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The association between SARS-CoV-2 infection and preterm delivery: a prospective study with a multivariable analysis

2021; BioMed Central; Volume: 21; Issue: 1 Linguagem: Inglês

10.1186/s12884-021-03742-4

1471-2393

Óscar Martínez Pérez, Pilar Prats, Marta Muner Hernandez, María Begoña Encinas Pardilla, Noelia Pérez Pérez, Marı́a Rosa Hernández, Ana Villalba Yarza, Olga Nieto Velasco, Pablo Guillermo Del Barrio Fernandez, Laura Forcén Acebal, Carmen Lago, Alicia Martínez‐Varea, Begoña Muñoz Abellana, María Suárez Arana, Laura Fuentes Ricoy, Clara Martinez Diago, María Jesús Freire, Macarena Alférez Álvarez-Mallo, Cristina Casanova Pedraz, Onofre Alomar Mateu, Cristina Lesmes Heredia, Juan Carlos Wizner de Alva, Rut Bernardo Vega, Montserrat Macia Badia, Cristina Álvarez Colomo, Antonio Sánchez Muñoz, Laia Pratcorona, Rubén Alonso Saiz, M. López Rodríguez, Maria del Carmen Barbancho Lopez, Marta Ruth Meca Casbas, Óscar Vaquerizo Ruiz, Eva Morán Antolín, María José Núñez Valera, Camino Fernández, A. Tubau, Alejandra Maria Cano Garcia, Carmen Baena Luque, Susana Soldevilla Pérez, Irene Gastaca Abásolo, José Adanez García, María Teulón González, Alberto Puertas Prieto, Rosa Serna, María del Pilar Guadix Martín, Mónica Catalina Coello, Elena Perez, África Caño Aguilar, María Luisa de la Cruz, José Antonio Sainz‐Bueno,

Pregnancy and preeclampsia studies

Abstract Background To determine whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, the cause of COVID-19 disease) exposure in pregnancy, compared to non-exposure, is associated with infection-related obstetric morbidity. Methods We conducted a multicentre prospective study in pregnancy based on a universal antenatal screening program for SARS-CoV-2 infection. Throughout Spain 45 hospitals tested all women at admission on delivery ward using polymerase-chain-reaction (PCR) for COVID-19 since late March 2020. The cohort of positive mothers and the concurrent sample of negative mothers was followed up until 6-weeks post-partum. Multivariable logistic regression analysis, adjusting for known confounding variables, determined the adjusted odds ratio (aOR) with 95% confidence intervals (95% CI) of the association of SARS-CoV-2 infection and obstetric outcomes. Main outcome measures: Preterm delivery (primary), premature rupture of membranes and neonatal intensive care unit admissions. Results Among 1009 screened pregnancies, 246 were SARS-CoV-2 positive. Compared to negative mothers (763 cases), SARS-CoV-2 infection increased the odds of preterm birth (34 vs 51, 13.8% vs 6.7%, aOR 2.12, 95% CI 1.32–3.36, p = 0.002); iatrogenic preterm delivery was more frequent in infected women (4.9% vs 1.3%, p = 0.001), while the occurrence of spontaneous preterm deliveries was statistically similar (6.1% vs 4.7%). An increased risk of premature rupture of membranes at term (39 vs 75, 15.8% vs 9.8%, aOR 1.70, 95% CI 1.11–2.57, p = 0.013) and neonatal intensive care unit admissions (23 vs 18, 9.3% vs 2.4%, aOR 4.62, 95% CI 2.43–8.94, p < 0.001) was also observed in positive mothers. Conclusion This prospective multicentre study demonstrated that pregnant women infected with SARS-CoV-2 have more infection-related obstetric morbidity. This hypothesis merits evaluation of a causal association in further research.