Will COVID-19 adversely affect pregnancy and neonatal outcomes?

Early in the coronavirus disease 2019 (COVID-19) pandemic, pregnant women are at an unusually high risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) compared to the general population or non-pregnant women It was thought. However, subsequent studies could not agree on the extent and nature of the danger posed by infection. Recent studies have reported adverse effects of SARS-CoV-2 infection on pregnant mothers and babies.

study: Maternal, fetal, and neonatal adverse outcomes in pregnant women with SARS-CoV-2 infection: a meta-analysis of individual participant dataImage Credit: ESB Professional/Shutterstock

prologue

Previous studies have shown conflicting results about the effects of this condition during pregnancy. A large review in 2021 found that her COVID-19 during pregnancy was associated with increased risk of death, intensive care unit (ICU) admission, premature birth, stillbirth and admission to the neonatal care unit. It was shown to be associated with high A significant shortcoming of this study is that in most cases, less than 10 studies were reviewed per outcome.

Other recent studies showed an increased likelihood of hypertensive disorders of pregnancy, as well as caesarean section and adverse neonatal outcomes. Nonetheless, these conclusions are controversial due to heterogeneous study design, erroneous selection of subjects and controls, and methodological flaws. Moreover, these included few data from low-income countries, and were often unable to generalize.

Current research published in BMJ Global Health, intended to draw more definitive conclusions. The researchers collaborated using high-quality individual participant data from 12 of her ongoing studies. These were conducted in her 12 countries and involved over 13,000 pregnant women.

In this study, we sought to perform a sequential prospective meta-analysis (sPMA) to identify COVID-19 outcomes during pregnancy in a prospective manner. Researchers used data from approximately 1,000 pregnancies (ongoing or within 7 days of delivery) with COVID-19 (confirmed or probable). All women were negative for virus and/or antibodies at birth.

The women had an average age of 31 years and obesity rates of 10% to 15%.

What did the research show?

Based on three studies that documented deaths during the study period (other studies had no deaths), the researchers found an eight-fold increased risk of maternal death among pregnant women infected with SARS-CoV-2. showed. Similarly, the risk of admission to the intensive care unit (ICU) was almost four times higher, with an absolute risk of 3% for her.

The risk of ventilator increased 15-fold, and the risk of receiving emergency care of any kind was 5.5-fold higher, 4%. There was a 32- to 5-fold higher risk of being diagnosed with pneumonia and a 5.5-fold increased risk of thromboembolic complications.

The risk of hypertension increased by up to 25% and the risk of pre-eclampsia/eclampsia increased by up to 40%. The underlying reason may be related to differential expression of angiotensin-converting enzyme 2 (ACE2) and its effects on blood vessels. Systemic inflammation and hypercoagulability due to COVID-19; or common risk factors for COVID-19 and hypertensive disorders of pregnancy. Alternatively, it is possible that all of these cases are not true eclampsia or pre-eclampsia, but similar syndromes caused by her co-occurring COVID-19.

In this study, newborns born to mothers infected with SARS-CoV-2 were twice as likely to be admitted to a neonatal care unit. Furthermore, a history of SARS-CoV-2 during pregnancy increased the risk of preterm or moderately preterm birth by 1.7- and 2.9-fold, respectively.

When only pregnant women without COVID-19 infection and symptomatic infections were included, results were similar, including increased risk of maternal mortality, critical care, ventilation, and other maternal/neonatal complications. , was more powerful. Infants were likely to be small due to gestational age and very low birth weight or preterm birth.

Interestingly, there was no association between SARS-CoV-2 infection during pregnancy and stillbirth or intrauterine growth restriction (low birth weight). However, previous studies have shown an association with a doubled risk of stillbirth. The reason for this discrepancy is not explained.

What is the impact?

The results of this study support those of other recent reviews and multinational studies.

