A population cohort study investigates the effect of SARS-CoV-2 infection on pregnancy outcomes

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Researchers have worked hard to understand different aspects of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the causative agent of the ongoing coronavirus 2019 (COVID-19) pandemic.

Study: Pregnancy outcome after infection with SARS-CoV-2 by the trimester: a large, population-based cohort study.  Image Credit: MM Vieira / Shutterstock
Stady: Pregnancy outcome after infection with SARS-CoV-2 by the trimester: a large, population-based cohort study. Image Credit: MM Vieira / Shutterstock

Several studies that have focused on pregnancy outcomes are available for women infected with COVID-19 during their hospital stay to terminate pregnancy or give birth. However, very few studies are available evaluating pregnancy outcomes for women infected with SARS-CoV-2 during different stages of pregnancy.

background

Among the limited number of studies that evaluated pregnancy outcomes for women with COVID-19 at different stages of pregnancy, few reported their results for the entire group. Furthermore, this subset of studies failed to analyze the outcome of pregnancy in the third trimester of infection. Therefore, there is a gap in the research regarding pregnancy outcomes for women infected with SARS-CoV-2 during the early stage of pregnancy.

The researchers report that the timing of viral infection may be important to fetal development, delivery, and other health outcomes of the newborn. Previous studies on the effect of influenza infection on pregnancy have reported negative outcomes with a higher rate of caesarean section and preterm birth (PTB) in women with influenza in the later stages of pregnancy.

Research on the other Corona VirusesIn particular, Middle East respiratory syndrome coronavirus (MERS-CoV) and severe acute respiratory syndrome coronavirus (SARS-CoV) have revealed a high risk of spontaneous abortion and preterm birth.

Scientists conducted a comparative study to understand the difference between pregnancy outcomes in women with COVID-19 and in healthy women. This study revealed that PTB and low birth weight (LBW) were associated to a greater degree in pregnant women with COVID-19 than in healthy pregnant women.

However, the relationship between the timing of infection with COVID-19 and the extent of pregnancy outcomes has yet to be revealed.

New study

In a new study published in PLUS ONEAnd the The researchers focused on assessing the rates of small gestational age (SGA) and PTB in a large cohort. The scientists followed the SARS-CoV-2 infection during pregnancy and the gestational age of infection.

This study was conducted in Israel at Maccabi Healthcare Services (MHS), which has 2.5 million members representing every segment of the Israeli population. MHS is a computerized database that includes each patient’s demographic data, and their medical records, including the SARS-CoV-2 polymerase chain reaction (PCR) test.

The researchers identified all pregnant female members with an ectopic pregnancy from the database between February 2020 (the first case of COVID-19 reported in Israel) and July 2021. The current study defined PTB as less than 37 weeks gestation. SGA was defined as an infant’s body weight at birth less than the sex-specific 10th percentile for gestational age. LBW was considered in infants who weighed less than 2500 g at birth. Pregnancy loss (PL) included spontaneous and induced abortions up to 20 weeks of gestation.

the findings

The current study revealed a high risk of PTB in women infected with SARS-CoV-2 in the third trimester. However, such a result has not been observed in patients infected with COVID-19 in early pregnancy. This finding is consistent with a previous study that reported an increased risk of PTB in pregnant women who contracted COVID-19 during the third trimester and showed symptomatic infection.

Scientists revealed that the rate of induced labor was higher in affected women in the third trimester than in healthy women. Despite a higher rate of PTB among women infected with COVID-19, no difference in SGA rates was observed between infected women and a matched healthy group. This result is very reassuring because SARS-CoV-2 infection during pregnancy does not affect intrauterine growth restriction.

Previous studies have reported an elevated risk of miscarriage during outbreaks of MERS and SARS. However, in the current COVID-19 scenario, no such result was observed, i.e. no difference in PL rates between infected and uninfected women was observed.

conclusion

One of the main strengths of this study is its large cohort size, which is representative of the Israeli population. A limitation of the study is that the delivery method was not evaluated, as it was not provided in the MHS database.

In addition, hospital discharge records for the entire study group were not evaluated due to unavailability. However, the authors strongly suggested that gestational age at the time of SARS-CoV-2 infection plays an important role in pregnancy outcome. Reports indicate that women in their third trimester, especially after 34 weeks of gestation, should strictly practice social distancing to avoid the risks of negative pregnancy outcomes.

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