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COVID-19 and Women’s Health

INTERCOVID Results: Maternal COVID-19 and Risk Factors for Neonatal Positivity

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BACKGROUND AND PURPOSE:

  • Giuliani et al. (AJOG, 2022) report on neonatal outcomes following antenatal SARS-CoV-2 infection

METHODS:

  • Prospective cohort study (INTERCOVID)
    • 43 institutions in 18 countries (including US)
    • March 2020 to March 2021
  • Participants
    • Pregnant women and their neonates
  • Exposures
    • SARS-CoV-2 infected pregnant women
    • Uninfected pregnant women   
  • Study design
    • After each antenatal COVID-19 diagnosis, 2 pregnant women receiving routine antenatal care were enrolled into the database the same day
      • ≥18 years | Similar gestational age (±2 weeks)
    • Follow-up through hospital discharge
    • Infection confirmed based on one of the following
      • Laboratory results | Radiological pulmonary findings | ≥2 predefined COVID-19 symptoms
  • Primary outcomes
    • Indices of neonatal and perinatal morbidity and mortality
    • Neonatal positivity and its correlation with
      • Mode of delivery
      • Breastfeeding
      • Hospital neonatal care practices

RESULTS:

  • Neonates born to infected women: 586 | Unexposed neonates: 1535
  • Women with COVID-19 diagnosis had a higher rate of
    • Cesarean delivery (P<0.01)
    • Pregnancy-related complications, such as hypertensive disorders of pregnancy and fetal distress (P<0.001)
    • Preterm birth (P≤0.001)
    • Lower neonatal weight, length and head circumference at birth (P≤0.001)
  • Length of in utero SARS-CoV-2 exposure was significantly correlated to the risk of the neonate testing positive
    • In utero exposure >14 days: odds ratio (OR) 4.5 (95% CI, 2.2 to 9.4)
  • Among neonates born to mothers with COVID-19 diagnosis, multivariable logistic analysis revealed birth via cesarean delivery was a risk factor for testing positive for COVID-19
    • OR 2.4 (95% CI, 1.2 to 4.7)
  • After adjusting for prematurity, in the subgroup of neonates born to women with COVID-19 diagnosis, neonatal outcomes worsened when the neonate also tested positive, with higher rates of
    • NICU admission
    • Fever
    • Gastrointestinal and respiratory symptoms
    • Death
  • The following were not associated with an increased risk of newborn positivity
    • Breastfeeding
    • Hospital neonatal care practices, including immediate skin-to-skin contact and rooming-in

CONCLUSION:

  • Antenatal COVID-19 diagnosis was associated with worse neonatal and maternal outcomes
  • Cesarean delivery was associated with increased odds of neonatal positivity
    • Vaginal delivery may be the safest option for women with COVID-19 in labor
  • There was no link between neonatal positivity and breastfeeding or immediate skin-to-skin contact

Learn More – Primary Sources:

Effects of prenatal exposure to maternal COVID-19 and perinatal care on neonatal outcome: results from the INTERCOVID Multinational Cohort Study

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Related ObG Topics:

How Do Perinatal Outcomes Compare During the Pre-Delta, Delta and Omicron Waves?
Second Update to Living Systematic Review and Meta-Analysis: Have Preterm Births Increased During the Pandemic?
Results from INTERCOVID Multinational Cohort Study: Pregnancy and Neonatal Outcomes
Latest Data on Transplacental Antibody Transfer Following COVID-19 Vaccination

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