Newborn Outcomes After Maternal COVID-19 Infection in Pregnancy and the Potential Role of Infection Severity [ID: 1373946

Abstract

INTRODUCTION: COVID-19 poses health risks in pregnancy including increased rates of cesarean sections, preeclampsia, and miscarriage. However, less is known about newborn effects and the effect of severity of infection. We evaluated the link between pregnancy COVID-19 infection status and severity, and newborn outcomes. METHODS: Participants in this IRB-approved retrospective chart review study were identified via medical records from a single university-affiliated obstetric practice and grouped as COVID-19 positive during pregnancy (n=69), or COVID-19 negative delivering pre-COVID (n=59). Severity of infection was based on emergency department visit, hospitalization, oxygen treatment, steroids, antibodies, or ventilation. Information on socioeconomic factors, medical history, and birth outcomes was also abstracted. RESULTS: Compared to controls, and after adjustment for background differences, those with COVID-19 infection during pregnancy had newborns 242 g lighter and were 4.3 times more likely to deliver preterm, 2.6 times more likely to have a newborn with a 1-minute Apgar score less than 8, and 2.9 times more likely to remain hospitalized a week or more. Differences were largely driven by earlier delivery. Finally, severe COVID-19 infection (which occurred for 41% of participants with COVID-19) was a strong predictor of preterm delivery, low birth weight, receipt of oxygen, neonatal intensive care unit admission, and longer hospital stay. CONCLUSION: COVID-19 infection during pregnancy predicts adverse newborn outcomes, especially as a result of reduced gestational duration. Additionally, severity of infection may predict worse outcomes. A larger, more diverse sample is needed to confirm findings, and to examine potential effect of vaccination in reducing the effect of COVID-19 infection during pregnancy.