Abstract
Background: COVID-19 is an emerging, highly contagious disease caused by the SARSCoV- 2 virus. Pregnant women appear to be at greater risk for COVID-19 infection and complications. Considering the importance of maternal and fetal healthcare, this study aims to evaluate some of the maternal, fetal, and neonatal outcomes in pregnant women with COVID-19.
Methods: Pregnant women at the gestational age of 20 weeks or more were recruited and divided into two groups: cases (those with COVID-19 infection) and controls (those without the infection). Maternal complications during the current pregnancy, delivery factors, and fetal/neonatal complications were recorded and compared between the groups.
Results: Maternal COVID-19 infection was highly associated with the need for emergency cesarean surgery (p = 0.005), preterm labor (p = 0.017), and the need for NICU admission for newborns (OR = 0.05, p = 0.000). Also, high rates of vertical transmission of the infection were observed in the cases.
Conclusion: Maternal COVID-19 disease could be associated with a range of complications for both the mother and her newborn. The vertical transmission rate was also observed to be higher than previously reported in the literature. Further studies are required to evaluate this phenomenon.
Graphical Abstract
[1]
Rasmussen, S.A.; Smulian, J.C.; Lednicky, J.A.; Wen, T.S.; Jamieson, D.J. Coronavirus Disease 2019 (COVID-19) and pregnancy: what obstetricians need to know. Am. J. Obstet. Gynecol., 2020, 222(5), 415-426.
[http://dx.doi.org/10.1016/j.ajog.2020.02.017] [PMID: 32105680]
[http://dx.doi.org/10.1016/j.ajog.2020.02.017] [PMID: 32105680]
[2]
Peeri, N.C.; Shrestha, N.; Rahman, M.S.; Zaki, R.; Tan, Z.; Bibi, S.; Baghbanzadeh, M.; Aghamohammadi, N.; Zhang, W.; Haque, U. The SARS, MERS and novel coronavirus (COVID-19) epidemics, the newest and biggest global health threats: what lessons have we learned? Int. J. Epidemiol., 2020, 49(3), 717-726.
[http://dx.doi.org/10.1093/ije/dyaa033] [PMID: 32086938]
[http://dx.doi.org/10.1093/ije/dyaa033] [PMID: 32086938]
[3]
Struyf, T.; Deeks, J.J.; Dinnes, J.; Takwoingi, Y.; Davenport, C.; Leeflang, M.M.; Spijker, R.; Hooft, L.; Emperador, D.; Domen, J.; Horn, S.R.A.; Van den Bruel, A. Signs and symptoms to determine if a patient presenting in primary care or hospital outpatient settings has COVID-19. Cochrane Database Syst. Rev., 2021, 2(2), CD013665.
[PMID: 33620086]
[PMID: 33620086]
[4]
Al Awaidy, S.T.; Khamis, F.; Mahomed, O.; Wesonga, R.; Al Shuabi, M.; Al Shabibi, N.S.; Al Dhahli, D.S.; Al Noumani, J.; Alhadidi, A.M.; Al Wahebi, M. Epidemiological risk factors for acquiring severe COVID-19: prospective cohort study. Oman Med. J., 2021, 36(5), e301-e301.
[http://dx.doi.org/10.5001/omj.2021.127] [PMID: 34676109]
[http://dx.doi.org/10.5001/omj.2021.127] [PMID: 34676109]
[5]
Wang, X.; Zhou, Z.; Zhang, J.; Zhu, F.; Tang, Y.; Shen, X. A case of 2019 novel coronavirus in a pregnant woman with preterm delivery. Clin. Infect. Dis., 2020, 71(15), 844-846.
[http://dx.doi.org/10.1093/cid/ciaa200] [PMID: 32119083]
[http://dx.doi.org/10.1093/cid/ciaa200] [PMID: 32119083]
[6]
Lü, M.; Qiu, L.; Jia, G.; Guo, R.; Leng, Q. Single-cell expression profiles of ACE2 and TMPRSS2 reveals potential vertical transmission and fetus infection of SARS-CoV-2. Aging (Albany NY), 2020, 12(20), 19880-19897.
