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Risk factors associated with adverse fetal outcomes in pregnancies affected by Coronavirus disease 2019 (COVID-19): a secondary analysis of the WAPM study on COVID-19.
J Perinat Med. 2020 11 26; 48(9):950-958.JP

Abstract

Objectives To evaluate the strength of association between maternal and pregnancy characteristics and the risk of adverse perinatal outcomes in pregnancies with laboratory confirmed COVID-19. Methods Secondary analysis of a multinational, cohort study on all consecutive pregnant women with laboratory-confirmed COVID-19 from February 1, 2020 to April 30, 2020 from 73 centers from 22 different countries. A confirmed case of COVID-19 was defined as a positive result on real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay of nasal and pharyngeal swab specimens. The primary outcome was a composite adverse fetal outcome, defined as the presence of either abortion (pregnancy loss before 22 weeks of gestations), stillbirth (intrauterine fetal death after 22 weeks of gestation), neonatal death (death of a live-born infant within the first 28 days of life), and perinatal death (either stillbirth or neonatal death). Logistic regression analysis was performed to evaluate parameters independently associated with the primary outcome. Logistic regression was reported as odds ratio (OR) with 95% confidence interval (CI). Results Mean gestational age at diagnosis was 30.6±9.5 weeks, with 8.0% of women being diagnosed in the first, 22.2% in the second and 69.8% in the third trimester of pregnancy. There were six miscarriage (2.3%), six intrauterine device (IUD) (2.3) and 5 (2.0%) neonatal deaths, with an overall rate of perinatal death of 4.2% (11/265), thus resulting into 17 cases experiencing and 226 not experiencing composite adverse fetal outcome. Neither stillbirths nor neonatal deaths had congenital anomalies found at antenatal or postnatal evaluation. Furthermore, none of the cases experiencing IUD had signs of impending demise at arterial or venous Doppler. Neonatal deaths were all considered as prematurity-related adverse events. Of the 250 live-born neonates, one (0.4%) was found positive at RT-PCR pharyngeal swabs performed after delivery. The mother was tested positive during the third trimester of pregnancy. The newborn was asymptomatic and had negative RT-PCR test after 14 days of life. At logistic regression analysis, gestational age at diagnosis (OR: 0.85, 95% CI 0.8-0.9 per week increase; p<0.001), birthweight (OR: 1.17, 95% CI 1.09-1.12.7 per 100 g decrease; p=0.012) and maternal ventilatory support, including either need for oxygen or CPAP (OR: 4.12, 95% CI 2.3-7.9; p=0.001) were independently associated with composite adverse fetal outcome. Conclusions Early gestational age at infection, maternal ventilatory supports and low birthweight are the main determinants of adverse perinatal outcomes in fetuses with maternal COVID-19 infection. Conversely, the risk of vertical transmission seems negligible.

Authors+Show Affiliations

Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy.Perinatal Medicine Foundation and Department of Perinatal Medicine, Memorial Hospital, Istanbul, Turkey.Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy.Fetal Medicine Unit, Maternal and Child Health and Development Network, University Hospital 12 de Octubre, Complutense University of MadridDepartment of Obstetrics and Gynaecology, Madrid, Spain.Department of Obstetrics and Gynaecology, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.Department of Perinatology and Gynaecology, National Cerebral and Cardiovascular Center, Osaka, Japan.Department of Obstetrics and Gynaecology, Medical School University of Zagreb, Sveti Duh University Hospital, Zagreb, Croatia.Department of Obstetrics and Gynaecology, Medical School University of Zagreb, Sveti Duh University Hospital, Zagreb, Croatia.Department of Obstetrics and Gynaecology, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.Hospital Universitario Central de Asturias, Asturias, Spain.Department of Obstetrics and Gynaecology, Ciudad Real University General Hospital, Ciudad Real, Spain.Department of Obstetrics and Gynaecology, Ciudad Real University General Hospital, Ciudad Real, Spain. University of Castilla-La Mancha, Ciudad Real, Spain.Department of Obstetrics and Gynaecology, Ciudad Real University General Hospital, Ciudad Real, Spain. University of Castilla-La Mancha, Ciudad Real, Spain.Fetal Medicine Unit, Maternal and Child Health anad Development Network, Gregorio Marañón Hospital, Complutense University of Madrid, Department of Obstetrics and Gynaecology, Madrid, Spain.Fetal Medicine Unit, Maternal and Child Health anad Development Network, Gregorio Marañón Hospital, Complutense University of Madrid, Department of Obstetrics and Gynaecology, Madrid, Spain.Fetal Medicine Unit, Maternal and Child Health anad Development Network, Gregorio Marañón Hospital, Complutense University of Madrid, Department of Obstetrics and Gynaecology, Madrid, Spain.Fetal Medicine Unit, Maternal and Child Health and Development Network, University Hospital 12 de Octubre, Complutense University of MadridDepartment of Obstetrics and Gynaecology, Madrid, Spain.Fetal Medicine Unit, Maternal and Child Health and Development Network, University Hospital 12 de Octubre, Complutense University of MadridDepartment of Obstetrics and Gynaecology, Madrid, Spain.Department of Obstetrics and Gynaecology, School of Medicin, Magna Graecia University of Catanzaro, Catanzaro, Italy.University of Roma Tor Vergata, Division of Maternal Fetal Medicine, Ospedale Cristo Re Roma, Rome, Italy. 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Pub Type(s)

