Severe Acute Respiratory Syndrome Coronavirus 2 and Pregnancy Outcomes According to Gestational Age at Time of Infection

Abstract

We conducted an international multicenter retrospective cohort study, PregOuTCOV, to examine the effect of gestational age at time of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on obstetric and neonatal outcomes. We included all singleton pregnancies with a live fetus at 10 weeks’ gestation in which pregnancy outcomes were known. The exposed group consisted of patients infected with SARS-CoV-2, whereas the unexposed group consisted of all remaining patients during the same period. Primary outcomes were defined as composite adverse obstetric outcomes and composite adverse neonatal outcomes. Of 10,925 pregnant women, 393 (3.60%) were infected with SARS-CoV-2 (exposed group). After matching for possible confounders, we identified statistically significant increases in the exposed group of composite adverse obstetric outcomes at > 20 weeks’ gestation and of composite adverse neonatal outcomes at > 26 weeks’ gestation (p<0.001). Vaccination programs should target women early in pregnancy or before conception, if possible.

The New Old CD8+ T Cells in the Immune Paradox of Pregnancy

“…The observation that maternal infections affect the pregnancy outcome by resulting in miscarriage, preterm birth, fetal malformations or enhanced risk for pregnancy complications, e.g. in the context of HCMV, ZIKV, and COVID19 infections (111)(112)(113)(114) highlights the urgent need for further research in this field.…”

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

“…Although some studies suggested higher rates of SARS-CoV-2 infection in pregnant women compared with adults of reproductive age, understanding the extent to which this reflects differences in exposure risk, threshold for investigating and rate of testing, rather than a genuine increase in susceptibility remains a challenge. Nevertheless, the growing evidence demonstrates an increased risk of severe adverse outcomes from SARS-CoV-2 infection in pregnant compared with non- pregnant women, particularly when infection occurs during late-second and early-third trimesters ( 11 , 12 ). This increased burden of COVID-19 appears to be disproportionately affecting mother-neonate dyads from low- and middle- income countries ( 13 ).…”

Management and implications of severe COVID‐19 in pregnancy in the UK: data from the UK Obstetric Surveillance System national cohort

“…Although a systematic review reported from four studies that risk was not increased in the third trimester (n = 29), 1 other studies have reported increased prevalence of symptomatic 4 and severe infection in the later stages of pregnancy. 3,5 A high proportion (17%) of women with COVID-19 in pregnancy are reported to have a preterm birth (<37 weeks of pregnancy), which reflects nearly a 50% increase compared with those without COVID-19 (OR 1.47), 1 and the odds of their baby being admitted to a neonatal unit (NNU) are also increased (OR 4.89). 1 Evidence from subsequent small studies suggests that women with severe illness are more likely to have a preterm birth (41.8% vs 15.2%, 2 45.4% vs 5.2% 3 ) and their babies more likely to be admitted to neonatal units (NNU, ie intensive or specialist care) than those with mild illness (50.4% vs 19.2%).…”