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The association between SARS-CoV-2 infection and preterm delivery: a prospective study with a multivariable analysis.
BMC Pregnancy Childbirth. 2021 Apr 01; 21(1):273.BP

Abstract

BACKGROUND

To determine whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, the cause of COVID-19 disease) exposure in pregnancy, compared to non-exposure, is associated with infection-related obstetric morbidity.

METHODS

We conducted a multicentre prospective study in pregnancy based on a universal antenatal screening program for SARS-CoV-2 infection. Throughout Spain 45 hospitals tested all women at admission on delivery ward using polymerase-chain-reaction (PCR) for COVID-19 since late March 2020. The cohort of positive mothers and the concurrent sample of negative mothers was followed up until 6-weeks post-partum. Multivariable logistic regression analysis, adjusting for known confounding variables, determined the adjusted odds ratio (aOR) with 95% confidence intervals (95% CI) of the association of SARS-CoV-2 infection and obstetric outcomes.

MAIN OUTCOME MEASURES

Preterm delivery (primary), premature rupture of membranes and neonatal intensive care unit admissions.

RESULTS

Among 1009 screened pregnancies, 246 were SARS-CoV-2 positive. Compared to negative mothers (763 cases), SARS-CoV-2 infection increased the odds of preterm birth (34 vs 51, 13.8% vs 6.7%, aOR 2.12, 95% CI 1.32-3.36, p = 0.002); iatrogenic preterm delivery was more frequent in infected women (4.9% vs 1.3%, p = 0.001), while the occurrence of spontaneous preterm deliveries was statistically similar (6.1% vs 4.7%). An increased risk of premature rupture of membranes at term (39 vs 75, 15.8% vs 9.8%, aOR 1.70, 95% CI 1.11-2.57, p = 0.013) and neonatal intensive care unit admissions (23 vs 18, 9.3% vs 2.4%, aOR 4.62, 95% CI 2.43-8.94, p < 0.001) was also observed in positive mothers.

CONCLUSION

This prospective multicentre study demonstrated that pregnant women infected with SARS-CoV-2 have more infection-related obstetric morbidity. This hypothesis merits evaluation of a causal association in further research.

