Maternal and neonatal COVID-19 – the pandemic experience in a tertiary maternity unit in Romania – unicentric, prospective study

Abstract

Background and objectives. Multiple reports, available while the pandemic progressed, raised concerns that COVID-19 poses higher risks to pregnant women and their newborns. Still, limited evidence exists on the impact of the COVID-19 pandemic during pregnancy and perinatal period. This study aimed to evaluate the rate of early-onset neonatal COVID and the outcomes of newborns born by mothers diagnosed with COVID-19 at delivery and concerning the presence of maternal symptoms and dominant SARS-CoV-2 variant. Materials and methods. The prospective study of maternal and neonatal data of mothers with confirmed SARS-CoV-2 infection at admission for delivery and their newborns was developed in a tertiary maternity hospital between February 1, 2020, and December 1, 2023. All pregnant women admitted for delivery were screened for the presence of SARS-CoV-2 infection, and, if positive, the newborn was also screened. Data of all pregnant women with positive RT-PCT test and of their newborns were extracted from the maternal and neonatal medical charts and the electronic data system of the hospital: data on pregnancy, delivery, COVID-19 symptoms, demographics, gestational age, birth weight, Apgar score, neonatal pathology, and routine laboratory tests, results of maternal and neonatal RT-PCR for SARS-CoV-2 virus, feedings, and death were extracted from the neonatal charts. The primary outcomes were neonatal: COVID-19 rates, prematurity, birth weight, symptoms, and neonatal conditions. IBM SPSS 23 was used for data analysis and comparisons. Results. A total number of 218 mothers with COVID-19 infection (92.7% asymptomatic) and their 218 neonates were included in the study. COVID-19 infection occurred in 1.91% of the deliveries registered in the unit during the study period. Neonatal COVID-19 was diagnosed in 3/218 infants, none symptomatic, with a rate of transmission of 1.37%. Most of the newborns delivered by COVID-19-positive mothers were born at term, only 14 were born prematurely, and 16 had birth weight <2500 g; 15% of the newborns delivered by COVID-19-infected mothers had a neonatal condition that needed significant interventions or therapies. The mean gestational age and Apgar score at 1 minute were significantly lower in infants delivered by symptomatic mothers and during the Delta/Omicron/other new variants period as compared to those born by asymptomatic mothers or during the pre-Delta period, respectively. Also, major and minor neonatal conditions were found more often in infants delivered by symptomatic mothers (p<0.050) and in those born during the Delta/Omicron/other new variants period (p<0.050). Conclusions. Our study found low rates of maternal COVID-19 at admission for delivery, and symptomatic maternal COVID-19. Also, we have found low rates of prematurity and LBW, in hospital maternal-neonatal transmission of SARSCoV-2, and excellent neonatal outcomes among the infants delivered by SARS-CoV-2 mothers, although gestational age and perinatal complications were more frequent in infants born by symptomatic mothers and during Delta/Omicron/ other new SARS-CoV-2 variants period. More studies are needed to completely reveal the impact of the virus on fetal, neonatal, infant, and child growth, health, and development.