Adverse perinatal outcomes in pregnancies affected by severe COVID-19 infection

Abstract

BackgroundSevere COVID-19 infection in pregnancy has been associated with an increase in adverse perinatal outcomes, though studies differ regarding which outcomes are affected. Increased characterization of obstetric and neonatal outcomes are needed including details on indications for preterm delivery and additional neonatal adverse outcomes.ObjectiveTo determine whether there is a higher rate of adverse perinatal outcomes amongst severe-critical COVID-19 infection compared to non-severe COVID-19 infection diagnosed during pregnancy.Study DesignThis was a retrospective observational cohort study that compared rates of adverse perinatal outcomes amongst singleton pregnancies identified as having a positive laboratory PCR diagnosis of COVID-19 infection with severe-critical COVID-19 infection versus non-severe (asymptomatic, mild or moderate). Primary outcomes included hypertensive disorders of pregnancy, cesarean delivery, fetal growth restriction, preterm birth, and neonatal intensive care unit (NICU) admission. Additional neonatal outcomes analyzed include need for CPR, low birthweight (<2500g), 1 or 5 min Apgar <7, need for supplemental oxygen, need for intubation, interventricular hemorrhage, sepsis, respiratory distress syndrome, bronchopulmonary dysplasia, blood transfusion, necrotizing enterocolitis, hypoxic ischemic encephalopathy, birth trauma or neonatal death. Appropriate bivariate analyses were used to compare groups. Logistic regression was used to examine primary outcomes adjusting for confounders.ResultsA total of 441 participants were identified and confirmed via detailed chart review to be pregnant with a singleton pregnancy while diagnosed with COVID-19. Of these, 44 (10%) met NIH criteria for severe-critical COVID-19 infection. The median gestational age at the time of maternal COVID-19 diagnosis was 36.4 weeks (IQR 29.6 – 38.6). Severe-critical COVID-19 infection had a higher risk of a composite adverse neonatal outcome (36.4% vs 21.4%, p=0.03). There was a high incidence of hypertensive disorders of pregnancy overall (20.6%) but this outcome was not higher in the severe-critical vs non-severe group. There were no maternal deaths. There was a low incidence of neonatal COVID-19 test positivity amongst those tested (1.8%). When adjusting for presence of heart disease and gestational age at COVID-19 diagnosis, severe-critical COVID-19 was strongly associated with fetal growth restriction (aOR 2.73, 1.03 – 7.25) and NICU admission (aOR 3.50, CI 1.56 – 7.87). Preterm delivery was more common but was no longer significant after adjustment (aOR 2.23, CI 0.99 – 5.05).ConclusionSevere-critical COVID-19 infection during pregnancy is associated with higher rates of adverse neonatal outcomes and strongly associated with NICU admission and fetal growth restriction compared to non-severe disease. There is a high rate of hypertensive disorders of pregnancy overall in all those affected by COVID-19, regardless of severity. Pregnant persons should be counseled on these risks to encourage vaccination, and those with infection during pregnancy should be monitored for fetal growth disorders.