Impact of mild COVID-19 infection on fetal growth during pregnancy

Abstract

During pregnancy, certain viral infections are known to significantly affect fetal development. Data regarding the impact of COVID-19 viral infection in pregnancy, specifically in asymptomatic or mild cases, remains limited. This presents a challenge in providing prenatal counseling and antepartum surveillance in pregnancies complicated by COVID-19 infection. Placenta studies have demonstrated that vascular malperfusion patterns attributed to COVID appear to depend on the timing of infection. Given reported placenta changes, we aim to evaluate the impact of COVID-19 on fetal growth in pregnant patients with asymptomatic or mild disease, stratified by trimester of infection. We hypothesize that COVID-19 infection, especially early in pregnancy, increases the risk of fetal growth restriction (FGR). This is a single institution, retrospective cohort study of patients with asymptomatic or mild COVID-19 disease, and without disease. All patients age 16-55 years old with a singleton delivery between December 10, 2020, and April 19, 2021 were included. The number of patients diagnosed with and without FGR in each group were evaluated. Group differences were assessed using Chi-Square test with significance at p< 0.05. A total of 1971 patients were enrolled; 208 with COVID-19 and 1763 without. There was no difference in demographics and gestational age at delivery in both groups. There was no difference in the rate of FGR in patients with and without COVID-19, (3.4% vs 4.8%, p=0.36). Within the COVID-19 group, 7 patients met criteria for diagnosis of FGR (p=0.205), with distribution of 2, 1 and 4 patients within 1st, 2nd and 3rd trimester infection respectively. Mild COVID-19 infection in pregnancy, regardless of timing of infection, does not appear to be associated with FGR. Routine serial fetal growth assessment may not be warranted solely for history of COVID-19 infection.