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Maternal and perinatal outcomes of pregnant women with SARS-CoV-2 infection at the time of birth in England: national cohort study.
Am J Obstet Gynecol. 2021 11; 225(5):522.e1-522.e11.AJ

Abstract

BACKGROUND

Some studies have suggested that women with SARS-CoV-2 infection during pregnancy are at increased risk of adverse pregnancy and neonatal outcomes, but these associations are still not clear.

OBJECTIVE

This study aimed to determine the association between SARS-CoV-2 infection at the time of birth and maternal and perinatal outcomes.

STUDY DESIGN

This is a population-based cohort study in England. The inclusion criteria were women with a recorded singleton birth between May 29, 2020, and January 31, 2021, in a national database of hospital admissions. Maternal and perinatal outcomes were compared between pregnant women with a laboratory-confirmed SARS-CoV-2 infection recorded in the birth episode and those without. Study outcomes were fetal death at or beyond 24 weeks' gestation (stillbirth), preterm birth (<37 weeks' gestation), small for gestational age infant (small for gestational age; birthweight at the <tenth centile), preeclampsia or eclampsia, induction of labor, mode of birth, specialist neonatal care, composite neonatal adverse outcome indicator, maternal and neonatal length of hospital stay after birth (3 days or more), and 28-day neonatal and 42-day maternal hospital readmission. Adjusted odds ratios and their 95% confidence interval for the association between SARS-CoV-2 infection status and outcomes were calculated using logistic regression, adjusting for maternal age, ethnicity, parity, preexisting diabetes mellitus, preexisting hypertension, and socioeconomic deprivation measured using the Index of Multiple Deprivation 2019. Models were fitted with robust standard errors to account for hospital-level clustering. The analysis of the neonatal outcomes was repeated for those born at term (≥37 weeks' gestation) because preterm birth has been reported to be more common in pregnant women with SARS-CoV-2 infection.

RESULTS

The analysis included 342,080 women, of whom 3527 had laboratory-confirmed SARS-CoV-2 infection. Laboratory-confirmed SARS-CoV-2 infection was more common in women who were younger, of non-White ethnicity, primiparous, or residing in the most deprived areas or had comorbidities. Fetal death (adjusted odds ratio, 2.21; 95% confidence interval, 1.58-3.11; P<.001) and preterm birth (adjusted odds ratio, 2.17; 95% confidence interval, 1.96-2.42; P<.001) occurred more frequently in women with SARS-CoV-2 infection than those without. The risk of preeclampsia or eclampsia (adjusted odds ratio, 1.55; 95% confidence interval, 1.29-1.85; P<.001), birth by emergency cesarean delivery (adjusted odds ratio, 1.63; 95% confidence interval, 1.51-1.76; P<.001), and prolonged admission after birth (adjusted odds ratio, 1.57; 95% confidence interval, 1.44-1.72; P<.001) were significantly higher for women with SARS-CoV-2 infection than those without. There were no significant differences (P>.05) in the rate of other maternal outcomes. The risk of neonatal adverse outcome (adjusted odds ratio, 1.45; 95% confidence interval, 1.27-1.66; P<.001), need for specialist neonatal care (adjusted odds ratio, 1.24; 95% confidence interval, 1.02-1.51; P=.03), and prolonged neonatal admission after birth (adjusted odds ratio, 1.61; 95% confidence interval, 1.49-1.75; P<.001) were all significantly higher for infants with mothers with laboratory-confirmed SARS-CoV-2 infection. When the analysis was restricted to pregnancies delivered at term (≥37 weeks), there were no significant differences in neonatal adverse outcome (P=.78), need for specialist neonatal care after birth (P=.22), or neonatal readmission within 4 weeks of birth (P=.05). Neonates born at term to mothers with laboratory-confirmed SARS-CoV-2 infection were more likely to have prolonged admission after birth (21.1% compared with 14.6%; adjusted odds ratio, 1.61; 95% confidence interval, 1.49-1.75; P<.001).

CONCLUSION

SARS-CoV-2 infection at the time of birth is associated with higher rates of fetal death, preterm birth, preeclampsia, and emergency cesarean delivery. There were no additional adverse neonatal outcomes, other than those related to preterm delivery. Pregnant women should be counseled regarding risks of SARS-CoV-2 infection and should be considered a priority for vaccination.

