Associations of Pregnancy Timing Relative to the COVID-19 Pandemic, Maternal SARS-CoV-2 Infection, and Adverse Perinatal Outcomes.

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To examine associations between COVID-19 pandemic and maternal SARS-CoV-2 infection with perinatal outcomes. We conducted a retrospective cohort study of 189,097 singleton births in South Carolina (2018-2021). Pregnancy timing relative to the pandemic was classified as pre-pandemic (delivered before March 1, 2020), partial pandemic overlap (conceived before and delivered during the pandemic), or pandemic (conceived and delivered during the pandemic). We examined COVID-19 testing, severity, and timing. Modified Poisson regression models with robust variance were used. Compared to pre-pandemic group, the partial overlap group had lower risks of low birthweight (LBW) (aRR=0.93, 95% CI 0.89-0.97) and preterm birth (PTB) (aRR=0.91, 95% CI 0.88-0.95). The pandemic group had increased risks for LBW (aRR=1.10, 95% CI 1.06-1.14), PTB (aRR=1.10, 95% CI 1.07-1.14), and NICU admissions (aRR=1.13, 95% CI 1.09-1.17) but a decreased risk for breastfeeding initiation (aRR=0.98, 95% CI 0.97-0.98). Moderate-to-severe COVID-19 symptoms increased PTB (aRR=1.34, 95% CI 1.13-1.58). Third-trimester COVID-19 infection increased LBW (aRR=1.23, 95% CI 1.10-1.37), PTB (aRR=1.18, 95% CI 1.07-1.30), and NICU admissions (aRR=1.17, 95% CI 1.05-1.30). Our findings highlight the importance of considering both maternal COVID-19 infection and pandemic-related factors in optimizing perinatal outcomes.