Links

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Authors+Show Affiliations

Martinez-Perez O
Department Gynaecology and Obstetrics, Puerta de Hierro University Hospital of Majadahonda, Majadahonda, Madrid, Spain. Oscarmartinezgine@gmail.com.
Prats Rodriguez P
Department Reproductive Medicine and Gynaecology, Obstetrics, Dexeus University Hospital, Barcelona, Catalunya, Spain.
Muner Hernandez M
Department Gynaecology and Obstetrics, La Paz University Hospital. Madrid, Madrid, Spain.
Encinas Pardilla MB
Department Gynaecology and Obstetrics, Puerta de Hierro University Hospital of Majadahonda, Majadahonda, Madrid, Spain.
Perez Perez N
Department Gynaecology and Obstetrics, San Carlos University Hospital. Madrid, Madrid, Spain.
Vila Hernandez MR
Department Gynaecology and Obstetrics, Santa Caterina Hospital, Girona, Catalunya, Spain.
Villalba Yarza A
Department Gynaecology and Obstetrics, University Hospital of Salamanca, Salamanca, Castilla y León, Spain.
Nieto Velasco O
Department Obstetrics and Gynaecology, Quironsalud Madrid University Hospital. Madrid, Madrid, Spain.
Del Barrio Fernandez PG
Department Gynaecology and Obstetrics, Getafe University Hospital, Getafe, Madrid, Spain.
Forcen Acebal L
Department Gynaecology and Obstetrics, Doce de Octubre University Hospital, Comunidad de Madrid, Madrid, Spain.
Orizales Lago CM
Department Gynaecology and Obstetrics, Severo Ochoa University Hospital, Leganes, Madrid, Spain.
Martinez Varea A
Department Gynaecology and Obstetrics, La Fe University and Polytechnic Hospital, Comunidad Valenciana, Valencia, Spain.
Muñoz Abellana B
Department Obstetrics and Gynaecology, Sant Joan de Reus University Hospital, Reus, Catalunya, Spain.
Suarez Arana M
Department Gynaecology and Obstetrics, Regional University Hospital of Malaga, Malaga, Andalucía, Spain.
Fuentes Ricoy L
Department Obstetrics and Gynaecology, University Hospital of Ferrol, Ferrol, A Coruña, Spain.
Martinez Diago C
Department Gynaecology and Obstetrics, Doctor Josep Trueta University Hospital of Girona, Girona, Catalunya, Spain.
Janeiro Freire MJ
Department Obstetrics and Gynaecology, University Hospital Complex of A Coruña, A Coruña, Spain.
Alférez Alvarez-Mallo M
Department Obstetrics and Gynaecology, HM Hospitals, Madrid, Spain.
Casanova Pedraz C
Department Gynaecology and Obstetrics, University Hospital of Torrejon, Torrejon de Ardoz, Madrid, Spain.
Alomar Mateu O
Department Obstetrics and Gynaecology, Regional Hospital of Inca, Inca, Illes Balears, Spain.
Lesmes Heredia C
Department Obstetrics and Gynaecology, Parc Taulí Hospital, Barcelona, Catalunya, Spain.
Wizner de Alva JC
Department Gynaecology and Obstetrics, San Pedro de Alcántara Hospital, Caceres, Extremadura, Spain.
Bernardo Vega R
Department Gynaecology and Obstetrics, Rio Hortega University Hospital, Valladolid, Castilla y León, Spain.
Macia Badia M
Department Gynaecology and Obstetrics, Arnau de Vilanova University Hospital, Lleida, Catalunya, Spain.
Alvarez Colomo C
Department Gynaecology and Obstetrics, Valladolid University Hospital, Valladolid, Castilla y León, Spain.
Sanchez Muñoz A