Journal Article

Language

eng

PubMed ID

32975205

Citation

Di Mascio, Daniele, et al. "Risk Factors Associated With Adverse Fetal Outcomes in Pregnancies Affected By Coronavirus Disease 2019 (COVID-19): a Secondary Analysis of the WAPM Study On COVID-19." Journal of Perinatal Medicine, vol. 48, no. 9, 2020, pp. 950-958.
Di Mascio D, Sen C, Saccone G, et al. Risk factors associated with adverse fetal outcomes in pregnancies affected by Coronavirus disease 2019 (COVID-19): a secondary analysis of the WAPM study on COVID-19. J Perinat Med. 2020;48(9):950-958.
Di Mascio, D., Sen, C., Saccone, G., Galindo, A., Grünebaum, A., Yoshimatsu, J., Stanojevic, M., Kurjak, A., Chervenak, F., Rodríguez Suárez, M. J., Gambacorti-Passerini, Z. M., Baz, M. L. A. A., Aguilar Galán, E. V., López, Y. C., De León Luis, J. A., Hernández, I. C., Herraiz, I., Villalain, C., Venturella, R., ... D'Antonio, F. (2020). Risk factors associated with adverse fetal outcomes in pregnancies affected by Coronavirus disease 2019 (COVID-19): a secondary analysis of the WAPM study on COVID-19. Journal of Perinatal Medicine, 48(9), 950-958. https://doi.org/10.1515/jpm-2020-0355
Di Mascio D, et al. Risk Factors Associated With Adverse Fetal Outcomes in Pregnancies Affected By Coronavirus Disease 2019 (COVID-19): a Secondary Analysis of the WAPM Study On COVID-19. J Perinat Med. 2020 11 26;48(9):950-958. PubMed PMID: 32975205.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Risk factors associated with adverse fetal outcomes in pregnancies affected by Coronavirus disease 2019 (COVID-19): a secondary analysis of the WAPM study on COVID-19. AU - Di Mascio,Daniele, AU - Sen,Cihat, AU - Saccone,Gabriele, AU - Galindo,Alberto, AU - Grünebaum,Amos, AU - Yoshimatsu,Jun, AU - Stanojevic,Milan, AU - Kurjak,Asım, AU - Chervenak,Frank, AU - Rodríguez Suárez,María José, AU - Gambacorti-Passerini,Zita Maria, AU - Baz,María de Los Angeles Anaya, AU - Aguilar Galán,Esther Vanessa, AU - López,Yolanda Cuñarro, AU - De León Luis,Juan Antonio, AU - Hernández,Ignacio Cueto, AU - Herraiz,Ignacio, AU - Villalain,Cecilia, AU - Venturella,Roberta, AU - Rizzo,Giuseppe, AU - Mappa,Ilenia, AU - Gerosolima,Giovanni, AU - Hellmeyer,Lars, AU - Königbauer,Josefine, AU - Ameli,Giada, AU - Frusca,Tiziana, AU - Volpe,Nicola, AU - Luca Schera,Giovanni Battista, AU - Fieni,Stefania, AU - Esposito,Eutalia, AU - Simonazzi,Giuliana, AU - Di Donna,Gaetana, AU - Youssef,Aly, AU - Della Gatta,Anna Nunzia, AU - Di Donna,Mariano Catello, AU - Chiantera,Vito, AU - Buono,Natalina, AU - Sozzi,Giulio, AU - Greco,Pantaleo, AU - Morano,Danila, AU - Bianchi,Beatrice, AU - Lombana Marino,Maria Giulia, AU - Laraud,Federica, AU - Ramone,Arianna, AU - Cagnacci,Angelo, AU - Barra,Fabio, AU - Gustavino,Claudio, AU - Ferrero,Simone, AU - Ghezzi,Fabio, AU - Cromi,Antonella, AU - Laganà,Antonio Simone, AU - Laurita Longo,Valentina, AU - Stollagli,Francesca, AU - Sirico,Angelo, AU - Lanzone,Antonio, AU - Driul,Lorenza, AU - Cecchini D,Fabiana, AU - Xodo,Serena, AU - Rodriguez,Brian, AU - Mercado-Olivares,Felipe, AU - Elkafrawi,Deena, AU - Sisti,Giovanni, AU - Esposito,Rosanna, AU - Coviello,Antonio, AU - Cerbone,Marco, AU - Morlando,Maddalena, AU - Schiattarella,Antonio, AU - Colacurci,Nicola, AU - De