[http://dx.doi.org/10.18632/aging.104015] [PMID: 33104520]
[http://dx.doi.org/10.18632/aging.104015] [PMID: 33104520]
[7]
Sessa, R.; Anastasi, E.; Brandolino, G.; Brunelli, R.; Di Pietro, M.; Filardo, S.; Masciullo, L.; Terrin, G.; Viscardi, M.F.; Porpora, M.G. What is the hidden biological mechanism underlying the possible SARS-CoV-2 vertical transmission? a mini review. Front. Physiol., 2022, 13, 875806.
[http://dx.doi.org/10.3389/fphys.2022.875806] [PMID: 35600312]
[http://dx.doi.org/10.3389/fphys.2022.875806] [PMID: 35600312]
[8]
Jamieson, D.J.; Rasmussen, S.A. An update on COVID-19 and pregnancy. Am. J. Obstet. Gynecol., 2022, 226(2), 177-186.
[http://dx.doi.org/10.1016/j.ajog.2021.08.054] [PMID: 34534497]
[http://dx.doi.org/10.1016/j.ajog.2021.08.054] [PMID: 34534497]
[9]
Salem, D.; Katranji, F.; Bakdash, T. COVID‐19 infection in pregnant women: Review of maternal and fetal outcomes. Int. J. Gynaecol. Obstet., 2021, 152(3), 291-298.
[http://dx.doi.org/10.1002/ijgo.13533] [PMID: 33305352]
[http://dx.doi.org/10.1002/ijgo.13533] [PMID: 33305352]
[10]
Wang, X.; Chen, X.; Zhang, K. Maternal infection with COVID-19 and increased risk of adverse pregnancy outcomes: a meta-analysis. J. Matern. Fetal Neonatal Med., 2022, 35(25), 9368-9375.
[http://dx.doi.org/10.1080/14767058.2022.2033722] [PMID: 35156521]
[http://dx.doi.org/10.1080/14767058.2022.2033722] [PMID: 35156521]
[11]
von Elm, E.; Altman, D.G.; Egger, M.; Pocock, S.J.; Gøtzsche, P.C.; Vandenbroucke, J.P. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Bull. World Health Organ., 2007, 85(11), 867-872.
[http://dx.doi.org/10.2471/BLT.07.045120] [PMID: 18038077]
[http://dx.doi.org/10.2471/BLT.07.045120] [PMID: 18038077]
[12]
General Assembly of the World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. J. Am. Coll. Dent., 2014, 81(3), 14-18.
[PMID: 25951678]
[PMID: 25951678]
[13]
Algarroba, G.N.; Rekawek, P.; Vahanian, S.A.; Khullar, P.; Palaia, T.; Peltier, M.R.; Chavez, M.R.; Vintzileos, A.M. Visualization of severe acute respiratory syndrome coronavirus 2 invading the human placenta using electron microscopy. Am. J. Obstet. Gynecol., 2020, 223(2), 275-278.
[http://dx.doi.org/10.1016/j.ajog.2020.05.023] [PMID: 32405074]
[http://dx.doi.org/10.1016/j.ajog.2020.05.023] [PMID: 32405074]
[14]
Kamali Aghdam, M.; Jafari, N.; Eftekhari, K. Novel coronavirus in a 15-day-old neonate with clinical signs of sepsis, a case report. Infect. Dis., 2020, 52(6), 427-429.
[http://dx.doi.org/10.1080/23744235.2020.1747634] [PMID: 32233816]
[http://dx.doi.org/10.1080/23744235.2020.1747634] [PMID: 32233816]
[15]
Zhang, Z.J.; Yu, X.J.; Fu, T.; Liu, Y.; Jiang, Y.; Yang, B.X.; Bi, Y. Novel coronavirus infection in newborn babies aged < 28 days in China. Eur. Respir. J., 2020, 55(6), 2000697.
