SARS‐CoV‐2 infection in pregnancy in Denmark—characteristics and outcomes after confirmed infection in pregnancy: A nationwide, prospective, population‐based cohort study

Aabakke, Anna J M; Krebs, Lone; Petersen, Tanja Gram; Kjeldsen, Frank; Corn, Giulia; Wøjdemann, K. R.; Ibsen, Mette Holm; Jónsdóttir, Fjóla; Rønneberg, Elisabeth; Andersen, Charlotte Sander; Sundtoft, Iben Blaabjerg; Clausen, Tine Dalsgaard; Milbak, Julie; Burmester, Lars; Lindved, Birgitte; Thorsen-Meyer, Annette; Khalil, Mohammed Rohi; Stokholm, Lonny; Jönsson, Lennart; Andersen, Lise L T; Karlsen, Kamilla; Pedersen, Monica L; Klemmensen, A.; Vestgaard, Marianne; Thisted, Dorthe; Tatla, Manrinder Kaur; Andersen, Line S.; Brülle, Anne-Line; Gulbech, Arense; Andersson, Charlotte; Farlie, Richard; Hansen, Lulu Anne; Hvidman, Lone; Sørensen, Anne; Rathcke, Sidsel L; Rubin, Katrine Hass; Petersen, Lone Kjeld; Jørgensen, Jan Stener; Bliddal, Mette

doi:10.1111/aogs.14252

Cited by 29 publications

(45 citation statements)

References 18 publications

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“…It has been shown that the risk of preterm birth and perinatal death may be increased in hospitalised pregnant women with COVID‐19 18 . This was also found in a Nordic study that included data from Denmark, 19 but until October 2020, we have data that show that only a few pregnant women were admitted to Danish hospitals due to COVID‐19 20 . Another study found that most of the preterm births in pregnant women with COVID‐19 were iatrogenic 21 .…”

Section: Discussionsupporting

confidence: 76%

“…18 This was also found in a Nordic study that included data from Denmark, 19 but until October 2020, we have data that show that only a few pregnant women were admitted to Danish hospitals due to COVID-19. 20 Another study found that most of the preterm births in pregnant women with COVID-19 were iatrogenic. 21 It is possible that a small change in interventions by professionals might have influenced the association between COVID-19 and preterm births.…”

Section: Discussionmentioning

confidence: 99%

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Preterm birth rates were slightly lower in Denmark during the first year of the COVID‐19 pandemic compared with the previous 4 years

Hansen

Cueto²,

Petersen

et al. 2022

Acta Paediatrica

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Aim Our aim was to investigate the rates of preterm births, live births and stillbirths in Denmark during the first year of the COVID‐19 pandemic. Methods This was a national, cross‐sectional registry‐based study that used the Danish Newborn Quality database, which covers all births in Denmark. The proportions of preterm births were compared between the COVID‐19 pandemic period of 1 March 2020 to 28 February 2021 and the preceding 4‐year pre‐pandemic period. Results We studied 60 323 and 244 481 newborn infants from the pandemic and pre‐pandemic periods, respectively. The proportion of preterm live births and stillbirths declined slightly, from 6.29% during the pre‐pandemic period to 6.02% during the pandemic period. This corresponded to a relative risk (RR) of 0.96, with a 95% confidence interval (CI) of 0.93–0.99 during the pandemic. The RRs for extremely preterm, very preterm and moderately preterm infants were 0.88 (95% CI 0.76–1.02), 0.91 (95% CI 0.82–1.02) and 0.97 (95% CI 0.93–1.01), respectively. Conclusion This comparative study showed a small reduction in just over 4%, from 6.29 to 6.02% in the proportion of all preterm births during the pandemic period, compared with the previous four pandemic‐free years. There were no differences between subcategories of preterm births.

