuaillon

et al. 2021

Life

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Understanding whether SARS-CoV-2 could infect cells and tissues handled during ART is crucial for risk mitigation, especially during the implantation window when either endometrial biopsies are often practiced for endometrial receptivity assessment or embryo transfer is performed. To address this question, this review analyzed current knowledge of the field and retrospectively examined the gene expression profiles of SARS-CoV-2-associated receptors and proteases in a cohort of ART candidates using our previous Affymetrix microarray data. Human endometrial tissue under natural and controlled ovarian stimulation cycles and preimplantation embryos were analyzed. A focus was particularly drawn on the renin-angiotensin system, which plays a prominent role in the virus infection, and we compared the gene expression levels of receptors and proteases related to SARS-CoV-2 infection in the samples. High prevalence of genes related to the ACE2 pathway during both cycle phases and mainly during the mid-secretory phase for ACE2 were reported. The impact of COS protocols on endometrial gene expression profile of SARS-CoV-2-associated receptors and proteases is minimal, suggesting no additional potential risks during stimulated ART procedure. In blastocysts, ACE2, BSG, CTSL, CTSA and FURIN were detectable in the entire cohort at high expression level. Specimens from female genital tract should be considered as potential targets for SARS-CoV-2, especially during the implantation window.

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“…The available data, on the other hand, show that SARS-Cov-2 infection is not associated with an increased risk of early pregnancy loss and are in line with our results: an Italian case-control study showed no significant difference in the cumulative incidence of COVID-19 in women who experienced spontaneous abortion than in those with ongoing pregnancy ( 13 ). A Danish cohort study found no significantly increased risk of early pregnancy loss in women with SARS-Cov-2 infection and demonstrated that women in their first trimester have not an increased risk of severe COVID-19 disease ( 14 ). A Canadian study showed that the outbreak does not seem to affect early first-trimester miscarriage rates in asymptomatic patients ( 15 ).…”

Section: Discussionmentioning

confidence: 99%

The COVID-19 Pandemic Impact on the Outcome of Medically Assisted Reproduction Pregnancies

Huri

Noferi

Renda

et al. 2022

Front. Reprod. Health

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BackgroundThe impact of the Coronavirus Disease-2019 (COVID-19) pandemic on pregnancy is not well-understood. During the outbreak, the initial approach suggested by the major societies was to postpone all non-urgent assisted reproductive technology (ART) treatments. Nevertheless, the Italian Society of Fertility and Sterility and Reproductive Medicine considered ethically correct to proceed with ART treatments, as the infertility rate is increasing over time, with a consistent decline in the live birth rate. The objective of our study was to assess the impact of the COVID-19 pandemic on the outcomes of ART pregnancies, in terms of early pregnancy loss, overall success rate, and live birth rate.MethodsWe conducted a single-center retro-prospective cohort study. Patients who underwent ART treatments from 1 March 2020 to 28 February 2021 (pandemic ART cohort, pART; n = 749) and from 1 March 2019 to 29 February 2020 (control cohort, CTR; n = 844) were enrolled. The study had a duration of 24 months. Patients underwent baseline severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) nasopharyngeal swab; quantitative serum beta human chorionic gonadotropin (β-hCG) to assess pregnancy; pelvic transvaginal ultrasound; and follow-up until delivery. The study took place at the ART Center of the University Hospital in Florence, Italy.ResultsThere were not statistically significant differences on implantation rate (pART 0.348 ± 0.034 vs. CTR 0.365 ± 0.033, CI = 95%, p = 0.49), clinical pregnancy rate (pART 0.847 ± 0.044 vs. CTR 0.864 ± 0.038, CI = 95%, p = 0.56), and ectopic pregnancy rate (pART 0.008 ± 0.011 vs. CTR 0.01 ± 0.011, CI = 95%, p = 0.79). Neither first trimester miscarriage rate was different between the groups (pART 0.224 ± 0.056 vs. CTR 0.213 ± 0.05, CI = 95%, p = 0.77) nor second trimester miscarriage rate (pART 0.018 ± 0.018 vs. CTR 0.019 ± 0.017, CI = 95%, p = 0.95). Live birth rate remained unchanged during the pandemic (pART 0.22 ± 0.03 vs. CTR 0.239 ± 0.029, CI = 95%, p = 0.37) and stable even when compared to our center rate between 2015 and 2019 (pART 0.222 ± 0.03 vs. general rate 0.224 ± 0.014, CI = 95%, p = 0.83).ConclusionThe COVID-19 pandemic did not cause a statistically significant change in the live birth rate and in the pregnancy loss rate. ART during the COVID-19 pandemic can be considered fair and safe, ethically and medically appropriate. Patients and physicians should be reassured that ART pregnancy outcomes do not seem to be jeopardized by the pandemic state.

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SARS-CoV-2 in First Trimester Pregnancy: A Cohort Study

Cited by 7 publications

References 0 publications

Impact of COVID-19 on Fetal Outcomes in Pregnant Women: A Systematic Review and Meta-Analysis

Impact of COVID-19 on Fetal Outcomes in Pregnant Women: A Systematic Review and Meta-Analysis

SARS-CoV-2 and Implantation Window: Gene Expression Mapping of Human Endometrium and Preimplantation Embryo

The COVID-19 Pandemic Impact on the Outcome of Medically Assisted Reproduction Pregnancies

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