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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 
1   Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
2   Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
,
Morgan R. Peltier
3   Department of Psychiatry, Jersey Shore University Medical Center, Neptune, New Jersey
,
Lawrence D. Lurvey
4   Department of Obstetrics and Gynecology, Southern California Permanente Medical Group, Pasadena, California
,
Jiaxiao M. Shi
1   Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
,
David Braun
1   Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
4   Department of Obstetrics and Gynecology, Southern California Permanente Medical Group, Pasadena, California
,
David A. Sacks
1   Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
5   Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California
,
Anthony E. Burgos
6   Department of Pediatrics, Kaiser Permanente Downey Medical Center, Downey, California
7   Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
,
Alex Fong
8   Department of Obstetrics and Gynecology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
,
Neha Trivedi
9   Department of Obstetrics and Gynecology, Kaiser Permanente San Diego Medical Center, San Diego, California
,
Lyn Yasumura
10   Department of Obstetrics and Gynecology, Kaiser Permanente Baldwin Park Medical Center, Baldwin Park, California
,
Kristi Reynolds
1   Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
2   Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
,
Marielle Nguyen
11   Department of Neonatal Medicine, Kaiser Permanente Orange County Medical Center, Anaheim, California
,
Marianna Volodarskiy
12   Kaiser Foundation Hospitals, Pasadena, California
,
Vicki Y. Chiu
1   Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
,
Adrian H. Lopez
8   Department of Obstetrics and Gynecology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
,
Michael J. Fassett
13   Department of Obstetrics and Gynecology, Kaiser Permanente West Los Angeles Medical Center, Los Angeles, California
› Author Affiliations
Funding This work was supported by Kaiser Permanente Southern California Direct Community Benefit funds. The funding agency has no role in the design, conduct and report of this study. The authors wish to thank Ms. Sole Cardoso for her technical assistance with submitting the final manuscript.
› Further Information
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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


Publication History

Received: 15 June 2021

Accepted: 17 February 2022

Article published online:
23 June 2022

© 2022. Thieme. All rights reserved.

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  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    Thieme ConnectPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 4 Mor G, Aldo P, Alvero AB. The unique immunological and microbial aspects of pregnancy. Nat Rev Immunol 2017; 17 (08) 469-482
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 16 Committee opinion no 700: methods for estimating the due date. Obstet Gynecol 2017; 129 (05) e150-e154
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 21 Goodrum LA. Pneumonia in pregnancy. Semin Perinatol 1997; 21 (04) 276-283
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar