Abstract
BackgroundThe spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, the possible development of serious illness, and the possibility of severe obstetric outcomes highlight the importance of addressing SARS-CoV-2 infection in obstetric management.Methods and findingsA cross-sectional study of pregnant women assisted in a high-risk maternity hospital in Brazil in 2020. All patients admitted for delivery or miscarriage care were tested for SARS-CoV-2 using polymerase chain reaction (PCR) and for immunoglobulin (I)gM, and/or IgG by immunochromatography. Clinical aspects and obstetric outcomes were analyzed. A total of 265 pregnant women were included in the study. There were 38 (14.4%) PCR positive cases during pregnancy, 12 (31.6%) on admission screening, and 71(27.2%) patients were IgM- and/or IgG-positive. Among the participants, 86 (32.4%) had at least one positive test during pregnancy. SARS-CoV-2 positive patients had greater contact with known positive patients (p = 0.005). The most frequently reported symptoms were runny nose, cough, loss of smell and taste, headache, and fever. There was also a 35% rate of asymptomatic infections and a 4.6% rate of severe or critical infections. Patients exposed or infected with SARS-CoV-2 had a higher incidence of preterm delivery, cesarean section, need for resuscitation in the delivery room, Apgar score <7 at 5 min, admission to the neonatal intensive care unit, and jaundice. Newborns with at least one positive test had a significantly greater need for phototherapy after delivery (p = 0.05). The results showed a high rate of positive tests among newborns (37.5%), which seems to be compatible with both neonatal and perinatal infection.ConclusionsIt is important to further investigate SARS-CoV-2 infection during pregnancy, including the clinical course and the possibility of adverse outcomes with impact on maternal and fetal health, regardless of the development of symptoms.
Highlights
In January 2020, the World Health Organization declared a public health emergency due to coronavirus disease 2019 (COVID-19)
Data from severe acute respiratory syndrome (SARS)-CoV-2 infection in pregnant women in Brazil are limited to a case series [11]
The objectives of this study were to determine the rate of positive RT-polymerase chain reaction (PCR) tests and/or positive antibody tests (IgG/IgM) for SARS-CoV-2 during pregnancy in patients admitted to the Cassiano Antonio Moraes University Hospital (HUCAM) maternity hospital for childbirth or abortion care, evaluate the most commonly reported symptoms in patients with positive test results for SARS-CoV-2, evaluate the rate of the main obstetric and neonatal outcomes in positive antibody patients and/or positive RT-PCR patients when compared with non-infected pregnancies (PCR and IgG/IgM negative), and to assess the positivity rate in newborns of mothers with recent infection (PCR positive and/or IgM positive and IgG negative on admission for delivery)
Summary
In January 2020, the World Health Organization declared a public health emergency due to coronavirus disease 2019 (COVID-19). The disease, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has challenged all health systems and has caused an unprecedented global public health crisis [1]. SARS-CoV-2, unlike other severe acute respiratory syndrome (SARS) viruses responsible for previous epidemics, has been transmitted by oligo- or asymptomatic patients, challenging previously implemented quarantine strategies [2]. Such reports of asymptomatic transmission led medical services to implement universal screening policies for certain groups of patients, including pregnant women admitted for delivery [3]. An observational cohort study including 683,905 women from 2022 showed that SARS-CoV-2 infection during pregnancy was associated with preterm birth, preeclampsia, and several other clinical complications, but was not associated with a higher incidence of stillbirths [4]. The spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, the possible development of serious illness, and the possibility of severe obstetric outcomes highlight the importance of addressing SARS-CoV-2 infection in obstetric management
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