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Section: Discussionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Preterm birth rates were slightly lower in Denmark during the first year of the COVID‐19 pandemic compared with the previous 4 years

Hansen

Cueto²,

Petersen

et al. 2022

Acta Paediatrica

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“…We obtained demographic and clinical data of participants as well as non‐participants in the “CareMum COVID‐19 study” from the Danish “COVID‐19 in pregnancy” database, which contains information based on medical records on all women with confirmed SARS‐CoV‐2 infection during pregnancy in Denmark, as described elsewhere. 12 Case completeness of the database was secured by a retrospective registry linkage to national databases containing information on positive SARS‐CoV‐2 tests. Furthermore, participants were asked to complete a questionnaire about COVID‐19 symptoms at the time of inclusion.…”

Section: Methodsmentioning

confidence: 99%

A prospective cohort study of confirmed severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection during pregnancy evaluating SARS‐CoV‐2 antibodies in maternal and umbilical cord blood and SARS‐CoV‐2 in vaginal swabs

Milbak

Holten

Axelsson

et al. 2021

Acta Obstet Gynecol Scand

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Introduction Evidence about the consequences of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection in pregnancy is rapidly increasing; however, data on antibody response and risk of transmission during pregnancy and delivery are still limited. The aim of this study was to evaluate if SARS‐CoV‐2 is detectable in vaginal swabs and whether antibodies against SARS‐CoV‐2 are present in maternal and umbilical cord blood of pregnant women with confirmed SARS‐CoV‐2. Material and methods A single‐unit prospective cohort study in Denmark including pregnant women with SARS‐CoV‐2 infection confirmed by a pharyngeal swab between August 20, 2020, and March 1, 2021, who gave birth during the same period. All patients admitted to the maternity ward and antepartum clinic were screened for SARS‐CoV‐2 infection. A maternal blood sample and vaginal swabs were collected at inclusion. If included antepartum, these samples were repeated intrapartum when an umbilical cord blood sample was also collected. Swabs were analyzed for SARS‐CoV‐2 and blood samples were analyzed for SARS‐CoV‐2 total antibodies. Placental and neonatal swabs as well as placental histopathological examinations were performed on clinical indications. Results We included 28 women, of whom four had serious maternal or fetal outcomes including one case of neonatal death. Within the first 8 days after confirmed SARS‐CoV‐2 infection, SARS‐CoV‐2 was detectable in two vaginal swabs (2/28) and SARS‐CoV‐2 antibodies were detected in 1 of 13 women. From 16 days after confirmed infection, antibodies were observed in 19 of 21 of women. Antibodies in cord blood were not detected during the first 16 days after confirmed infection ( n = 7). However, from 26 days, antibodies were present in 16 of 17 cord blood samples of seropositive mothers. Placental examination in two cases of severe fetal outcomes preceded by reduced fetal movements revealed SARS‐CoV‐2 in swabs and severe histopathological abnormalities. Conclusions SARS‐CoV‐2 was detected in only 2 of 28 vaginal swabs within 8 days after confirmed infection in pregnant women. Our data suggest that maternal seroconversion occurs between days 8 and 16, whereas antibodies in cord blood of seropositive mothers were present in the majority from 26 days after confirmed infection. Additional data are needed regarding timing of seroconversion for the mother and appearance of antibodies in cord blood.

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“…Evidence of poor maternal and infant outcomes from past outbreaks of viral respiratory illness, including the coronaviruses SARS 1,2 and Middle East respiratory syndrome (MERS), 3 as well as 2009 influenza A(H1N1), 4,5 suggested that SARS-CoV-2 may also differentially affect pregnant individuals. However, international reports have been varied in the degree of illness severity resulting from SARS-CoV-2 infection [6][7][8][9][10][11][12][13][14][15] and the degree and nature of associated adverse pregnancy outcomes, such as preeclampsia, preterm birth, stillbirth, and cesarean delivery. [8][9][10][11]14 Since existent studies are highly heterogeneous, with many including only cases of COVID-19 identified at the time of hospital admission for obstetric delivery, they may not adequately represent the full effect of SARS-CoV-2 on pregnant populations, which includes infection acquired throughout pregnancy and a range of disease severity.…”

mentioning

confidence: 99%

Association of SARS-CoV-2 Infection During Pregnancy With Maternal and Perinatal Outcomes