Department Gynaecology and Obstetrics, General University Hospital of Ciudad Real, Ciudad Real, Castilla-La Mancha, Spain.
Pratcorona Alicart L
Department Obstetrics and Gynaecology, Germans Trias i Pujol University Hospital, Barcelona, Catalunya, Spain.
Alonso Saiz R
Department Gynaecology and Obstetrics, University Hospital of Burgos, Burgos, Castilla y León, Spain.
Lopez Rodriguez M
Department Obstetrics and Gynaecology, Joan XXIII University Hospital of Tarragona, Tarragona, Catalunya, Spain.
Del Carmen Barbancho Lopez M
Department Gynaecology and Obstetrics, Infanta Sofia University Hospital, San Sebastian de los Reyes, Madrid, Spain.
Meca Casbas MR
Department Obstetrics and Gynaecology, Poniente Hospital of Almería, El Ejido, Andalucía, Spain.
Vaquerizo Ruiz O
Department Obstetrics and Gynaecology, University Hospital of Cabueñes, Gijon, Asturias, Spain.
Moran Antolin E
Department Obstetrics and Gynaecology, Son Espases University Hospital, Palma de Mallorca, Illes Balears, Spain.
Nuñez Valera MJ
Department Obstetrics and Gynaecology, Virgen de la Luz Hospital, Cuenca, Castilla-La Mancha, Spain.
Fernandez Fernandez C
Department Gynaecology and Obstetrics, University Assistance Complex of Leon, Leon, Castilla y Leon, Spain.
Tubau Navarra A
Department Obstetrics and Gynaecology, Son Llatzer University Hospital, Palma de Mallorca, Illes Balears, Spain.
Cano Garcia AM
Department Gynaecology and Obstetrics, University Hospital of El Tajo, Aranjuez, Madrid, Spain.
Baena Luque C
Department Gynaecology and Obstetrics, Infanta Margarita Hospital, Andalucía, Cabra, Spain.
Soldevilla Perez S
Department Obstetrics and Gynaecology, University Hospital of Jerez de la Frontera, Jerez de la Frontera, Andalucía, Spain.
Gastaca Abasolo I
Department Obstetrics and Gynaecology, Txagorritxu University Hospital of Araba, Vitoria-Gasteiz, País Vasco, Spain.
Adanez Garcia J
Department Obstetrics and Gynaecology, Central University Hospital of Asturias, Oviedo, Asturias, Spain.
Teulon Gonzalez M
Department Gynaecology and Obstetrics, University Hospital of Fuenlabrada, Fuenlabrada, Madrid, Spain.
Puertas Prieto A
Department Obstetrics and Gynaecology, Virgen de las Nieves University Hospital, Granada, Andalucía, Spain.
Ostos Serna R
Department Gynaecology and Obstetrics, Virgen de Valme University Hospital, Sevilla, Andalucía, Spain.
Del Pilar Guadix Martin M
Department Obstetrics and Gynaecology, Virgen Macarena University Hospital, Sevilla, Andalucía, Spain.
Catalina Coello M
Department Gynaecology and Obstetrics, Virgen de la Concha Hospital, Zamora, Castilla y León, Spain.
Ferriols Perez E
Department Gynaecology and Obstetrics, Parc de Salut Mar University Hospital, Barcelona, Catalunya, Spain.
Caño Aguilar A
Department Obstetrics and Gynaecology, San Cecilio University Hospital of Granada, Granada, Andalucía, Spain.
De la Cruz Conty ML
Fundación de Investigación Biomédica, Puerta de Hierro University Hospital of Majadahonda, Majadahonda, Madrid, Spain.
Sainz Bueno JA
Department Gynaecology and Obstetrics, University of Seville, G. Chacon (Viamed Santa Angela de la Cruz Hospital), Sevilla, Andalucia, Spain.
Spanish Obstetric Emergency Group
No affiliation info available