Authors+Show Affiliations

Royal College of Obstetricians and Gynaecologists, London, United Kingdom; Department of Health Services Research, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom.Royal College of Obstetricians and Gynaecologists, London, United Kingdom; Department of Health Services Research, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom.Royal College of Obstetricians and Gynaecologists, London, United Kingdom.Royal College of Obstetricians and Gynaecologists, London, United Kingdom; Department of Women's Health, North Bristol NHS Trust, Bristol, United Kingdom.Royal College of Obstetricians and Gynaecologists, London, United Kingdom.Royal College of Obstetricians and Gynaecologists, London, United Kingdom.Centre for Reproduction Research, Faculty of Health and Life Sciences, De Montfort University, Leicester, United Kingdom.Royal Free London NHS Foundation Trust, London, United Kingdom.Royal College of Obstetricians and Gynaecologists, London, United Kingdom; Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, United Kingdom.Royal College of Obstetricians and Gynaecologists, London, United Kingdom; Department of Health Services Research, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom.Royal College of Obstetricians and Gynaecologists, London, United Kingdom.Royal College of Obstetricians and Gynaecologists, London, United Kingdom.Department of Health Services Research, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom.Fetal Medicine Unit, St George's Hospital, London, United Kingdom; Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, United Kingdom. Electronic address: akhalil@sgul.ac.uk.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

