SARS-COV-2 infection in pregnant women and newborns in a Spanish cohort (GESNEO-COVID) during the first wave

Abstract

Background Knowledge about SARS-CoV-2 infection in pregnancy and newborns is scarce. The objective of this study is to analyse clinical and epidemiological characteristics of a cohort of women infected with SARS-CoV-2 during pregnancy and their newborns exposed to SARS-CoV-2 during gestation. Methods Multicentric observational study of Spanish hospitals from the GESNEO-COVD cohort, participants in RECLIP (Spanish Network of Paediatric Clinical Assays). Women with confirmed SARS-CoV-2 infection by PCR and/or serology during pregnancy, diagnosed and delivering during the period 15/03/2020–31/07/2020 were included. Epidemiological, clinical, and analytical data was collected. Results A total of 105 pregnant women with a median of 34.1 years old (IQR: 28.8–37.1) and 107 newborns were included. Globally, almost 65% of pregnant women had some COVID-19 symptoms and more than 43% were treated for SARS-COV-2. Overall, 30.8% of pregnant women had pneumonia and 5 (4.8%) women were admitted to the intensive care unit needing invasive mechanical ventilation. There was a rate of 36.2% of caesarean sections, which was associated with pneumonia during pregnancy (OR: 4.203, CI 95%: 1.473–11.995) and lower gestational age at delivery (OR: 0.724, CI 95%: 0.578–0.906). The prevalence of preterm birth was 20.6% and prematurity was associated with pneumonia during gestation (OR: 6.970, CI95%: 2.340–22.750) and having a positive SARS-CoV-2 PCR at delivery (OR: 6.520, CI95%: 1.840–31.790). All nasopharyngeal PCR in newborns were negative at birth and one positivized at 15 days of life. Two newborns died, one due to causes related to prematurity and another of unexpected sudden death during early skin-to-skin contact after delivery. Conclusions Although vertical transmission has not been reported in this cohort, the prognosis of newborns could be worsened by SARS-CoV-2 infection during pregnancy as COVID-19 pneumonia increased the risk of caesarean section deliveries and preterm births.

The Current Evidence Regarding COVID-19 and Pregnancy: Where Are We Now and Where Should We Head to Next?

“…Delivery via cesarean section but not breast feeding was associated with an increased risk of neonatal transmission [ 62 ]. Similar results are also provided from other smaller cohort studies performed in different populations worldwide, including cohorts in Spain, Turkey, India, and Iran [ 63 , 64 , 65 , 66 ]. These recently published data demonstrate that in comparison to the general pregnant population, COVID-19 infected pregnant women present with increased risk of adverse maternal, neonatal, and perinatal outcomes, highlighting the need for careful monitoring of pregnancies implicating COVID-19.…”

Coronavirus disease 2019 and preterm birth: A systematic review and meta analysis

“…The PRISMA Flow Diagram (Figure 1) summarizes the process of literature search and selection of studies. After screening the titles and abstracts, we read 63 full-text papers and enrolled 26 studies with comparable outcomes [11][12][13][14][15][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] and 10 of them were prospective cohorts, 13 were retrospective cohorts, 4 were case control studies. Of the 436695 pregnant participants, 11866 SARS-CoV-2 infected pregnant women and 424829 unaffected pregnant controls assessed for the SARS-CoV-2 on preterm birth in this systematic review and meta-analysis, compared with pregnant women without SARS-CoV-2 infection , the affected pregnant women were at higher risk of experience preterm birth (OR 1.30, 95% CI 1.20 to 1.39; I 2 = 41%; 26 studies) (Figure 2).…”

“…As a special population, SARS-CoV-2 infected pregnant women may be at higher risk for worse pregnancy outcomes when compared to the healthy matches [10,11]. The possible effect on pregnancy and birth outcomes were reported inconsistently [12,13]. An increased frequency of preterm births and caesarean deliveries in pregnant patients with COVID-19 was reported [14,15].…”

SARS-CoV-2 Infection and C-Section: A Prospective Observational Study

“…Most international obstetrics and gynecology guidelines state that vaginal delivery in SARS-CoV-2-infected patients is safe [11] and, when a C-section is performed, it should be based on obstetric indications. However, although the frequency of C-sections has decreased throughout the pandemic, the rates in SARS-CoV-2 infected mothers remain high (above 25%), and significantly higher than those registered in non-infected mothers [12,13].…”