MeSH

AdolescentAdultCOVID-19Case-Control StudiesCesarean SectionFemaleFetal Membranes, Premature RuptureGestational AgeHumansInfant, Extremely PrematureInfant, NewbornInfant, PrematureIntensive Care Units, NeonatalLabor, InducedLogistic ModelsMiddle AgedMultivariate AnalysisOdds RatioPregnancyPregnancy Complications, InfectiousPremature BirthProspective StudiesSARS-CoV-2SpainYoung Adult

Pub Type(s)

Journal Article

Language

eng

PubMed ID

33794829

Citation

Martinez-Perez, Oscar, et al. "The Association Between SARS-CoV-2 Infection and Preterm Delivery: a Prospective Study With a Multivariable Analysis." BMC Pregnancy and Childbirth, vol. 21, no. 1, 2021, p. 273.
Martinez-Perez O, Prats Rodriguez P, Muner Hernandez M, et al. The association between SARS-CoV-2 infection and preterm delivery: a prospective study with a multivariable analysis. BMC Pregnancy Childbirth. 2021;21(1):273.
Martinez-Perez, O., Prats Rodriguez, P., Muner Hernandez, M., Encinas Pardilla, M. B., Perez Perez, N., Vila Hernandez, M. R., Villalba Yarza, A., Nieto Velasco, O., Del Barrio Fernandez, P. G., Forcen Acebal, L., Orizales Lago, C. M., Martinez Varea, A., Muñoz Abellana, B., Suarez Arana, M., Fuentes Ricoy, L., Martinez Diago, C., Janeiro Freire, M. J., Alférez Alvarez-Mallo, M., Casanova Pedraz, C., ... Sainz Bueno, J. A. (2021). The association between SARS-CoV-2 infection and preterm delivery: a prospective study with a multivariable analysis. BMC Pregnancy and Childbirth, 21(1), 273. https://doi.org/10.1186/s12884-021-03742-4
Martinez-Perez O, et al. The Association Between SARS-CoV-2 Infection and Preterm Delivery: a Prospective Study With a Multivariable Analysis. BMC Pregnancy Childbirth. 2021 Apr 1;21(1):273. PubMed PMID: 33794829.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The association between SARS-CoV-2 infection and preterm delivery: a prospective study with a multivariable analysis. AU - Martinez-Perez,Oscar, AU - Prats Rodriguez,Pilar, AU - Muner Hernandez,Marta, AU - Encinas Pardilla,Maria Begoña, AU - Perez Perez,Noelia, AU - Vila Hernandez,Maria Rosa, AU - Villalba Yarza,Ana, AU - Nieto Velasco,Olga, AU - Del Barrio Fernandez,Pablo Guillermo, AU - Forcen Acebal,Laura, AU - Orizales Lago,Carmen Maria, AU - Martinez Varea,Alicia, AU - Muñoz Abellana,Begoña, AU - Suarez Arana,Maria, AU - Fuentes Ricoy,Laura, AU - Martinez Diago,Clara, AU - Janeiro Freire,Maria Jesus, AU - Alférez Alvarez-Mallo,Macarena, AU - Casanova Pedraz,Cristina, AU - Alomar Mateu,Onofre, AU - Lesmes Heredia,Cristina, AU - Wizner de Alva,Juan Carlos, AU - Bernardo Vega,Rut, AU - Macia Badia,Montserrat, AU - Alvarez Colomo,Cristina, AU - Sanchez Muñoz,Antonio, AU - Pratcorona Alicart,Laia, AU - Alonso Saiz,Ruben, AU - Lopez Rodriguez,Monica, AU - Del Carmen Barbancho Lopez,Maria, AU - Meca Casbas,Marta Ruth, AU - Vaquerizo Ruiz,Oscar, AU - Moran Antolin,Eva, AU - Nuñez Valera,Maria Jose, AU - Fernandez Fernandez,Camino, AU - Tubau Navarra,Albert, AU - Cano Garcia,Alejandra Maria, AU - Baena Luque,Carmen, AU - Soldevilla Perez,Susana, AU - Gastaca Abasolo,Irene, AU - Adanez Garcia,Jose, AU - Teulon Gonzalez,Maria, AU - Puertas Prieto,Alberto, AU - Ostos Serna,Rosa, AU - Del Pilar Guadix Martin,Maria, AU - Catalina Coello,Monica, AU - Ferriols Perez,Elena, AU - Caño Aguilar,Africa, AU - De la Cruz Conty,Maria Luisa, AU - Sainz Bueno,Jose Antonio, AU - ,, Y1 - 2021/04/01/ PY - 2020/10/21/received PY - 2021/03/22/accepted PY - 2021/4/2/entrez PY - 2021/4/3/pubmed PY - 2021/4/13/medline KW - COVID-19 KW - Coronavirus KW - Intensive care units, neonatal KW - Pregnancy KW - Premature birth KW - Premature rupture of membranes KW - SARS-CoV-2 SP - 273 EP - 273 JF - BMC pregnancy and childbirth JO - BMC Pregnancy Childbirth VL - 21 IS - 1 N2 - BACKGROUND: To determine whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, the cause of COVID-19 disease) exposure in pregnancy, compared to non-exposure, is associated with infection-related obstetric morbidity. METHODS: We conducted a multicentre prospective study in pregnancy based on a universal antenatal screening program for SARS-CoV-2 infection. Throughout Spain 45 hospitals tested all women at admission on delivery ward using polymerase-chain-reaction (PCR) for COVID-19 since late March 2020. The cohort of positive mothers and the concurrent sample of negative mothers was followed up until 6-weeks post-partum. Multivariable logistic regression analysis, adjusting for known confounding variables, determined the adjusted odds ratio (aOR) with 95% confidence intervals (95% CI) of the association of SARS-CoV-2 infection and obstetric outcomes. MAIN OUTCOME MEASURES: Preterm delivery (primary), premature rupture of membranes and neonatal intensive care unit admissions. RESULTS: Among 1009 screened pregnancies, 246 were SARS-CoV-2 positive. Compared to negative mothers (763 cases), SARS-CoV-2 infection increased the odds of preterm birth (34 vs 51, 13.8% vs 6.7%, aOR 2.12, 95% CI 1.32-3.36, p = 0.002); iatrogenic preterm delivery was more frequent in infected women (4.9% vs 1.3%, p = 0.001), while the occurrence of spontaneous preterm deliveries was statistically similar (6.1% vs 4.7%). An increased risk of premature rupture of membranes at term (39 vs 75, 15.8% vs 9.8%, aOR 1.70, 95% CI 1.11-2.57, p = 0.013) and neonatal intensive care unit admissions (23 vs 18, 9.3% vs 2.4%, aOR 4.62, 95% CI 2.43-8.94, p < 0.001) was also observed in positive mothers. CONCLUSION: This prospective multicentre study demonstrated that pregnant women infected with SARS-CoV-2 have more infection-related obstetric morbidity. This hypothesis merits evaluation of a causal association in further research. SN - 1471-2393 UR - https://www.unboundmedicine.com/medline/citation/33794829/The_association_between_SARS_CoV_2_infection_and_preterm_delivery:_a_prospective_study_with_a_multivariable_analysis_ DB - PRIME DP - Unbound Medicine ER -