Diagnosis of COVID-19 during pregnancy and the postpartum period: a study

Even as the SARS-CoV-2 virus continues to spread worldwide, killing more than 6.2 million people to date, there is still significant debate regarding the pathogen’s impact on children and fetuses during pregnancy. new American Journal of Obstetrics and Gynecology The study provides new information about the impact of coronavirus disease 2019 (COVID-19) on pregnancy and postpartum outcomes.

Stady: Effects of prenatal exposure to COVID-19 maternal and perinatal care on neonatal outcomes: results of the INTERCOVID multinational cohort study. Image Credit: KieferPix / Shutterstock.com

an introduction

Pregnancy is usually surrounded by joy and apprehension, as there are many factors that contribute to a healthy outcome. Thus, the emergence of SARS-CoV-2 and how it affects both pregnant women and their unborn children has been the focus of significant research.

Previous research indicated a mild effect of COVID-19 in neonates, although pregnant women are considered to be more susceptible to infection. These findings led to an initiative called INTERCOVID, a multicenter, multi-country study of pregnancy complicated by COVID-19.

The current study evaluates how maternal COVID-19 affects fetal and neonatal outcomes. Here, the researchers also examined how delivery, breastfeeding, and neonatal care practices might contribute to vertical transmission.

Results

The current study was conducted in 18 countries and included more than 40 centres. The presence of COVID-19 during pregnancy was diagnosed by clinical features or radiological features in the lung (n = 55), or laboratory tests (~690).

Nearly 570 pregnant women with COVID-19 were matched with two controls each at enrollment, at the same stage of pregnancy, and at the same level of care. All study participants were closely monitored until discharge from hospital.

The rate of caesarean section (C-section) was higher, with more than half of mothers with COVID-19 reporting giving birth in this position compared to less than 40% in controls. Likewise, pregnancy complications were more common in MERS-CoV mothers who had a caesarean section, including hypertensive disorders and fetal distress.

Nearly 590 newborns were born to women infected with COVID-19 during pregnancy, compared to more than 1,500 newborns to control mothers. Previously, the risks of premature birth, low birth weight and smaller babies were higher. This included spontaneous and medically indicated preterm birth.

Fetal distress, admission to the neonatal intensive care unit (NICU) and other complications of the neonatal period were more likely to occur in infants born to mothers with COVID-19, regardless of neonatal testing status. However, babies who tested positive for the disease had a higher risk of infection and were a week younger at birth than babies born to women without COVID-19.

Interestingly, mothers with COVID-19 were more likely to have neonatal deaths, premature births or low birth weight babies than controls.

Increased risk of newborns testing positive for COVID-19 with longer durations in the womb Exposure, ie, maternal infection in early pregnancy. Babies born by caesarean section were 2.4 times more likely to have a positive test, regardless of the severity of the disease in the mother.

Overall, two out of three babies born to mothers with COVID-19 tested negative, while 28% were not tested because they had no symptoms. The rest was positive.

The longer the gap between infection and delivery, the more likely it is that a newborn will return a positive test at a lower gestational age. Thus, children were twice as likely to be infected if delivery occurred seven days after the mother’s infection and 4.5 times more likely if it occurred at 14 days.

Children who tested positive for COVID-19 had a higher risk of adverse outcomes, including admission to the NICU, neurological features (five times), fever, gut symptoms (six times), respiratory symptoms (more than three times), and death , regardless of the higher risks associated with preterm birth when compared to children born to control mothers. These babies were five times more likely to be admitted to the neonatal intensive care unit, too.

Encouragingly, no association was found between common care practices such as skin-to-skin contact, lactation and breastfeeding, and the risk of a positive test in the newborn. Notably, the asymptomatic neonates were often breastfed.

Ramifications

The present study included different cohorts from many different countries and centres. The results of this study confirm the high risk of complications for both pregnant or newborn women, as well as their babies, who were diagnosed with COVID-19 during pregnancy.

Maternal presence of COVID-19 has increased the risk of the baby testing positive and requiring a caesarean delivery. This may be due to decreased intake of antibody-rich colostrum by the newborn after the mother’s cesarean delivery, which may increase the risk of infection.

Vaginal delivery remains the safest option whenever possible, even with the mother infected with COVID-19. Furthermore, other childcare practices that encourage mother-infant bonding and promote breastfeeding may be continued safely without increasing the risk of vertical transmission.

Journal reference:

  • Giuliani, F., Gunier, R.B., Deantoni, S., and others. (2022). Effects of prenatal exposure to COVID-19 maternal and perinatal care on neonatal outcomes: results from the INTERCOVID multinational study. American Journal of Obstetrics and Gynecology. doi: 10.1016/j.ajog.2022.04.019.

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