Although the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues to spread worldwide and has killed over 6.2 million people to date, there is still considerable controversy about the effect of the pathogen on children and fetuses. during pregnancy. A new one American Journal of Obstetrics and Gynecology study provides new information on the effect of coronavirus disease 2019 (COVID-19) on pregnancy and postpartum outcomes.
Examination: Effects of prenatal exposure to maternal COVID-19 and perinatal care on neonatal outcome: Results from the INTERCOVID Multinational Cohort Study. Image Credit: KieferPix / Shutterstock.com
The pregnancy period is traditionally surrounded by joy as well as fear as there are numerous factors that contribute to a healthy outcome. Thus, the emergence of SARS-CoV-2 and how it affects both pregnant women and their unborn children has been the focus of considerable research.
Previous research has suggested a mild effect of COVID-19 in newborns, although pregnant women have been considered to have a higher risk of infection. These results led to the initiative called INTERCOVID, which is a multi-center and multi-nation study of pregnancy complicated by COVID-19.
The present study assesses how maternal COVID-19 affects fetal and neonatal outcomes. In it, the researchers also investigated how the diet, breastfeeding and common neonatal care practices can contribute to vertical transmission.
The current study was conducted in 18 countries and involved more than 40 centers. The presence of COVID-19 during pregnancy was diagnosed by the clinical features or radiological features of the lung (n = 55) or laboratory tests (~ 690).
Approx. 570 pregnant women with COVID-19 were matched with two controls each at enrollment, at the same stage of pregnancy, and at the same level of care. All study participants were closely monitored until discharged from the hospital.
The incidence of caesarean section (cesarean section) was higher, with more than half of the COVID-19-positive mothers reporting childbirth in this way compared to less than 40% in the controls. Similarly, pregnancy complications were more common in COVID-19 mothers who underwent a caesarean section, including hypertensive disorders and fetal difficulties.
Nearly 590 newborns were born to women infected with COVID-19 during pregnancy, compared to over 1,500 newborns born to control mothers. The risk of premature birth, lower birth weight and smaller babies were all higher in the former. This included spontaneous and medically indicated preterm birth.
Fetal problems, hospitalization in the neonatal intensive care unit (NICU) and other complications during the neonatal period were more likely to occur in babies born to COVID-19-positive mothers, regardless of the test status of the newborns. However, infants tested positive had a higher risk and were one week younger at birth compared to those born to women without COVID-19.
Interestingly, COVID-19-affected mothers were more likely to have had previous neonatal deaths, premature births, or low birth weight babies than the controls.
The risk of newborns being tested positive for COVID-19 was increased with longer periods of in utero exposure, that is, with maternal infection at an earlier stage of pregnancy. Babies born by caesarean section were 2.4 times more likely to test positive, regardless of the severity of the disease in the mother.
Overall, two out of three babies born to mothers with COVID-19 had a negative test result, while 28% were untested because they were asymptomatic. The rest were tested positive.
The longer the distance between the infection and the birth, the greater the chances that the newborn would return a positive test at a lower gestational age. Thus, infants were twice as likely to become infected if the birth took place seven days after the mother’s infection and 4.5 times more likely if it took place after 14 days.
Babies who tested positive for COVID-19 had a higher risk of adverse outcomes, including admission to the NICU, neurological features (five times), fever, intestinal symptoms (six times), respiratory symptoms (more than three times), and death, regardless of the higher risk associated with premature birth compared to the babies born to control mothers. These babies were more than five times more likely to require admission to the NICU as well.
Encouragingly, no correlation was found between common care practices such as skin-to-skin contact, rooming-in and breastfeeding and the risk of a positive test in the newborn. In particular, asymptomatic newborns were breastfed more often.
The current study involved different cohorts from many different countries and centers. The results of this study confirm a higher risk of complications for both pregnant and newborn women, as well as their babies, who were diagnosed with COVID-19 during pregnancy.
The presence of the mother’s COVID-19 increased the risk that the baby would test positive and require a cesarean section. This may be due to the lower intake of antibody-rich colostrum in the newborn after a cesarean section from the mother, which may increase the risk of infection.
Vaginal birth remains the safest option whenever possible, even with maternal COVID-19. In addition, other infant care practices that encourage maternal-infant bonding and promote breastfeeding can be safely continued without a higher risk of vertical transmission.
- Giuliani, F., Gunier, RB, Deantoni, S., et al. (2022). Effects of prenatal exposure to maternal COVID-19 and perinatal care on neonatal outcome: Results from the INTERCOVID Multinational Cohort Study. American Journal of Obstetrics and Gynecology. doi: 10.1016 / j.ajog.2022.04.019.