Effects of prenatal exposure to maternal COVID-19 and perinatal care on neonatal outcome: results from the INTERCOVID Multinational Cohort Study - 23/08/22
, Daniel Oros, PhD b, Robert B. Gunier, PhD c, Sonia Deantoni, MD d, e, f, Stephen Rauch, MPH c, Roberto Casale, PhD g, Ricardo Nieto, MD h, Enrico Bertino, MD i, Albertina Rego, PhD j, Camilla Menis, MD k, Michael G. Gravett, MD l, Massimo Candiani, MD m, Philippe Deruelle, PhD n, Perla K. García-May, MD o, Mohak Mhatre, MD p, Mustapha Ado Usman, MBBS q, Sherief Abd-Elsalam, PhD r, Saturday Etuk, MD s, Raffaele Napolitano, PhD t, u, Becky Liu, MBBS v, Federico Prefumo, PhD w, x, Valeria Savasi, PhD y, Marynéa Silva Do Vale, MD z, Eric Baafi, MD aa, Shabina Ariff, FCPS bb, Nerea Maiz, PhD cc, Muhammad Baffah Aminu, MD dd, Jorge Arturo Cardona-Perez, MD ee, Rachel Craik, BSc d, Gabriela Tavchioska, MSc ff, Babagana Bako, MD gg, Caroline Benski, MD hh, Fatimah Hassan-Hanga, MSc ii, jj, Mónica Savorani, MD kk, Loïc Sentilhes, PhD ll, Maria Carola Capelli, MD mm, Ken Takahashi, PhD nn, Carmen Vecchiarelli, MD oo, Satoru Ikenoue, MD pp, Ramachandran Thiruvengadam, MD qq, Constanza P. Soto Conti, MD h, Irene Cetin, MD rr, Vincent Bizor Nachinab, MD ss, Ernawati Ernawati, PhD tt, uu, Eduardo A. Duro, MD vv, ww, Alexey Kholin, MD xx, Jagjit Singh Teji, MD yy, Sarah Rae Easter, MD zz, Laurent J. Salomon, PhD aaa, Adejumoke Idowu Ayede, FMCPaed bbb, ccc, Rosa Maria Cerbo, MD ddd, Josephine Agyeman-Duah, MSc eee, Paola Roggero, MD k, fff, Brenda Eskenazi, PhD c, Ana Langer, MD ggg, Zulfiqar A. Bhutta, PhD hhh, Stephen H. Kennedy, MD d, e, Aris T. Papageorghiou, MD d, e, v, Jose Villar, MD d, e
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Abstract |
Background |
The effect of COVID-19 in pregnancy on maternal outcomes and its association with preeclampsia and gestational diabetes mellitus have been reported; however, a detailed understanding of the effects of maternal positivity, delivery mode, and perinatal practices on fetal and neonatal outcomes is urgently needed.
Objective |
To evaluate the impact of COVID-19 on fetal and neonatal outcomes and the role of mode of delivery, breastfeeding, and early neonatal care practices on the risk of mother-to-child transmission.
Study Design |
In this cohort study that took place from March 2020 to March 2021, involving 43 institutions in 18 countries, 2 unmatched, consecutive, unexposed women were concomitantly enrolled immediately after each infected woman was identified, at any stage of pregnancy or delivery, and at the same level of care to minimize bias. Women and neonates were followed up until hospital discharge. COVID-19 in pregnancy was determined by laboratory confirmation and/or radiological pulmonary findings or ≥2 predefined COVID-19 symptoms. The outcome measures were indices of neonatal and perinatal morbidity and mortality, neonatal positivity and its correlation with mode of delivery, breastfeeding, and hospital neonatal care practices.
Results |
A total of 586 neonates born to women with COVID-19 diagnosis and 1535 neonates born to women without COVID-19 diagnosis were enrolled. Women with COVID-19 diagnosis had a higher rate of cesarean delivery (52.8% vs 38.5% for those without COVID-19 diagnosis, P<.01) and pregnancy-related complications, such as hypertensive disorders of pregnancy and fetal distress (all with P<.001), than women without COVID-19 diagnosis. Maternal diagnosis of COVID-19 carried an increased rate of preterm birth (P≤.001) and lower neonatal weight (P≤.001), length, and head circumference at birth. In mothers with COVID-19 diagnosis, the length of in utero exposure was significantly correlated to the risk of the neonate testing positive (odds ratio, 4.5; 95% confidence interval, 2.2–9.4 for length of in utero exposure >14 days). Among neonates born to mothers with COVID-19 diagnosis, birth via cesarean delivery was a risk factor for testing positive for COVID-19 (odds ratio, 2.4; 95% confidence interval, 1.2–4.7), even when severity of maternal conditions was considered and after multivariable logistic analysis. In the subgroup of neonates born to women with COVID-19 diagnosis, the outcomes worsened when the neonate also tested positive, with higher rates of neonatal intensive care unit admission, fever, gastrointestinal and respiratory symptoms, and death, even after adjusting for prematurity.
Breastfeeding by mothers with COVID-19 diagnosis and hospital neonatal care practices, including immediate skin-to-skin contact and rooming-in, were not associated with an increased risk of newborn positivity.
Conclusion |
In this multinational cohort study, COVID-19 in pregnancy was associated with increased maternal and neonatal complications. Cesarean delivery was significantly associated with newborn COVID-19 diagnosis. Vaginal delivery should be considered the safest mode of delivery if obstetrical and health conditions allow it. Mother-to-child skin-to-skin contact, rooming-in, and direct breastfeeding were not risk factors for newborn COVID-19 diagnosis, thus well-established best practices can be continued among women with COVID-19 diagnosis.
Le texte complet de cet article est disponible en PDF.Key words : birthweight, breastfeeding, cesarean delivery, cohort, COVID-19, feeding problems, hospital stay, infections, intrauterine growth restriction, morbidity, mortality, multicenter study, neonatal intensive care unit admission, neonatal outcomes, neonate, neurologic outcome, newborn, perinatal practices, preeclampsia, pregnancy, preterm birth, respiratory support, respiratory symptoms, risk ratio, rooming-in, SARS-CoV-2, SARS-CoV-2 exposure, skin-to-skin, small for gestational age
Plan
| A.T.P. and J.V. contributed equally to this study. |
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| A.T.P. is supported by the Oxford Partnership Comprehensive Biomedical Research Centre with funding from the National Institute for Health Research Biomedical Research Centre. All other authors declare no conflict of interest. |
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| The study was supported by the COVID-19 Research Response Fund from the University of Oxford (reference 0009083). The investigators acknowledge the philanthropic support of the donors to the University of Oxford’s COVID-19 Research Response Fund. The funding organization had no involvement in the design and conduct of the study; collection, management, analysis, and interpretation of data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The views expressed herein are those of the authors and not necessarily those of the National Health Service, the National Institute for Health and Care Research, the Department of Health, or any of the other funders. |
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| Cite this article as: Giuliani F, Oros D, Gunier RB, et al. Effects of prenatal exposure to maternal COVID-19 and perinatal care on neonatal outcome: results from the INTERCOVID Multinational Cohort Study. Am J Obstet Gynecol 2022;227:488.e1-17. |
Vol 227 - N° 3
P. 488.e1-488.e17 - septembre 2022 Retour au numéro
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