Z Geburtshilfe Neonatol 2024; 228(01): 57-64
DOI: 10.1055/a-2224-2262
Original Article

Evolution of Fetal Growth in Symptomatic Sars-Cov-2 Pregnancies

Entwicklung des fetalen Wachstums bei symptomatischen SARS-CoV-2-Schwangerschaften
1   Department of Gynecology and Obstetrics, Hannover Medical School, Hannover, Germany
Julia Guenther
1   Department of Gynecology and Obstetrics, Hannover Medical School, Hannover, Germany
Lena Steinkasserer
1   Department of Gynecology and Obstetrics, Hannover Medical School, Hannover, Germany
Lars Brodowski
1   Department of Gynecology and Obstetrics, Hannover Medical School, Hannover, Germany
2   Frauenklinik, Medizinische Hochschule Hannover, Hannover, Germany
Ansgard Lena Dueppers
1   Department of Gynecology and Obstetrics, Hannover Medical School, Hannover, Germany
Maria Delius
3   Obstetrics and Gynecology, LMU, München, Germany
Loredana Delle Chiaie
4   Department of Gynecology and Obstetrics, City of Stuttgart Hospitals, Stuttgart, Germany
Silvia Lobmaier
5   Frauenheilkunde und Geburtshilfe, Klinikum rechts der Isar der Technischen Universitat München, München, Germany
Marina Sourouni
6   Department of Gynecology and Obstetrics, University Hospital Münster, Münster, Germany
Manuela F. Richter
7   Neonatologie, KKB, Hannover, Germany
Jula Manz
8   Department of Gynecology and Obstetrics, Darmstadt Hospital, Darmstadt, Germany
Olaf Parchmann
9   Department of Gynecology and Obstetrics, HELIOS Klinik Sangerhausen, Sangerhausen, Germany
Saskia Schmidt
10   Department of Gynecology and Obstetrics, Sana Klinikum Lichtenberg, Berlin, Germany
Jennifer Winkler
11   Department of Gynecology and Obstetrics, Dresden University Hospital, Dresden, Germany
Pia Werring
12   Department of Gynecology and Obstetrics, Christophorus-Kliniken GmbH Betriebsstätte Sankt-Vincenz-Hospital Coesfeld, Coesfeld, Germany
Katrina Kraft
13   Department of Gynecology and Obstetrics, München Klinik Harlaching, München, Germany
Mirjam Kunze
14   Frauenklinik, Universitätsklinik Freiburg, Freiburg, Germany
15   Department of Obstetrics and Gynaecology, Klinikum Darmstadt, Darmstadt, Germany
Christian Eichler
16   Department of Obstetrics and Gynecology, St Franziskus-Hospital Münster GmbH, Münster, Germany
Viola Schaefer
17   Department of Gynecology and Obstetrics, University Hospital Marburg Department of Gynaecology and Obstetrics, Marburg, Germany
Martin Berghaeuser
18   Department of Gynecology and Obstetrics, Florence-Nightingale-Krankenhaus, Düsseldorf, Germany
Dietmar Schlembach
19   Klinik für Geburtsmedizin, Vivantes Klinikum Neukölln, Berlin, Germany
Sven Seeger
20   KH St. Elisabeth und St. Barbara Halle, Klinik für Frauenheilkunde und Geburtshilfe, Perinatalzentrum, Halle/Saale, Germany
Ute Schäfer-Graf
21   Klinik für Geburtshilfe, St Joseph Krankenhaus Berlin-Tempelhof, Berlin, Germany
Ioannis Kyvernitakis
22   Dept. of Obstetrics and Gynecology, Philipps-University of Marburg, Marburg, Germany
23   Frauenheilkunde und Geburtshilfe, St Elisabethen-Krankenhaus Lörrach gGmbH, Lörrach, Germany
Babette Ramsauer
24   Department of Gynecology and Obstetrics, Vivantes Klinikum Neukölln, Berlin, Germany
Christine Angela Morfeld
25   Perinatalzentrum, DIAKOVERE gGmbH, Hannover, Germany
26   Department of Neonatology, Dresden University Hospital, Dresden, Germany
Ulrich Pecks
27   Universitätsklinikum Schleswig-Holstein, Campus Kiel, Klinik für Gynäkologie und Geburtshilfe, Kiel, Germany
Constantin von Kaisenberg
1   Department of Gynecology and Obstetrics, Hannover Medical School, Hannover, Germany
› Author Affiliations
Funding Information Krumme Foundation


Introduction SARS-CoV-2 is a viral disease with potentially devastating effects. Observational studies of pregnant women infected with SARS-CoV-2 report an increased risk for FGR. This study utilizes data from a prospective SARS-CoV-2 registry in pregnancy, investigating the progression of fetuses to fetal growth restriction (FGR) at birth following maternal SARS-CoV-2 and evaluating the hypothesis of whether the percentage of SGA at birth is increased after maternal SARS-CoV-2 taking into account the time interval between infection and birth.

Materials & Methods CRONOS is a prospective German registry enrolling pregnant women with confirmed SARS-CoV-2 infection during their pregnancy. SARS-CoV-2 symptoms, pregnancy- and delivery-specific information were recorded. The data evaluated in this study range from March 2020 until August 2021. Women with SARS-CoV-2 were divided into three groups according to the time of infection/symptoms to delivery: Group I<2 weeks, Group II 2–4 weeks, and Group III>4 weeks. FGR was defined as estimated and/or birth weight<10% ile, appropriate for gestational age (AGA) was within 10 and 90%ile, and large for gestational age (LGA) was defined as fetal or neonatal weight>90%ile.

Results Data for a total of 2,650 SARS-CoV-2-positive pregnant women were available. The analysis was restricted to symptomatic cases that delivered after 24+0 weeks of gestation. Excluding those cases with missing values for estimated fetal weight at time of infection and/or birth weight centile, 900 datasets remained for analyses. Group I consisted of 551 women, Group II of 112 women, and Group III of 237 women. The percentage of changes from AGA to FGR did not differ between groups. However, there was a significantly higher rate of large for gestational age (LGA) newborns at the time of birth compared to the time of SARS-CoV-2 infection in Group III (p=0.0024), respectively.

Conclusion FGR rates did not differ between symptomatic COVID infections occurring within 2 weeks and>4 weeks before birth. On the contrary, it presented a significant increase in LGA pregnancies in Group III. However, in this study population, an increase in the percentage of LGA may be attributed to pandemic measures and a reduction in daily activity.

Publication History

Received: 18 July 2023

Accepted: 08 December 2023

Article published online:
08 February 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
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