34023315

Citation

Gurol-Urganci, Ipek, et al. "Maternal and Perinatal Outcomes of Pregnant Women With SARS-CoV-2 Infection at the Time of Birth in England: National Cohort Study." American Journal of Obstetrics and Gynecology, vol. 225, no. 5, 2021, pp. 522.e1-522.e11.
Gurol-Urganci I, Jardine JE, Carroll F, et al. Maternal and perinatal outcomes of pregnant women with SARS-CoV-2 infection at the time of birth in England: national cohort study. Am J Obstet Gynecol. 2021;225(5):522.e1-522.e11.
Gurol-Urganci, I., Jardine, J. E., Carroll, F., Draycott, T., Dunn, G., Fremeaux, A., Harris, T., Hawdon, J., Morris, E., Muller, P., Waite, L., Webster, K., van der Meulen, J., & Khalil, A. (2021). Maternal and perinatal outcomes of pregnant women with SARS-CoV-2 infection at the time of birth in England: national cohort study. American Journal of Obstetrics and Gynecology, 225(5), e1-e11. https://doi.org/10.1016/j.ajog.2021.05.016
Gurol-Urganci I, et al. Maternal and Perinatal Outcomes of Pregnant Women With SARS-CoV-2 Infection at the Time of Birth in England: National Cohort Study. Am J Obstet Gynecol. 2021;225(5):522.e1-522.e11. PubMed PMID: 34023315.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Maternal and perinatal outcomes of pregnant women with SARS-CoV-2 infection at the time of birth in England: national cohort study. AU - Gurol-Urganci,Ipek, AU - Jardine,Jennifer E, AU - Carroll,Fran, AU - Draycott,Tim, AU - Dunn,George, AU - Fremeaux,Alissa, AU - Harris,Tina, AU - Hawdon,Jane, AU - Morris,Edward, AU - Muller,Patrick, AU - Waite,Lara, AU - Webster,Kirstin, AU - van der Meulen,Jan, AU - Khalil,Asma, Y1 - 2021/05/20/ PY - 2021/05/04/received PY - 2021/05/13/revised PY - 2021/05/14/accepted PY - 2021/5/24/pubmed PY - 2021/11/23/medline PY - 2021/5/23/entrez KW - COVID-19 KW - birth KW - fetal death KW - neonatal outcome KW - obstetrics KW - preeclampsia KW - pregnancy KW - preterm birth KW - stillbirth SP - 522.e1 EP - 522.e11 JF - American journal of obstetrics and gynecology JO - Am J Obstet Gynecol VL - 225 IS - 5 N2 - BACKGROUND: Some studies have suggested that women with SARS-CoV-2 infection during pregnancy are at increased risk of adverse pregnancy and neonatal outcomes, but these associations are still not clear. OBJECTIVE: This study aimed to determine the association between SARS-CoV-2 infection at the time of birth and maternal and perinatal outcomes. STUDY DESIGN: This is a population-based cohort study in England. The inclusion criteria were women with a recorded singleton birth between May 29, 2020, and January 31, 2021, in a national database of hospital admissions. Maternal and perinatal outcomes were compared between pregnant women with a laboratory-confirmed SARS-CoV-2 infection recorded in the birth episode and those without. Study outcomes were fetal death at or beyond 24 weeks' gestation (stillbirth), preterm birth (<37 weeks' gestation), small for gestational age infant (small for gestational age; birthweight at the <tenth centile), preeclampsia or eclampsia, induction of labor, mode of birth, specialist neonatal care, composite neonatal adverse outcome indicator, maternal and neonatal length of hospital stay after birth (3 days or more), and 28-day neonatal and 42-day maternal hospital readmission. Adjusted odds ratios and their 95% confidence interval for the association between SARS-CoV-2 infection status and outcomes were calculated using logistic regression, adjusting for maternal age, ethnicity, parity, preexisting diabetes mellitus, preexisting hypertension, and socioeconomic deprivation measured using the Index of Multiple Deprivation 2019. Models were fitted with robust standard errors to account for hospital-level clustering. The analysis of the neonatal outcomes was repeated for those born at term (≥37 weeks' gestation) because preterm birth has been reported to be more common in pregnant women with SARS-CoV-2 infection. RESULTS: The analysis included 342,080 women, of whom 3527 had laboratory-confirmed SARS-CoV-2 infection. Laboratory-confirmed SARS-CoV-2 infection was more common in women who were younger, of non-White ethnicity, primiparous, or residing in the most deprived areas or had comorbidities. Fetal death (adjusted odds ratio, 2.21; 95% confidence interval, 1.58-3.11; P<.001) and preterm birth (adjusted odds ratio, 2.17; 95% confidence interval, 1.96-2.42; P<.001) occurred more frequently in women with SARS-CoV-2 infection than those without. The risk of preeclampsia or eclampsia (adjusted odds ratio, 1.55; 95% confidence interval, 1.29-1.85; P<.001), birth by emergency cesarean delivery (adjusted odds ratio, 1.63; 95% confidence interval, 1.51-1.76; P<.001), and prolonged admission after birth (adjusted odds ratio, 1.57; 95% confidence interval, 1.44-1.72; P<.001) were significantly higher for women with SARS-CoV-2 infection than those without. There were no significant differences (P>.05) in the rate of other maternal outcomes. The risk of neonatal adverse outcome (adjusted odds ratio, 1.45; 95% confidence interval, 1.27-1.66; P<.001), need for specialist neonatal care (adjusted odds ratio, 1.24; 95% confidence interval, 1.02-1.51; P=.03), and prolonged neonatal admission after birth (adjusted odds ratio, 1.61; 95% confidence interval, 1.49-1.75; P<.001) were all significantly higher for infants with mothers with laboratory-confirmed SARS-CoV-2 infection. When the analysis was restricted to pregnancies delivered at term (≥37 weeks), there were no significant differences in neonatal adverse outcome (P=.78), need for specialist neonatal care after birth (P=.22), or neonatal readmission within 4 weeks of birth (P=.05). Neonates born at term to mothers with laboratory-confirmed SARS-CoV-2 infection were more likely to have prolonged admission after birth (21.1% compared with 14.6%; adjusted odds ratio, 1.61; 95% confidence interval, 1.49-1.75; P<.001). CONCLUSION: SARS-CoV-2 infection at the time of birth is associated with higher rates of fetal death, preterm birth, preeclampsia, and emergency cesarean delivery. There were no additional adverse neonatal outcomes, other than those related to preterm delivery. Pregnant women should be counseled regarding risks of SARS-CoV-2 infection and should be considered a priority for vaccination. SN - 1097-6868 UR - https://www.unboundmedicine.com/medline/citation/34023315/Maternal_and_perinatal_outcomes_of_pregnant_women_with_SARS_CoV_2_infection_at_the_time_of_birth_in_England:_national_cohort_study_ DB - PRIME DP - Unbound Medicine ER -