[http://dx.doi.org/10.1183/13993003.00697-2020] [PMID: 32269087]
[http://dx.doi.org/10.1183/13993003.00697-2020] [PMID: 32269087]
[16]
Ferrazzi, E.; Frigerio, L.; Savasi, V.; Vergani, P.; Prefumo, F.; Barresi, S.; Bianchi, S.; Ciriello, E.; Facchinetti, F.; Gervasi, M.T.; Iurlaro, E.; Kustermann, A.; Mangili, G.; Mosca, F.; Patanè, L.; Spazzini, D.; Spinillo, A.; Trojano, G.; Vignali, M.; Villa, A.; Zuccotti, G.V.; Parazzini, F.; Cetin, I. Vaginal delivery in SARS‐CoV‐2‐infected pregnant women in Northern Italy: a retrospective analysis. BJOG, 2020, 127(9), 1116-1121.
[http://dx.doi.org/10.1111/1471-0528.16278] [PMID: 32339382]
[http://dx.doi.org/10.1111/1471-0528.16278] [PMID: 32339382]
[17]
Yan, J.; Guo, J.; Fan, C.; Juan, J.; Yu, X.; Li, J.; Feng, L.; Li, C.; Chen, H.; Qiao, Y.; Lei, D.; Wang, C.; Xiong, G.; Xiao, F.; He, W.; Pang, Q.; Hu, X.; Wang, S.; Chen, D.; Zhang, Y.; Poon, L.C.; Yang, H. Coronavirus disease 2019 in pregnant women: a report based on 116 cases. Am. J. Obstet. Gynecol., 2020, 223(1), 111.e1-111.e14.
[http://dx.doi.org/10.1016/j.ajog.2020.04.014] [PMID: 32335053]
[http://dx.doi.org/10.1016/j.ajog.2020.04.014] [PMID: 32335053]
[18]
Chen, L.; Li, Q.; Zheng, D.; Jiang, H.; Wei, Y.; Zou, L.; Feng, L.; Xiong, G.; Sun, G.; Wang, H.; Zhao, Y.; Qiao, J. Clinical characteristics of pregnant women with COVID-19 in Wuhan, China. N. Engl. J. Med., 2020, 382(25), e100.
[http://dx.doi.org/10.1056/NEJMc2009226] [PMID: 32302077]
[http://dx.doi.org/10.1056/NEJMc2009226] [PMID: 32302077]
[19]
Fan, S.; Yan, S.; Liu, X.; Liu, P.; Huang, L.; Wang, S. Human coronavirus infections and pregnancy. Maternal-Fetal Med., 2021, 3(1), 53-65.
[http://dx.doi.org/10.1097/FM9.0000000000000071] [PMID: 34192279]
[http://dx.doi.org/10.1097/FM9.0000000000000071] [PMID: 34192279]
[20]
Sattari, M.; Bashirian, S.; Masoumi, S.Z.; Shayan, A.; Jenabi, E.; Ghelichkhani, S.; Shirzadeh, A.A.; Jalili, E.; Alimohammadi, S. Evaluating clinical course and risk factors of infection and demographic characteristics of pregnant women with COVID-19 in Hamadan province. West of Iran. J. Res. Health Sci., 2020, 20(3), e00488-e00488.
[http://dx.doi.org/10.34172/jrhs.2020.22] [PMID: 33169720]
[http://dx.doi.org/10.34172/jrhs.2020.22] [PMID: 33169720]
[21]
Kyle, M.H.; Hussain, M.; Saltz, V.; Mollicone, I.; Bence, M.; Dumitriu, D. Vertical transmission and neonatal outcomes following maternal SARS-CoV-2 infection during pregnancy. Clin. Obstet. Gynecol., 2022, 65(1), 195-202.
[http://dx.doi.org/10.1097/GRF.0000000000000667] [PMID: 35045041]
[http://dx.doi.org/10.1097/GRF.0000000000000667] [PMID: 35045041]
[22]
Knight, M.; Bunch, K.; Vousden, N.; Morris, E.; Simpson, N.; Gale, C.; O’Brien, P.; Quigley, M.; Brocklehurst, P.; Kurinczuk, J.J. Characteristics and outcomes of pregnant women admitted to hospital with confirmed SARS-CoV-2 infection in UK: national population based cohort study. BMJ, 2020, 369, m2107.
