COVID-19 during pregnancy may predict worse birth outcomes

Key takeaways:

• COVID-19 during pregnancy increased likelihood of low birthweight, preterm delivery, high Apgar score and longer hospitalization.
• Severe COVID-19 infection also strongly predicted adverse newborn outcomes.

BALTIMORE — COVID-19 infection during pregnancy predicted worse birth outcomes, including preterm delivery, low birthweight and longer hospital stay, researchers reported at the ACOG Annual Clinical & Scientific Meeting.

“We found that COVID-19 infection during pregnancy predicted poor birth outcomes — it decreased birthweight by almost half a pound and increased the risk of an extended delivery hospitalization almost threefold. These effects were largely driven by earlier delivery, as those who had COVID-19 during pregnancy had a fourfold increased risk of preterm delivery,” Yosra Elsayed, BS, MD candidate at Central Michigan University College of Medicine, Mount Pleasant, told Healio.

Researchers performed a retrospective chart review and identified 128 participants who received care at a single university-affiliated obstetrics practice in Michigan from January 2019 to July 2022. Participants were grouped as having COVID-19 during pregnancy (n = 69; mean age, 26.1 years) or negative for COVID-19 before the pandemic (n = 59; mean age, 25.1 years). Infection was deemed severe if the participant went to the ED, was hospitalized, or required oxygen, steroids or antibody treatments.

Forty-one percent of participants had severe COVID-19 during their pregnancy. Compared with COVID-19-negative participants, those with COVID-19 during pregnancy were:

Yosra Elsayed, BS

• likely to deliver newborns that were an average of 242 g lighter;
• 4.3 times more likely to have preterm delivery;
• 2.6 times more likely to deliver a newborn with a 1-minute Apgar score higher than 8; and
• 2.9 times more likely to remain hospitalized for 1 week or longer.

In addition, compared with participants without severe COVID-19 infection, those with severe COVID-19 infection during pregnancy were:

• four times more likely to have preterm delivery;
• times more likely to deliver a newborn with low birthweight;
• 3.14 times more likely to require oxygen treatment;
• 2.85 times more likely to have a newborn requiring NICU admission; and
• 4.4 times more likely to have a longer hospital length of stay.

“Severity of COVID-19 infection during pregnancy matters,” Elsayed told Healio. “In our study, severe infection ... was a strong predictor of poor outcomes with the worse outcomes among those with the most severe infections during pregnancy.”

According to Elsayed, these findings may be utilized to aid pregnant women to make informed decisions about their care during pregnancy and to also guide provider recommendations for education and treatment of pregnant women regarding COVID-19 and similar infections.

“A larger, more diverse sample is needed to confirm findings and to examine the potential impact of vaccination in reducing the impact of COVID-19 infection during pregnancy,” Elsayed said.

Reference:

• Elsayed Y, et al. Obstet Gynecol. 2023;doi:10.1097/01.AOG.0000930388.39095.11.