Association between SARS-CoV-2 Infection and Adverse Perinatal Outcomes in a Large Health Maintenance Organization

Darios Getahun; Morgan R. Peltier; Lawrence D. Lurvey; Jiaxiao M. Shi; David Braun; David A. Sacks; Anthony E. Burgos; Alex Fong; Neha Trivedi; Lyn Yasumura; Kristi Reynolds; Marielle Nguyen; Marianna Volodarskiy; Vicki Y. Chiu; Adrian H. Lopez; Michael J. Fassett

doi:10.1055/s-0042-1749666

American Journal of Perinatology, Inhaltsverzeichnis

Am J Perinatol 2024; 41(02): 199-207
DOI: 10.1055/s-0042-1749666

Original Article

Association between SARS-CoV-2 Infection and Adverse Perinatal Outcomes in a Large Health Maintenance Organization

Darios Getahun

¹Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California

²Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California

,

Morgan R. Peltier

³Department of Psychiatry, Jersey Shore University Medical Center, Neptune, New Jersey

,

Lawrence D. Lurvey

⁴Department of Obstetrics and Gynecology, Southern California Permanente Medical Group, Pasadena, California

,

Jiaxiao M. Shi

¹Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California

,

David Braun

¹Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California

⁴Department of Obstetrics and Gynecology, Southern California Permanente Medical Group, Pasadena, California

,

David A. Sacks

¹Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California

⁵Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California

,

Anthony E. Burgos

⁶Department of Pediatrics, Kaiser Permanente Downey Medical Center, Downey, California

⁷Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California

,

Alex Fong

⁸Department of Obstetrics and Gynecology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California

,

Neha Trivedi

⁹Department of Obstetrics and Gynecology, Kaiser Permanente San Diego Medical Center, San Diego, California

,

Lyn Yasumura

¹⁰Department of Obstetrics and Gynecology, Kaiser Permanente Baldwin Park Medical Center, Baldwin Park, California

,

Kristi Reynolds

¹Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California

²Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California

,

Marielle Nguyen

¹¹Department of Neonatal Medicine, Kaiser Permanente Orange County Medical Center, Anaheim, California

,

Marianna Volodarskiy

¹²Kaiser Foundation Hospitals, Pasadena, California

,

Vicki Y. Chiu

¹Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California

,

Adrian H. Lopez

⁸Department of Obstetrics and Gynecology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California

,

Michael J. Fassett

¹³Department of Obstetrics and Gynecology, Kaiser Permanente West Los Angeles Medical Center, Los Angeles, California

› Institutsangaben

Abstract

Objective This study aimed to examine whether severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection during pregnancy is associated with increased odds of perinatal complications and viral transmission to the infant.

Study Design A retrospective cohort study of women who delivered at Kaiser Permanente Southern California hospitals (April 6, 2020–February 28, 2021) was performed using data extracted from electronic health records (EHRs). During this time polymerize chain reaction (PCR)-based tests for SARS-CoV-2 was universally offered to all pregnant women at labor and delivery admission, as well as earlier in the pregnancy, if they were displaying symptoms consistent with SARS-CoV-2 infection or a possible exposure to the virus. Adjusted odds ratio (aOR) was used to estimate the strength of associations between positive test results and adverse perinatal outcomes.

Results Of 35,123 women with a singleton pregnancy, 2,203 (6%) tested positive for SARS-CoV-2 infection with 596 (27%) testing positive during the first or second trimester and 1,607 (73%) during the third trimester. Women testing positive were younger than those who tested negative (29.7 [5.4] vs. 31.1 [5.3] years; mean [standard deviation (SD)]; p < .001). The SARS-CoV-2 infection tended to increase the odds of an abnormal fetal heart rate pattern (aOR: 1.10; 95% confidence interval [CI]: 1.00, 1.21; p = 0.058), spontaneous preterm birth (aOR: 1.28; 95% CI: 1.03, 1.58; p = 0.024), congenital anomalies (aOR: 1.69; 95% CI: 1.15, 2.50; p = 0.008), and maternal intensive care unit admission at delivery (aOR: 7.44; 95% CI: 4.06, 13.62; p < 0.001) but not preeclampsia/eclampsia (aOR: 1.14; 95% CI: 0.98, 1.33; p = 0.080). Eighteen (0.8%) neonates of mothers who tested positive also had a positive SARS-CoV-2 test after 24 hours of birth, but all were asymptomatic during the neonatal period.

Conclusion These findings suggest that prenatal SARS-CoV-2 infection increases the odds of some adverse perinatal outcomes. The likelihood of vertical transmission from the mother to the fetus was low (0.3%), suggesting that pregnancy complications resulting from SARS-CoV-2 infection pose more risk to the baby than transplacental viral transmission.

