Pregnancy outcomes after SARS-CoV-2 infection: the current evidence

Authors

  • William WK TO
  • Choi Wah KONG

DOI:

https://doi.org/10.12809/hkjgom.23.1.10

Keywords:

COVID-19, Pre-eclampsia, Pregnancy outcome, Preterm birth, SARS-CoV-2

Abstract

Many questions have been raised about SARS-CoV-2 infection complicating pregnancy such as whether pregnancy increases the susceptibility to SARS-CoV-2 infection, whether SARS-CoV-2 infection in pregnancy is associated with more severe disease and higher mortality, and whether SARS CoV-2 infection during various stages of pregnancy is associated with increased risks of adverse pregnancy and neonatal outcomes. Moreover, there are controversies on the association between SARS-CoV-2 infection and the development of pregnancy complications such as preeclampsia, preterm delivery, and fetal growth restriction. In addition to the direct impact of COVID-19 infection on pregnancy outcomes, social restriction measures and changes in healthcare system during the COVID pandemic are reported to lead to adverse pregnancy outcomes such as increased stillbirths. This review aims to summarise the current evidence in the literature on these issues.

References

Coronavirus (COVID-19) Infection in Pregnancy. Information for healthcare professionals. Royal College of Obstetricians and Gynaecologists. Version 15.0. Available from: https://www.rcog.org.uk/media/ftzilsfj/2022-12-15-coronaviruscovid-19-infection-in-pregnancy-v16.pdf.

COVID-19 Treatment Guidelines Panel. Coronavirus Disease 2019 (COVID-19) Treatment Guidelines. National Institutes of Health. Available from https://www.covid19treatmentguidelines.nih.gov/.

COVID-19 and Pregnancy: What Maternal-Fetal Medicine Subspecialists Need to Know. The Society for Maternal-Fetal Medicine (SMFM) COVID Task Force. Available from: https://s3.amazonaws.com/cdn.smfm.org/media/3559/COVID19-What_MFMs_need_to_know_%286-21-22%29_final.pdf.

Ellington S, Strid P, Tong VT, et al. Characteristics of women of reproductive age with laboratory-confirmed SARS-CoV-2 infection by pregnancy status — United States, January 22-June 7, 2020. MMWR Morb Mortal Wkly Rep 2020;69:769-75.

Lokken EM, Taylor GG, Huebner EM, et al. Higher severe acute respiratory syndrome coronavirus 2 infection rate in pregnant patients. Am J Obstet Gynecol 2021;225:75.e1-75.e16.

Emeruwa UN, Ona S, Shaman JL, et al. Associations between built environment, neighborhood socioeconomic status, and SARSCoV-2 infection among pregnant women in New York City. JAMA 2020;324:390-2.

Joseph NT, Stanhope KK, Badell ML, Horton JP, Boulet SL, Jamieson DJ. Sociodemographic predictors of SARS-CoV-2 infection in obstetric patients, Georgia, USA. Emerg Infect Dis 2020;26:2787-9.

Chung RY, Chung GK, Marmot M, et al. COVID-19-related health inequality exists even in a city where disease incidence is relatively low: a telephone survey in Hong Kong. J Epidemiol Community Health 2021;jech-2020-215392.

Chung GKK, Robinson M, Marmot M, Woo J. Monitoring socioeconomic inequalities in health in Hong Kong: insights and lessons from the UK and Australia. Lancet Reg Health West Pac 2022:100636.

Wong SF, Chow KM, Leung TN, et al. Pregnancy and perinatal outcome of women with severe acute respiratory syndrome. Am J Obstet Gynecol 2004;191:292-7.

Zambrano LD, Ellington S, Strid P, et al. Update: characteristics of symptomatic women of reproductive age with laboratory-confirmed SARS-CoV-2 infection by pregnancy status — United States, January 22-October 3, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1641-7.

Martinez-Portilla RJ, Sotiriadis A, Chatzakis C, et al. Pregnant women with SARS-CoV-2 infection are at higher risk of death and pneumonia: propensity score matched analysis of a nationwide prospective cohort (COV19Mx). Ultrasound Obstet Gynecol 2021;57:224-31.

Villar J, Ariff S, Gunier RB, et al. Maternal and neonatal morbidity and mortality among pregnant women with and without COVID-19 Infection. The INTERCOVID Multinational Cohort Study. JAMA Pediatr 2021;175:817-26.

McClymont E, Albert AY, Alton GD, et al. Association of SARS-CoV-2 infection during pregnancy with maternal and perinatal outcomes. JAMA 2022;327:1983-91.

Allotey J, Stallings E, Bonet M, et al. Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis. BMJ 2020;370:m3320.

