Having a COVID-19 diagnosis during pregnancy significantly increases the risks of adverse maternal and neonatal outcomes compared with pregnant individuals who have not been infected by the virus.

That’s according to a new multinational study that finds, among other adverse outcomes, that newborns of infected mothers had markedly higher severe neonatal morbidity index and severe perinatal morbidity and mortality index compared with newborns of women without COVID-19 diagnoses.

The University of Oxford–led study focused on 2,130 pregnant women in 18 countries and found those who were affected with SARS-CoV-2 were more likely to do worse on a composite maternal morbidity and mortality index.
“This study indicates a consistent association between pregnant individuals with COVID-19 diagnosis and higher rates of adverse outcomes, including maternal mortality, preeclampsia, and preterm birth compared with pregnant individuals without COVID-19 diagnosis,” according to the study in JAMA Pediatrics.

The cohort study included participants from 43 institutions around the world. The researchers focused on COVID-19 in pregnancy determined by laboratory confirmation of COVID-19 and/or radiological pulmonary findings or two or more predefined COVID-19 symptoms.

Defined as the primary outcome measures were indices of maternal and severe neonatal/perinatal morbidity and mortality, with the individual components of the indices considered secondary outcomes. Models for these outcomes were adjusted for country, month entering study, maternal age, and history of morbidity.

Enrolled in the study were 706 pregnant women with COVID-19 diagnosis and 1,424 pregnant women without COVID-19 diagnosis. The two groups had similar demographic characteristics, with a mean age of 30.2 years.

The researchers report that being overweight early in pregnancy occurred in 323 women (48.6%) with COVID-19 diagnosis and 554 women (40.2%) without. They also advise that women with the virus were at higher risk for:
• Preeclampsia/eclampsia (relative risk [RR], 1.76; 95% CI, 1.27-2.43)
• Severe infections (RR, 3.38; 95% CI, 1.63-7.01), ICU admission (RR, 5.04; 95% CI, 3.13-8.10),
• Maternal mortality (RR, 22.3; 95% CI, 2.88-172)
• Preterm birth (RR, 1.59; 95% CI, 1.30-1.94)
• Medically indicated preterm birth (RR, 1.97; 95% CI, 1.56-2.51)
• Severe neonatal morbidity index (RR, 2.66; 95% CI, 1.69-4.18) and
• Severe perinatal morbidity and mortality index (RR, 2.14; 95% CI, 1.66-2.75).

Increased risk of severe maternal complications (RR, 2.56; 95% CI, 1.92-3.40) and neonatal complications (RR, 4.97; 95% CI, 2.11-11.69) were found to be associated with fever or shortness of breath of any duration.

On the other hand, asymptomatic women with COVID-19 diagnoses remained at higher risk only for maternal morbidity (RR, 1.24; 95% CI, 1.00-1.54) and preeclampsia (RR, 1.63; 95% CI, 1.01-2.63), with no increased risk to their offspring, according to the authors.

The expectant mothers only occasionally passed COVID-19 to their unborn children, according to the report. Among women who tested positive (98.1% by real-time polymerase chain reaction), 54 (13%) of their neonates tested positive. Researchers determined that Cesarean delivery (RR, 2.15; 95% CI, 1.18-3.91) but not breastfeeding (RR, 1.10; 95% CI, 0.66-1.85) was associated with increased risk for neonatal test positivity.

“In this multinational cohort study, COVID-19 in pregnancy was associated with consistent and substantial increases in severe maternal morbidity and mortality and neonatal complications when pregnant women with and without COVID-19 diagnosis were compared,” the authors concluded. “The findings should alert pregnant individuals and clinicians to implement strictly all the recommended COVID-19 preventive measures.”

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