Franciscis,Pasquale, AU - Cataneo,Ilaria, AU - Lenzi,Marinella, AU - Sandri,Fabrizio, AU - Buscemi,Riccardo, AU - Gattei,Giorgia, AU - Sala,Francesca Della, AU - Valori,Eleonora, AU - Rovellotti,Maria Cristina, AU - Done,Elisa, AU - Faron,Gilles, AU - Gucciardo,Leonardo, AU - Esposito,Valentina, AU - Vena,Flaminia, AU - Giancotti,Antonella, AU - Brunelli,Roberto, AU - Muzii,Ludovico, AU - Nappi,Luigi, AU - Sorrentino,Felice, AU - Vasciaveo,Lorenzo, AU - Liberati,Marco, AU - Buca,Danilo, AU - Leombroni,Martina, AU - Di Sebastiano,Francesca, AU - Di Tizio,Luciano, AU - Gazzolo,Diego, AU - Franchi,Massimo, AU - Ianniciello,Quintino Cesare, AU - Garzon,Simone, AU - Petriglia,Giuliano, AU - Borrello,Leonardo, AU - Nieto-Calvache,Albaro Josè, AU - Burgos-Luna,Juan Manuel, AU - Kadji,Caroline, AU - Carlin,Andrew, AU - Bevilacqua,Elisa, AU - Moucho,Marina, AU - Pinto,Pedro Viana, AU - Figueiredo,Rita, AU - Morales Roselló,José, AU - Loscalzo,Gabriela, AU - Martinez-Varea,Alicia, AU - Diago,Vincente, AU - Jimenez Lopez,Jesús S, AU - Aykanat,Alicia Yeliz, AU - Cosma,Stefano, AU - Carosso,Andrea, AU - Benedetto,Chiara, AU - Bermejo,Amanda, AU - May Feuerschuette,Otto Henrique, AU - Uyaniklar,Ozlem, AU - Ocakouglu,Sakine Rahimli, AU - Atak,Zeliha, AU - Gündüz,Reyhan, AU - Haberal,Esra Tustas, AU - Froessler,Bernd, AU - Parange,Anupam, AU - Palm,Peter, AU - Samardjiski,Igor, AU - Taccaliti,Chiara, AU - Okuyan,Erhan, AU - Daskalakis,George, AU - Moreira de Sa,Renato Augusto, AU - Pittaro,Alejandro, AU - Gonzalez-Duran,Maria Luisa, AU - Guisan,Ana Concheiro, AU - Genç,Şerife Özlem, AU - Zlatohlávková,Blanka, AU - Piqueras,Anna Luengo, AU - Oliva,Dolores Esteban, AU - Cil,Aylin Pelin, AU - Api,Olus, AU - Antsaklis,Panos, AU - Ples,Liana, AU - Kyvernitakis,Ioannis, AU - Maul,Holger, AU - Malan,Marcel, AU - Lila,Albert, AU - Granese,Roberta, AU - Ercoli,Alfredo, AU - Zoccali,Giuseppe, AU - Villasco,Andrea, AU - Biglia,Nicoletta, AU - Madalina,Ciuhodaru, AU - Costa,Elena, AU - Daelemans,Caroline, AU - Pintiaux,Axelle, AU - Cueto,Elisa, AU - Hadar,Eran, AU - Dollinger,Sarah, AU - Brzezinski Sinai,Noa A, AU - Huertas,Erasmo, AU - Arango,Pedro, AU - Sanchez,Amadeo, AU - Schvartzman,Javier Alfonso, AU - Cojocaru,Liviu, AU - Turan,Sifa, AU - Turan,Ozhan, AU - Di Dedda,Maria Carmela, AU - Molpeceres,Rebeca Garrote, AU - Zdjelar,Snezana, AU - Premru-Srsen,Tanja, AU - Cerar,Lilijana Kornhauser, AU - Druškovič,Mirjam, AU - De Robertis,Valentina, AU - Stefanovic,Vedran, AU - Nupponen,Irmeli, AU - Nelskylä,Kaisa, AU - Khodjaeva,Zulfiya, AU - Gorina,Ksenia A, AU - Sukhikh,Gennady T, AU - Maruotti,Giuseppe Maria, AU - Visentin,Silvia, AU - Cosmi,Erich, AU - Ferrari,Jacopo, AU - Gatti,Alessandra, AU - Luvero,Daniela, AU - Angioli,Roberto, AU - Puri,Ludovica, AU - Palumbo,Marco, AU - D'Urso,Giusella, AU - Colaleo,Francesco, AU - Chiara Rapisarda,Agnese Maria, AU - Carbone,Ilma Floriana, AU - Mollo,Antonio, AU - Nazzaro,Giovanni, AU - Locci,Mariavittoria, AU - Guida,Maurizio, AU - Di Spiezio Sardo,Attilio, AU - Panici,Pierluigi Benedetti, AU - Berghella,Vincenzo, AU - Flacco,Maria Elena, AU - Manzoli,Lamberto, AU - Bifulco,Giuseppe, AU - Scambia,Giovanni, AU - Zullo,Fulvio, AU - D'Antonio,Francesco, PY - 2020/07/27/received PY - 2020/08/21/accepted