TY - JOUR
T1 - Risk Factors Associated with Adverse Fetal Outcomes in Pregnancies Affected by Coronavirus Disease 2019 (COVID-19)
T2 - A Secondary Analysis of the WAPM study on COVID-19
AU - Di Mascio, Daniele
AU - Sen, Cihat
AU - Saccone, Gabriele
AU - Galindo, Alberto
AU - Grünebaum, Amos
AU - Yoshimatsu, Jun
AU - Stanojevic, Milan
AU - Kurjak, Aslm
AU - Chervenak, Frank
AU - Rodríguez Suárez, María José
AU - Gambacorti-Passerini, Zita Maria
AU - Baz, María De Los Angeles Anaya
AU - Aguilar Galán, Esther Vanessa
AU - López, Yolanda Cuñarro
AU - De León Luis, Juan Antonio
AU - Hernández, Ignacio Cueto
AU - Herraiz, Ignacio
AU - Villalain, Cecilia
AU - Venturella, Roberta
AU - Rizzo, Giuseppe
AU - Mappa, Ilenia
AU - Gerosolima, Giovanni
AU - Hellmeyer, Lars
AU - Königbauer, Josefine
AU - Ameli, Giada
AU - Frusca, Tiziana
AU - Volpe, Nicola
AU - Luca Schera, Giovanni Battista
AU - Fieni, Stefania
AU - Esposito, Eutalia
AU - Simonazzi, Giuliana
AU - Di Donna, Gaetana
AU - Youssef, Aly
AU - Della Gatta, Anna Nunzia
AU - Di Donna, Mariano Catello
AU - Chiantera, Vito
AU - Buono, Natalina
AU - Sozzi, Giulio
AU - Greco, Pantaleo
AU - Morano, Danila
AU - Bianchi, Beatrice
AU - Lombana Marino, Maria Giulia
AU - Laraud, Federica
AU - Ramone, Arianna
AU - Cagnacci, Angelo
AU - Ferrero, Simone
AU - Lanzone, Antonio
AU - Costa, Elena
AU - Carbone, Ilma Floriana
AU - Scambia, Giovanni
PY - 2020
Y1 - 2020
N2 - To evaluate the strength of association between maternal and pregnancy characteristics and the risk of adverse perinatal outcomes in pregnancies with laboratory confirmed COVID-19. Secondary analysis of a multinational, cohort study on all consecutive pregnant women with laboratory-confirmed COVID-19 from February 1, 2020 to April 30, 2020 from 73 centers from 22 different countries. A confirmed case of COVID-19 was defined as a positive result on real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay of nasal and pharyngeal swab specimens. The primary outcome was a composite adverse fetal outcome, defined as the presence of either abortion (pregnancy loss before 22 weeks of gestations), stillbirth (intrauterine fetal death after 22 weeks of gestation), neonatal death (death of a live-born infant within the first 28 days of life), and perinatal death (either stillbirth or neonatal death). Logistic regression analysis was performed to evaluate parameters independently associated with the primary outcome. Logistic regression was reported as odds ratio (OR) with 95% confidence interval (CI). Mean gestational age at diagnosis was 30.6±9.5 weeks, with 8.0% of women being diagnosed in the first, 22.2% in the second and 69.8% in the third trimester of pregnancy. There were six miscarriage (2.3%), six intrauterine device (IUD) (2.3) and 5 (2.0%) neonatal deaths, with an overall rate of perinatal death of 4.2% (11/265), thus resulting into 17 cases experiencing and 226 not experiencing composite adverse fetal outcome. Neither stillbirths nor neonatal deaths had congenital anomalies found at antenatal or postnatal evaluation. Furthermore, none of the cases experiencing IUD had signs of impending demise at arterial or venous Doppler. Neonatal deaths were all considered as prematurity-related adverse events. Of the 250 live-born neonates, one (0.4%) was found positive at RT-PCR pharyngeal swabs performed after delivery. The mother was tested positive during the third trimester of pregnancy. The newborn was asymptomatic and had negative RT-PCR test after 14 days of life. At logistic regression analysis, gestational age at diagnosis (OR: 0.85, 95% CI 0.8-0.9 per week increase; p<0.001), birthweight (OR: 1.17, 95% CI 1.09-1.12.7 per 100 g decrease; p=0.012) and maternal ventilatory support, including either need for oxygen or CPAP (OR: 4.12, 95% CI 2.3-7.9; p=0.001) were independently associated with composite adverse fetal outcome. Early gestational age at infection, maternal ventilatory supports and low birthweight are the main determinants of adverse perinatal outcomes in fetuses with maternal COVID-19 infection. Conversely, the risk of vertical transmission seems negligible.
AB - To evaluate the strength of association between maternal and pregnancy characteristics and the risk of adverse perinatal outcomes in pregnancies with laboratory confirmed COVID-19. Secondary analysis of a multinational, cohort study on all consecutive pregnant women with laboratory-confirmed COVID-19 from February 1, 2020 to April 30, 2020 from 73 centers from 22 different countries. A confirmed case of COVID-19 was defined as a positive result on real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay of nasal and pharyngeal swab specimens. The primary outcome was a composite adverse fetal outcome, defined as the presence of either abortion (pregnancy loss before 22 weeks of gestations), stillbirth (intrauterine fetal death after 22 weeks of gestation), neonatal death (death of a live-born infant within the first 28 days of life), and perinatal death (either stillbirth or neonatal death). Logistic regression analysis was performed to evaluate parameters independently associated with the primary outcome. Logistic regression was reported as odds ratio (OR) with 95% confidence interval (CI). Mean gestational age at diagnosis was 30.6±9.5 weeks, with 8.0% of women being diagnosed in the first, 22.2% in the second and 69.8% in the third trimester of pregnancy. There were six miscarriage (2.3%), six intrauterine device (IUD) (2.3) and 5 (2.0%) neonatal deaths, with an overall rate of perinatal death of 4.2% (11/265), thus resulting into 17 cases experiencing and 226 not experiencing composite adverse fetal outcome. Neither stillbirths nor neonatal deaths had congenital anomalies found at antenatal or postnatal evaluation. Furthermore, none of the cases experiencing IUD had signs of impending demise at arterial or venous Doppler. Neonatal deaths were all considered as prematurity-related adverse events. Of the 250 live-born neonates, one (0.4%) was found positive at RT-PCR pharyngeal swabs performed after delivery. The mother was tested positive during the third trimester of pregnancy. The newborn was asymptomatic and had negative RT-PCR test after 14 days of life. At logistic regression analysis, gestational age at diagnosis (OR: 0.85, 95% CI 0.8-0.9 per week increase; p<0.001), birthweight (OR: 1.17, 95% CI 1.09-1.12.7 per 100 g decrease; p=0.012) and maternal ventilatory support, including either need for oxygen or CPAP (OR: 4.12, 95% CI 2.3-7.9; p=0.001) were independently associated with composite adverse fetal outcome. Early gestational age at infection, maternal ventilatory supports and low birthweight are the main determinants of adverse perinatal outcomes in fetuses with maternal COVID-19 infection. Conversely, the risk of vertical transmission seems negligible.
KW - Coronavirus
KW - perinatal morbidity
KW - perinatal mortality
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U2 - 10.1515/jpm-2020-0355
DO - 10.1515/jpm-2020-0355
M3 - Article
C2 - 32975205
AN - SCOPUS:85092655173
VL - 48
SP - 950
EP - 958
JO - Journal of Perinatal Medicine
JF - Journal of Perinatal Medicine
SN - 0300-5577
IS - 9
ER -