Epelboin S, Labrosse J, De Mouzon J, et al. Obstetrical outcomes and maternal morbidities associated with COVID-19 in pregnant women in France: a national retrospective cohort study. PLoS Med 2021;18:e1003857.

Metz TD, Clifton RG, Hughes BL, et al. Disease severity and perinatal outcomes of pregnant patients with coronavirus disease 2019 (COVID-19). Obstet Gynecol 2021;137:571-80.

Badr DA, Mattern J, Carlin A, et al. Are clinical outcomes worse for pregnant women at 20 weeks’ gestation infected with coronavirus disease 2019? A multicenter case control study with propensity score matching. Am J Obstet Gynecol 2020;223:764-8.

Lokken EM, Huebner EM, Taylor GG, et al. Disease severity, pregnancy outcomes, and maternal deaths among pregnant patients with severe acute respiratory syndrome coronavirus infection in Washington State. Am J Obstet Gynecol 2021;225:77.e1-77.e14.

Knight M, Bunch K, Vousden N, et al. Characteristics and outcomes of pregnant women admitted to hospital with confirmed SARS-CoV-2 infection in UK: national population based cohort study. BMJ 2020;369:m2107.

Mupanomunda M, Fakih MG, Miller C, et al. Comparison of severe maternal morbidities associated with delivery during periods of circulation of specific SARS-CoV-2 variants. JAMA Netw Open 2022;5:e2226436.

Birolilter P, Prasad S, Mutlu MA, et al. Maternal and perinatal outcomes of SARS-CoV-2 infection in unvaccinated pregnancies during Delta and Omicron waves. Ultrasound Obstet Gynecol 2022;60:96-102.

World Health Organization. Definition and categorization of the timing of mother-to-child transmission of SARSCoV-2. Available from: https://apps.who.int/iris/handle/10665/339422.

Edlow AG, Li JZ, Collier AY, et al. Assessment of maternal and neonatal SARS-CoV-2 viral load, transplacental antibody transfer, and placental pathology in pregnancies during the COVID-19 pandemic. JAMA Netw Open 2020;3:e2030455.

Groß R, Conzelmann C, Müller JA, et al. Detection of SARSCoV-2 in human breastmilk. Lancet 2020;395:1757-8.

Chambers C, Krogstad P, Bertrand K, et al. Evaluation for SARS-CoV-2 in breast milk from 18 infected women. JAMA 2020;324:1347-8.

Salvatore CM, Han JY, Acker KP, et al. Neonatal management and outcomes during the COVID-19 pandemic: an observation cohort study. Lancet Child Adolesc Health 2020;4:721-7.

Allotey J, Chatterjee S, Kew T, et al. SARS-CoV-2 positivity in offspring and timing of mother-to-child transmission: living systematic review and meta-analysis. BMJ 2022;376:e067696.

Raschetti R, Vivanti AJ, Vauloup-Fellous C, Loi B, Benachi A, De Luca D. Synthesis and systematic review of reported neonatal SARS-CoV-2 infections. Nat Commun 2020;11:5164.

American College of Obstetricians and Gynecologists. COVID-19, Pregnancy, Childbirth, and Breastfeeding: Answers From Ob-Gyns. Available from: https://www.acog.org/womens-health-faqs/coronavirus-covid-19-pregnancyand-breastfeeding.

Gulersen M, Rochelson B, Shan W, et al. Severe maternal morbidity in pregnant patients with SARS-CoV-2 infection. Am J Obstet Gynecol 2022;4:100636.

Hughes BL, Sandoval GJ, Metz TD, et al. First- or secondtrimester SARS-CoV-2 infection and subsequent pregnancy outcomes. Am J Obstet Gynecol 2022 Aug 13:S0002-9378(22)00641-X.

Cosma S, Carosso AR, Cusato J, et al. Obstetric and neonatal outcomes after SARS-CoV-2 infection in the first trimester of pregnancy: a prospective comparative study. J Obstet Gynaecol Res 2022;48:393-401.

Aydin GA, Unal S, Ozsoy HGT. The effect of gestational age at the time of diagnosis on adverse pregnancy outcomes in women with COVID-19. J Obstet Gynaecol Res 2021;47:4232-40.

Zlatkin R, Dollinger S, Jacoby C, et al. Obstetric and perinatal outcomes in parturients with active SARS‑CoV‑2 infection during labor and delivery: a retrospective cohort study. BMC Pregnancy Childbirth 2022;22:511.

Badr DA, Picone O, Bevilacqua E, et al. Severe acute respiratory syndrome coronavirus 2 and pregnancy outcomes according to gestational age at time of infection. Emerg Infect Dis 2021;27:2535-43.

