The Association of COVID-19 Infection in Pregnancy With Preterm Birth: A Retrospective Cohort Study in California

Karasek, Deborah; Baer, Rebecca J.; McLemore, Monica R.; Bell, April J.; Blebu, Bridgette; Casey, Joan A.; Coleman‐Phox, Kimberly; Costello, J; Felder, Jennifer N.; Flowers, Elena; Fuchs, Jonathan; Gómez, Anu Manchikanti; Karvonen, Kayla L.; Kuppermann, Miriam; Liang, Liang; McKenzie‐Sampson, Safyer; McCulloch, Charles E.; Oltman, Scott P.; Pantell, Matthew S.; Piao, Xianhua; Prather, Aric A.; Schmidt, Rebecca J.; Scott, Karen A.; Stookey, Jodi; Tesfalul, Martha; Rand, Larry; Jelliffe‐Pawlowski, Laura L.

doi:10.2139/ssrn.3857659

Cited by 19 publications

(31 citation statements)

References 16 publications

(20 reference statements)

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“… 1 SARS-CoV-2 infection is also associated with adverse pregnancy outcomes, including a possible increased risk of preterm birth and, rarely, vertical transmission or stillbirth. 2 – 8 In utero exposures to infection may have life-long consequences. Rates of adverse outcomes, including stillbirth, have increased with variants of concern (variants), including the Delta variant.…”

Section: Introductionmentioning

confidence: 99%

Placental Pathology After SARS-CoV-2 Infection in the Pre-Variant of Concern, Alpha / Gamma, Delta, or Omicron Eras

et al. 2022

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Objectives.The goal of this study is to describe placental pathology after infection with SARS-CoV-2 before the predominance of variants of concern (pre-VOC) and during eras of predominant transmission of the Alpha & Gamma (co-circulating), Delta, and Omicron variants. Methods. We used county-level variant data to establish population-level variant proportions, SARS-CoV-2 PCR to identify cases, and IgG serology to exclude latent infections from controls and histopathologic examination to identify placental pathology. Results. We report findings in 870 placentas from pregnancies complicated by SARS-CoV-2 including 90 with infection in the Alpha/Gamma era, 60 from the Delta era and 56 from the Omicron era. Features of maternal vascular malperfusion (MVM), including decidual arteriopathy, were significantly more frequent after SARS-CoV-2 infection. The risk of these findings varied over time, with the highest rates in the Delta era. Increased COVID-19 severity and the presence of comorbidities strengthened these associations. Conclusion. MVM is a feature of SARS-CoV-2 infection in pregnancy. Lesion frequency changed with the predominant circulating virus and should be considered with new variants.

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Section: Introductionmentioning

confidence: 99%

Placental Pathology After SARS-CoV-2 Infection in the Pre-Variant of Concern, Alpha / Gamma, Delta, or Omicron Eras

et al. 2022

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“…In their study, Chaudhary et al [ 14 ] saw similar findings. Many reviews report high rates of preterm deliveries among COVID-19 affected pregnant women [ 5 , 23 , 24 ], but the cause for the high preterm births remains unclear in these studies. The rate of neonatal intensive care unit (NICU) admissions was also high, being 21.31% and 33.33%, respectively, during the two waves.…”

Section: Discussionmentioning

confidence: 99%

Maternal and Neonatal Outcome of Pregnant Women With SARS-CoV-2 Infection During the First and Second Wave of COVID-19 in a Tertiary Care Institute in Eastern India