Key Points

SARS-CoV-2 infection is associated with increased odds of adverse perinatal outcomes.
The odds of specific adverse outcomes were greater when a mother was infected earlier in pregnancy.
The proportion of vertical transmission from mother to fetus was 0.3%

Keywords

COVID-19 - SARS-CoV-2 - infection - pregnancy - outcomes - pandemic

Volltext

Referenzen

Reference
1 Dong E, Du H, Gardner L. An interactive web-based dashboard to track COVID-19 in real time. Lancet Infect Dis 2020; 20 (05) 533-534
2 Fassett MJ, Lurvey LD, Yasumura L. et al. Universal SARS-Cov-2 screening in women admitted for delivery in a large managed care organization. Am J Perinatol 2020; 37 (11) 1110-1114
3 Sutton D, Fuchs K, D'Alton M, Goffman D. Universal screening for SARS-CoV-2 in women admitted for delivery. N Engl J Med 2020; 382 (22) 2163-2164
4 Mor G, Aldo P, Alvero AB. The unique immunological and microbial aspects of pregnancy. Nat Rev Immunol 2017; 17 (08) 469-482
5 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 (02) 224-231
6 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 (06) e759-e772
7 Perzow SED, Hennessey EP, Hoffman MC, Grote NK, Davis EP, Hankin BL. Mental health of pregnant and postpartum women in response to the COVID-19 pandemic. J Affect Disord Rep 2021; 4: 100123
8 Di Mascio D, Khalil A, Saccone G. et al. Outcome of coronavirus spectrum infections (SARS, MERS, COVID-19) during pregnancy: a systematic review and meta-analysis. Am J Obstet Gynecol MFM 2020; 2 (02) 100107
9 Boelig RC, Manuck T, Oliver EA. et al. Labor and delivery guidance for COVID-19. Am J Obstet Gynecol MFM 2020; 2 (02) 100110
10 Wong SF, Chow KM, Leung TN. et al. Pregnancy and perinatal outcomes of women with severe acute respiratory syndrome. Am J Obstet Gynecol 2004; 191 (01) 292-297
11 Koebnick C, Langer-Gould AM, Gould MK. et al. Sociodemographic characteristics of members of a large, integrated health care system: comparison with US Census Bureau data. Perm J 2012; 16 (03) 37-41
12 Getahun D, Rhoads GG, Fassett MJ. et al. Accuracy of reporting maternal and infant perinatal service system coding and clinical utilization coding. J Med Stat Inform 2013; 1: 1-3
13 Andrade SE, Scott PE, Davis RL. et al. Validity of health plan and birth certificate data for pregnancy research. Pharmacoepidemiol Drug Saf 2013; 22 (01) 7-15
14 American College of Obstetricians and Gynecologists. Practice bulletin no. 116: Management of intrapartum fetal heart rate tracings. Obstet Gynecol 2010; 116 (05) 1232-1240
15 Kierans WJ, Joseph KS, Luo ZC, Platt R, Wilkins R, Kramer MS. Does one size fit all? The case for ethnic-specific standards of fetal growth. BMC Pregnancy Childbirth 2008; 8: 1
16 Committee opinion no 700: methods for estimating the due date. Obstet Gynecol 2017; 129 (05) e150-e154
17 Quan H, Sundararajan V, Halfon P. et al. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care 2005; 43 (11) 1130-1139
18 Kleinbaum DG, Kupper LL, Muller KE. Applied Regression Analysis and Other Multivariable Methods. The Duxbury Series in Statistics and Decision Sciences.. 2nd ed. Boston, MA: PWS-Kent Pub Co; 1988. -369
19 Getahun D, Ananth CV, Peltier MR, Smulian JC, Vintzileos AM. Acute and chronic respiratory diseases in pregnancy: associations with placental abruption. Am J Obstet Gynecol 2006; 195 (04) 1180-1184
20 Munn MB, Groome LJ, Atterbury JL, Baker SL, Hoff C. Pneumonia as a complication of pregnancy. J Matern Fetal Med 1999; 8 (04) 151-154
21 Goodrum LA. Pneumonia in pregnancy. Semin Perinatol 1997; 21 (04) 276-283
22 Getahun D, Ananth CV, Oyelese Y, Peltier MR, Smulian JC, Vintzileos AM. Acute and chronic respiratory diseases in pregnancy: associations with spontaneous premature rupture of membranes. J Matern Fetal Neonatal Med 2007; 20 (09) 669-675
23 Patabendige M, Gamage MM, Weerasinghe M, Jayawardane A. Psychological impact of the COVID-19 pandemic among pregnant women in Sri Lanka. Int J Gynaecol Obstet 2020; 151 (01) 150-153
24 Menter T, Mertz KD, Jiang S. et al. Placental pathology findings during and after SARS-CoV-2 infection: features of villitis and malperfusion. Pathobiology 2021; 88 (01) 69-77
25 Algarroba GN, Rekawek P, Vahanian SA. et al. Visualization of severe acute respiratory syndrome coronavirus 2 invading the human placenta using electron microscopy. Am J Obstet Gynecol 2020; 223 (02) 275-278
26 Zamaniyan M, Ebadi A, Aghajanpoor S, Rahmani Z, Haghshenas M, Azizi S. Preterm delivery, maternal death, and vertical transmission in a pregnant woman with COVID-19 infection. Prenat Diagn 2020; 40 (13) 1759-1761
27 Sanchez J, Vigil-De Gracia P, Guerrero E. et al. Severe acute respiratory syndrome coronavirus 2 detected in placentas of 2 coronavirus disease 2019-positive asymptomatic pregnant women-case report. AJOG Glob Rep 2021; 1 (01) 100001
28 Chen H, Guo J, Wang C. et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet 2020; 395 (10226): 809-815
29 Dumitriu D, Emeruwa UN, Hanft E. et al. Outcomes of neonates born to mothers with severe acute respiratory syndrome coronavirus 2 infection at a large medical center in New York City. JAMA Pediatr 2021; 175 (02) 157-167
30 Buka SL, Shenassa ED, Niaura R. Elevated risk of tobacco dependence among offspring of mothers who smoked during pregnancy: a 30-year prospective study. Am J Psychiatry 2003; 160 (11) 1978-1984