Wei SQ, Bilodeau-Bertrand M, Liu S, Auger N. The impact of COVID-19 on pregnancy outcomes: a systematic review and meta-analysis. CMAJ 2021;193:E540-E548.

Conde-Agudelo A, Romero R. SARS-CoV-2 infection during pregnancy and risk of preeclampsia: a systematic review and meta-analysis. Am J Obstet Gynecol 2021;226:68-89.e3.

Gurol-Urganci I, Jardine JE, Carroll F, et al. Maternal and perinatal outcomes of pregnant women with SARS-CoV-2 infection at the time of birth in England: national cohort study. Am J Obstet Gynecol 2021;225:522.e1-522.e11.

Jering KS, Claggett BL, Cunningham JW, et al. Clinical characteristics and outcomes of hospitalized women giving birth with and without COVID-19. JAMA Intern Med 2021;181:714-7.

Khalil A, Samara A, Chowdhury T, O’Brien P. Does COVID-19 cause pre-eclampsia? Ultrasound Obstet Gynecol 2022;59:146-52.

Mullins E, Perry A, Banerjee J, et al. Pregnancy and neonatal outcomes of COVID-19: the PAN-COVID study. Eur J Obstet Gynecol Reprod Biol 2022;276:161-7.

Tran M, Alessandrini V, Lepercq J, Goffinet F. Risk of preeclampsia in patients with symptomatic COVID-19 infection. J Gynecol Obstet Hum Reprod 2022;51:102459.

Smith LH, Dollinger CY, VanderWeele TJ, Wyszynski DF, Hernandez‑Diaz S. Timing and severity of COVID‑19 during pregnancy and risk of preterm birth in the International Registry of Coronavirus Exposure in Pregnancy. BMC Pregnancy Childbirth 2022;22:775.

Fallach N, Segal Y, Agassy J, et al. Pregnancy outcomes after SARS-CoV-2 infection by trimester: a large, population-based cohort study. PLoS One 2022;17:e0270893.

Karasek D, Baer RJ, McLemore MR, et al. The association of COVID-19 infection in pregnancy with preterm birth: a retrospective cohort study in California. Lancet Reg Health Am 2021;2:100027.

Cosma S, Carosso AR, Cusato J, et al. Preterm birth is not associated with asymptomatic/mild SARS-CoV-2 infection per se: pre-pregnancy state is what matters. PLoS One 2021;16:e0254875.

Moltner S, de Vrijer B, Banner H. Placental infarction and intrauterine growth restriction following SARS‑CoV‑2 infection. Arch Gynecol Obstet 2021;304:1621-2.

Rizzo G, Mappa I, Maqina P, et al. Effect of SARS-CoV-2 infection during the second half of pregnancy on fetal growth and hemodynamics: a prospective study. Acta Obstet Gynecol Scand 2021;100:1034-9.

Obata S, Matsumoto R, Kakinoki M, et al. Changes in fetal growth restriction and retinopathy of prematurity during the coronavirus disease 2019 pandemic: a cross-sectional study. PLoS One 2022;17:e0265147.

Hui L, Marzan MB, Potenza S, et al. Increase in preterm stillbirths in association with reduction in iatrogenic preterm births during COVID-19 lockdown in Australia: a multicenter cohort study. Am J Obstet Gynecol 2022;227:491.e1-491.e17.

Rolnik DL, Matheson A, Liu Y, et al. Impact of COVID-19 pandemic restrictions on pregnancy duration and outcome in Melbourne. Ultrasound Obstet Gynecol 2021;58:677-87.

Gurol-Urganci I, Waite L, Webster K, et al. Obstetric interventions and pregnancy outcomes during the COVID-19 pandemic in England: a nationwide cohort study. PLoS Med 2022;19:e1003884.

Bhatia K, Columb M, Bewlay A, et al. Decision-to-delivery interval and neonatal outcomes for category-1 caesarean sections during the COVID-19 pandemic. Anaesthesia 2021;76:1051-9.

Chmielewska B, Barratt I, Townsend R, et al. Effects of the COVID-19 pandemic on maternal and perinatal outcomes: a systematic review and meta-analysis. Lancet Glob Health 2021;9:e759-e772.

Downloads

Published

2023-04-06

How to Cite

1.
TO WW, KONG CW. Pregnancy outcomes after SARS-CoV-2 infection: the current evidence. Hong Kong J Gynaecol Obstet Midwifery [Internet]. 2023 Apr. 6 [cited 2024 Mar. 29];23(1). Available from: https://hkjgom.org/home/article/view/333

Issue

Section

Perspective

Most read articles by the same author(s)

1 2 3 4 > >>