Singh¹,

Choudhary²,

Datta³

et al. 2022

Cureus

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BackgroundThe ongoing coronavirus 2019 (COVID-19) pandemic is the most devastating health care crisis of our times. Pregnant women with COVID-19 infection belong to a vulnerable group with concerns about the effect of the disease on maternal and neonatal health. As we are dealing with a new disease, we must study the changing trend of disease presentation, diagnosis, and treatment to successfully manage such pregnancies. ObjectiveThe purpose of the present study was to evaluate the differences in presenting features, comorbidities, the fetal and maternal outcomes in COVID-19 positive pregnant women in the first and second wave of the pandemic in a tertiary care institute in eastern India. MethodologyThis study was a retrospective observational cohort study conducted at Tata Main Hospital, Jamshedpur, a tertiary care hospital in eastern India. All COVID-19 positive by reverse transcription-polymerase chain reaction or rapid antigen (RTPCR) test pregnant women (249 women) admitted to the hospital from May 2020 to August 2021 were included in this study. Out of the total, 139 women were admitted during the first wave (May 2020 to February 2021), and 110 women were admitted during the second wave (March 2021 to August 2021) of the pandemic. Data like baseline characteristics, clinical presentation, associated comorbidities, management modalities, the maternal and neonatal outcomes were analyzed and compared. ResultsThe peak of the first wave of COVID-19 was found during the months of August-October 2020, while the second wave was in April-May 2021. The majority of women had the asymptomatic or mild disease during both waves, but 14 women had moderate to severe disease during the second wave as compared to two women during the first wave. There was a significant increase in maternal deaths in the second wave (3.64%) as compared to the first wave (0.00%). During the second wave, out of 85 women who delivered, 78.8% (n=67) women had a cesarean section which was significantly higher than the first wave (64.6%). Hypertensive disorders (pre-eclampsia, gestational hypertension, and chronic hypertension) were the most common associated comorbidity, followed by diabetes (gestational diabetes, diabetes mellitus type 2) and anemia during both waves of the pandemic. The rate of preterm delivery was 27.78% (n=35) and 24.71% (n=21) during the first and second waves, respectively. Two babies tested positive within 24 hours of delivery during the first wave and one during the second wave. ConclusionA significantly higher number of moderate to severe disease and maternal deaths were reported during the second wave of the pandemic. A higher incidence of severe oligohydramnios and cesarean section was seen during the second wave. The frequency of preterm deliveries and low birth weight remained high during both waves. Neonatal COVID-19 infection was seen during both waves, but the incidence remained low.

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“…Recent reports show that pregnant individuals with severe SARS-CoV-2 infection are at higher risk of intensive care unit admission, mechanical ventilation, extracorporeal membrane oxygenation, and mortality compared to non-pregnant individuals [8,9]. Other studies show that active SARS-CoV-2 infection at delivery (mainly confirmed through a PCR positive test) is associated with obstetric and neonatal complications including increased risk of preterm birth, stillbirth, miscarriage, preeclampsia, emergency cesarean section and higher neonatal morbidity [8,[10][11][12][13][14][15][16][17][18]. However, in other reports, including ours from New York City and a Denmark study, SARS-CoV-2 IgG seropositivity without RT-PCR positivity at delivery was not associated with adverse pregnancy outcomes [19,20].…”

Section: Introductionmentioning

confidence: 99%

Gestational SARS-CoV-2 infection is associated with placental expression of immune and trophoblast genes

Lesseur

Jessel

Ohrn

et al. 2022

Preprint

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Introduction: Maternal SARS-CoV-2 infection during pregnancy is associated with adverse pregnancy outcomes and can have effects on the placenta, even in the absence of severe disease or vertical transmission to the fetus. This study aimed to evaluate histopathologic and molecular effects in the placenta after SARS-CoV-2 infection during pregnancy. Methods: We performed a study of 45 pregnant participants from the Generation C prospective cohort study at the Mount Sinai Health System in New York City. We compared histologic features and the expression of 48 immune and trophoblast genes in placentas delivered from 15 SARS-CoV-2 IgG antibody positive and 30 IgG SARS-CoV-2 antibody negative mothers. Statistical analyses were performed using Fisher exact tests, Spearman correlations and linear regression models. Results: The median gestational age at the time of SARS-CoV-2 IgG serology test was 35 weeks. Two of the IgG positive participants also had a positive RT-PCR nasal swab at delivery. 82.2% of the infants were delivered at term (≥37 weeks), and gestational age at delivery did not differ between the SARS-CoV-2 antibody positive and negative groups. No significant differences were detected between the groups in placental histopathology features. Differential expression analyses revealed decreased expression of two trophoblast genes (PSG3 and CGB3) and increased expression of three immune genes (CXCL10, TLR3 and DDX58) in placentas delivered from SARS-CoV-2 IgG positive participants. Discussion: SARS-CoV-2 infection during pregnancy is associated with gene expression changes of immune and trophoblast genes in the placenta at birth which could potentially contribute to long-term health effects in the offspring.

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The Association of COVID-19 Infection in Pregnancy With Preterm Birth: A Retrospective Cohort Study in California

Cited by 19 publications

References 16 publications

Placental Pathology After SARS-CoV-2 Infection in the Pre-Variant of Concern, Alpha / Gamma, Delta, or Omicron Eras

Placental Pathology After SARS-CoV-2 Infection in the Pre-Variant of Concern, Alpha / Gamma, Delta, or Omicron Eras

Maternal and Neonatal Outcome of Pregnant Women With SARS-CoV-2 Infection During the First and Second Wave of COVID-19 in a Tertiary Care Institute in Eastern India

Gestational SARS-CoV-2 infection is associated with placental expression of immune and trophoblast genes

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