Abstract
BackgroundThe coronavirus disease 2019 (COVID-19) outbreak is evolving rapidly worldwide. However, little is known about the association between pregnant women with COVID-19 and the risk of adverse birth outcomes.MethodWe conducted a retrospective cohort study based on the Maternal and Child Health Information System (MCHIMS) of Wuhan, China. All pregnant women with singleton live birth recorded by the system between January 13 and March 18, 2020, were included. The adverse birth outcomes were preterm birth, low birth weight, neonatal asphyxia, premature rupture of membrane (PROM), and cesarean section delivery. Multivariate logistic regression was used to evaluate the associations between maternal COVID-19 diagnosis and adverse birth outcomes.ResultsOut of 11,078 pregnant women, 65 were confirmed with coronavirus disease 2019 (COVID-19). No deaths occurred from these confirmed cases or their newborns. Compared to pregnant women without COVID-19, pregnant women with a confirmed COVID-19 diagnosis had an increased risk of preterm birth (OR 3.34, 95% CI 1.60–7.00) and cesarean section (OR 3.63, 95% CI 1.95–6.76). There was no statistical difference in low birth weight, neonatal asphyxia, and PROM between the mothers with and without COVID-19. Among these newborns that were born to mothers with confirmed COVID-19, none was tested severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive or had abnormal CT results. Only one had diarrhea and three had a fever.ConclusionsThis population-based cohort study suggests that COVID-19 during the later pregnancy is associated with an increased risk of adverse birth outcomes, including iatrogenic preterm birth and cesarean section delivery. Our data provide little evidence for maternal-fetal vertical transmission of SARS-CoV-2. It is important to monitor the long-term health effects of SARS-CoV-2 infection on pregnant women and their children.
Highlights
The coronavirus disease 2019 (COVID-19) outbreak is evolving rapidly worldwide
Compared to pregnant women without COVID-19, pregnant women with a confirmed COVID-19 diagnosis had an increased risk of preterm birth and cesarean section
Among these newborns that were born to mothers with confirmed COVID-19, none was tested severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive or had abnormal computed tomography (CT) results
Summary
Little is known about the association between pregnant women with COVID-19 and the risk of adverse birth outcomes. As of April 14, the cumulative number of confirmed COVID-19 cases had reached 1,930,000 with 120,000 (6%) deaths worldwide. The capital of Hubei province where COVID-19 was first reported, was the hardest-hit Chinese city and accounts for 60% of confirmed cases and 83% of COVID-19 deaths in China. The consequences of infection with SARS-CoV-2 among pregnant women are currently uncertain. Several hundreds of pregnant women in Hubei province were infected with SARSCoV-2 based on infectious disease surveillance systems in Hubei province, China. While several case series studies have analyzed the clinical symptoms and prognosis of COVID-19 cases, no population-based study so far has been conducted to examine the relationship between SARS-CoV-2 infection and adverse birth outcomes
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