These results may reinforce the need to vaccinate pregnant women with an effective and safe COVID-19 vaccine, but more than that, to provide preventive and therapeutic care for COVID-19 during pregnancy. It shows that health systems globally need to be strengthened to do so.

journal reference

Smith, ER et al. (2023). Maternal, fetal, and neonatal adverse outcomes in pregnant women with SARS-CoV-2 infection: a meta-analysis of individual participant data. BMJ Global Healthdoi:10.1136/bmjgh-2022-009495. https://gh.bmj.com/content/8/1/e009495

Early in the coronavirus disease 2019 (COVID-19) pandemic, pregnant women are at an unusually high risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) compared to the general population or non-pregnant women It was thought. However, subsequent studies could not agree on the extent and nature of the danger posed by infection. Recent studies have reported adverse effects of SARS-CoV-2 infection on pregnant mothers and babies.

prologue

Previous studies have shown conflicting results about the effects of this condition during pregnancy. A large review in 2021 found that her COVID-19 during pregnancy was associated with increased risk of death, intensive care unit (ICU) admission, premature birth, stillbirth and admission to the neonatal care unit. It was shown to be associated with high A significant shortcoming of this study is that in most cases, less than 10 studies were reviewed per outcome.

Other recent studies showed an increased likelihood of hypertensive disorders of pregnancy, as well as caesarean section and adverse neonatal outcomes. Nonetheless, these conclusions are controversial due to heterogeneous study design, erroneous selection of subjects and controls, and methodological flaws. Moreover, these included few data from low-income countries, and were often unable to generalize.

Current research published in BMJ Global Health, intended to draw more definitive conclusions. The researchers collaborated using high-quality individual participant data from 12 of her ongoing studies. These were conducted in her 12 countries and involved over 13,000 pregnant women.

In this study, we sought to perform a sequential prospective meta-analysis (sPMA) to identify COVID-19 outcomes during pregnancy in a prospective manner. Researchers used data from approximately 1,000 pregnancies (ongoing or within 7 days of delivery) with COVID-19 (confirmed or probable). All women were negative for virus and/or antibodies at birth.

The women had an average age of 31 years and obesity rates of 10% to 15%.

What did the research show?

Based on three studies that documented deaths during the study period (other studies had no deaths), the researchers found an eight-fold increased risk of maternal death among pregnant women infected with SARS-CoV-2. showed. Similarly, the risk of admission to the intensive care unit (ICU) was almost four times higher, with an absolute risk of 3% for her.

The risk of ventilator increased 15-fold, and the risk of receiving emergency care of any kind was 5.5-fold higher, 4%. There was a 32- to 5-fold higher risk of being diagnosed with pneumonia and a 5.5-fold increased risk of thromboembolic complications.

The risk of hypertension increased by up to 25% and the risk of pre-eclampsia/eclampsia increased by up to 40%. The underlying reason may be related to differential expression of angiotensin-converting enzyme 2 (ACE2) and its effects on blood vessels. Systemic inflammation and hypercoagulability due to COVID-19; or common risk factors for COVID-19 and hypertensive disorders of pregnancy. Alternatively, it is possible that all of these cases are not true eclampsia or pre-eclampsia, but similar syndromes caused by her co-occurring COVID-19.

In this study, newborns born to mothers infected with SARS-CoV-2 were twice as likely to be admitted to a neonatal care unit. Furthermore, a history of SARS-CoV-2 during pregnancy increased the risk of preterm or moderately preterm birth by 1.7- and 2.9-fold, respectively.

When only pregnant women without COVID-19 infection and symptomatic infections were included, results were similar, including increased risk of maternal mortality, critical care, ventilation, and other maternal/neonatal complications. , was more powerful. Infants were likely to be small due to gestational age and very low birth weight or preterm birth.

Interestingly, there was no association between SARS-CoV-2 infection during pregnancy and stillbirth or intrauterine growth restriction (low birth weight). However, previous studies have shown an association with a doubled risk of stillbirth. The reason for this discrepancy is not explained.

What is the impact?

“This analysis shows that infection with SARS-CoV-2 at any time during pregnancy increases the risk of maternal mortality, severe maternal morbidity, and neonatal morbidity, but not stillbirth or intrauterine growth restriction. increase.”

The results of this study support those of other recent reviews and multinational studies.

These results may strengthen the advocacy of vaccinating pregnant women with an effective and safe COVID-19 vaccine, but also provide preventive and therapeutic care for COVID-19 during pregnancy. It shows that health systems globally need to be strengthened to do so.