McClymont

Albert

Alton

et al. 2022

JAMA

123

129

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IMPORTANCEThere are limited high-quality, population-level data about the effect of SARS-CoV-2 infection on pregnancy using contemporaneous comparator cohorts.OBJECTIVES To describe maternal and perinatal outcomes associated with SARS-CoV-2 infection in pregnancy and to assess variables associated with severe disease in the pregnant population.DESIGN, SETTING, AND PARTICIPANTS CANCOVID-Preg is an observational surveillance program for SARS-CoV-2-affected pregnancies in Canada. This analysis presents exploratory, population-level data from 6 Canadian provinces for the period of March 1, 2020, to October 31, 2021. A total of 6012 pregnant persons with a positive SARS-CoV-2 polymerase chain reaction test result at any time in pregnancy (primarily due to symptomatic presentation) were included and compared with 2 contemporaneous groups including age-matched female individuals with SARS-CoV-2 and unaffected pregnant persons from the pandemic time period.EXPOSURE SARS-CoV-2 infection during pregnancy. Incident infections in pregnancy were reported to CANCOVID-Preg by participating provinces/territories. MAIN OUTCOMES AND MEASURESMaternal and perinatal outcomes associated with SARS-CoV-2 infection as well as risk factors for severe disease (ie, disease requiring hospitalization, admission to an intensive care unit/critical care unit, and/or oxygen therapy). RESULTS Among 6012 pregnant individuals with SARS-CoV-2 in Canada (median age, 31 [IQR, 28-35] years), the greatest proportion of cases were diagnosed at 28 to 37 weeks' gestation (35.7%). Non-White individuals were disproportionately represented. Being pregnant was associated with a significantly increased risk of SARS-CoV-2-related hospitalization compared with SARS-CoV-2 cases among all women aged 20 to 49 years in the general population of Canada (7.75% vs 2.93%; relative risk, 2.65 [95% CI, 2.41-2.88]) as well as an increased risk of intensive care unit/critical care unit admission (2.01% vs 0.37%; relative risk, 5.46 [95% CI, 4.50-6.53]). Increasing age, preexisting hypertension, and greater gestational age at diagnosis were significantly associated with worse maternal outcomes. The risk of preterm birth was significantly elevated among SARS-CoV-2-affected pregnancies (11.05% vs 6.76%; relative risk, 1.63 [95% CI, 1.52-1.76]), even in cases of milder disease not requiring hospitalization, compared with unaffected pregnancies during the same time period. CONCLUSIONS AND RELEVANCEIn this exploratory surveillance study conducted in Canada from March 2020 to October 2021, SARS-CoV-2 infection during pregnancy was significantly associated with increased risk of adverse maternal outcomes and preterm birth.

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SARS‐CoV‐2 infection in pregnancy in Denmark—characteristics and outcomes after confirmed infection in pregnancy: A nationwide, prospective, population‐based cohort study

Abstract: This is an open access article under the terms of the Creat ive Commo ns Attri butio n-NonCo mmerc ial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Cited by 29 publications

References 18 publications

Preterm birth rates were slightly lower in Denmark during the first year of the COVID‐19 pandemic compared with the previous 4 years

Preterm birth rates were slightly lower in Denmark during the first year of the COVID‐19 pandemic compared with the previous 4 years

A prospective cohort study of confirmed severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection during pregnancy evaluating SARS‐CoV‐2 antibodies in maternal and umbilical cord blood and SARS‐CoV‐2 in vaginal swabs

Association of SARS-CoV-2 Infection During Pregnancy With Maternal and Perinatal Outcomes

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