[http://dx.doi.org/10.1136/bmj.m2107] [PMID: 32513659]
[http://dx.doi.org/10.1136/bmj.m2107] [PMID: 32513659]
[23]
Villar, J.; Ariff, S.; Gunier, R.B.; Thiruvengadam, R.; Rauch, S.; Kholin, A.; Roggero, P.; Prefumo, F.; do Vale, M.S.; Cardona-Perez, J.A.; Maiz, N.; Cetin, I.; Savasi, V.; Deruelle, P.; Easter, S.R.; Sichitiu, J.; Soto Conti, C.P.; Ernawati, E.; Mhatre, M.; Teji, J.S.; Liu, B.; Capelli, C.; Oberto, M.; Salazar, L.; Gravett, M.G.; Cavoretto, P.I.; Nachinab, V.B.; Galadanci, H.; Oros, D.; Ayede, A.I.; Sentilhes, L.; Bako, B.; Savorani, M.; Cena, H.; García-May, P.K.; Etuk, S.; Casale, R.; Abd-Elsalam, S.; Ikenoue, S.; Aminu, M.B.; Vecciarelli, C.; Duro, E.A.; Usman, M.A.; John-Akinola, Y.; Nieto, R.; Ferrazzi, E.; Bhutta, Z.A.; Langer, A.; Kennedy, S.H.; Papageorghiou, A.T. Maternal and neonatal morbidity and mortality among pregnant women with and without COVID-19 infection. JAMA Pediatr., 2021, 175(8), 817-826.
[http://dx.doi.org/10.1001/jamapediatrics.2021.1050] [PMID: 33885740]
[http://dx.doi.org/10.1001/jamapediatrics.2021.1050] [PMID: 33885740]
[24]
Hantoushzadeh, S.; Shamshirsaz, A.A.; Aleyasin, A.; Seferovic, M.D.; Aski, S.K.; Arian, S.E.; Pooransari, P.; Ghotbizadeh, F.; Aalipour, S.; Soleimani, Z.; Naemi, M.; Molaei, B.; Ahangari, R.; Salehi, M.; Oskoei, A.D.; Pirozan, P.; Darkhaneh, R.F.; Laki, M.G.; Farani, A.K.; Atrak, S.; Miri, M.M.; Kouchek, M.; Shojaei, S.; Hadavand, F.; Keikha, F.; Hosseini, M.S.; Borna, S.; Ariana, S.; Shariat, M.; Fatemi, A.; Nouri, B.; Nekooghadam, S.M.; Aagaard, K. Maternal death due to COVID-19. Am. J. Obstet. Gynecol., 2020, 223(1), 109.e1-109.e16.
[http://dx.doi.org/10.1016/j.ajog.2020.04.030] [PMID: 32360108]
[http://dx.doi.org/10.1016/j.ajog.2020.04.030] [PMID: 32360108]
[25]
Lassi, Z.S.; Ana, A.; Das, J.K.; Salam, R.A.; Padhani, Z.A.; Irfan, O.; Bhutta, Z.A. A systematic review and meta-analysis of data on pregnant women with confirmed COVID-19: Clinical presentation, and pregnancy and perinatal outcomes based on COVID-19 severity. J. Glob. Health, 2021, 11, 05018.
[http://dx.doi.org/10.7189/jogh.11.05018] [PMID: 34221361]
[http://dx.doi.org/10.7189/jogh.11.05018] [PMID: 34221361]
[26]
Papapanou, M.; Papaioannou, M.; Petta, A.; Routsi, E.; Farmaki, M.; Vlahos, N.; Siristatidis, C. Maternal and neonatal characteristics and outcomes of COVID-19 in pregnancy: An overview of systematic reviews. Int. J. Environ. Res. Public Health, 2021, 18(2), 596.
[http://dx.doi.org/10.3390/ijerph18020596] [PMID: 33445657]
[http://dx.doi.org/10.3390/ijerph18020596] [PMID: 33445657]