PY - 2020/9/26/pubmed PY - 2020/11/21/medline PY - 2020/9/25/entrez KW - Coronavirus KW - perinatal morbidity KW - perinatal mortality SP - 950 EP - 958 JF - Journal of perinatal medicine JO - J Perinat Med VL - 48 IS - 9 N2 - Objectives To evaluate the strength of association between maternal and pregnancy characteristics and the risk of adverse perinatal outcomes in pregnancies with laboratory confirmed COVID-19. Methods Secondary analysis of a multinational, cohort study on all consecutive pregnant women with laboratory-confirmed COVID-19 from February 1, 2020 to April 30, 2020 from 73 centers from 22 different countries. A confirmed case of COVID-19 was defined as a positive result on real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay of nasal and pharyngeal swab specimens. The primary outcome was a composite adverse fetal outcome, defined as the presence of either abortion (pregnancy loss before 22 weeks of gestations), stillbirth (intrauterine fetal death after 22 weeks of gestation), neonatal death (death of a live-born infant within the first 28 days of life), and perinatal death (either stillbirth or neonatal death). Logistic regression analysis was performed to evaluate parameters independently associated with the primary outcome. Logistic regression was reported as odds ratio (OR) with 95% confidence interval (CI). Results Mean gestational age at diagnosis was 30.6±9.5 weeks, with 8.0% of women being diagnosed in the first, 22.2% in the second and 69.8% in the third trimester of pregnancy. There were six miscarriage (2.3%), six intrauterine device (IUD) (2.3) and 5 (2.0%) neonatal deaths, with an overall rate of perinatal death of 4.2% (11/265), thus resulting into 17 cases experiencing and 226 not experiencing composite adverse fetal outcome. Neither stillbirths nor neonatal deaths had congenital anomalies found at antenatal or postnatal evaluation. Furthermore, none of the cases experiencing IUD had signs of impending demise at arterial or venous Doppler. Neonatal deaths were all considered as prematurity-related adverse events. Of the 250 live-born neonates, one (0.4%) was found positive at RT-PCR pharyngeal swabs performed after delivery. The mother was tested positive during the third trimester of pregnancy. The newborn was asymptomatic and had negative RT-PCR test after 14 days of life. At logistic regression analysis, gestational age at diagnosis (OR: 0.85, 95% CI 0.8-0.9 per week increase; p<0.001), birthweight (OR: 1.17, 95% CI 1.09-1.12.7 per 100 g decrease; p=0.012) and maternal ventilatory support, including either need for oxygen or CPAP (OR: 4.12, 95% CI 2.3-7.9; p=0.001) were independently associated with composite adverse fetal outcome. Conclusions Early gestational age at infection, maternal ventilatory supports and low birthweight are the main determinants of adverse perinatal outcomes in fetuses with maternal COVID-19 infection. Conversely, the risk of vertical transmission seems negligible. SN - 1619-3997 UR - https://www.unboundmedicine.com/medline/citation/32975205/Risk_factors_associated_with_adverse_fetal_outcomes_in_pregnancies_affected_by_Coronavirus_disease_2019__COVID_19_:_a_secondary_analysis_of_the_WAPM_study_on_COVID_19_ DB - PRIME DP - Unbound Medicine ER -