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

BACKGROUND AND PURPOSE:

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

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

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

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

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