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Am J Perinatol 2024; 41(02): 199-207
DOI: 10.1055/s-0042-1749666
Original Article

Association between SARS-CoV-2 Infection and Adverse Perinatal Outcomes in a Large Health Maintenance Organization

Darios Getahun 
1   Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
2   Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
,
Morgan R. Peltier
3   Department of Psychiatry, Jersey Shore University Medical Center, Neptune, New Jersey
,
Lawrence D. Lurvey
4   Department of Obstetrics and Gynecology, Southern California Permanente Medical Group, Pasadena, California
,
Jiaxiao M. Shi
1   Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
,
David Braun
1   Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
4   Department of Obstetrics and Gynecology, Southern California Permanente Medical Group, Pasadena, California
,
David A. Sacks
1   Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
5   Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California
,
Anthony E. Burgos
6   Department of Pediatrics, Kaiser Permanente Downey Medical Center, Downey, California
7   Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
,
Alex Fong
8   Department of Obstetrics and Gynecology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
,
Neha Trivedi
9   Department of Obstetrics and Gynecology, Kaiser Permanente San Diego Medical Center, San Diego, California
,
Lyn Yasumura
10   Department of Obstetrics and Gynecology, Kaiser Permanente Baldwin Park Medical Center, Baldwin Park, California
,
Kristi Reynolds
1   Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
2   Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
,
Marielle Nguyen
11   Department of Neonatal Medicine, Kaiser Permanente Orange County Medical Center, Anaheim, California
,
Marianna Volodarskiy
12   Kaiser Foundation Hospitals, Pasadena, California
,
Vicki Y. Chiu
1   Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
,
Adrian H. Lopez
8   Department of Obstetrics and Gynecology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
,
Michael J. Fassett
13   Department of Obstetrics and Gynecology, Kaiser Permanente West Los Angeles Medical Center, Los Angeles, California
› Author Affiliations Funding This work was supported by Kaiser Permanente Southern California Direct Community Benefit funds. The funding agency has no role in the design, conduct and report of this study. The authors wish to thank Ms. Sole Cardoso for her technical assistance with submitting the final manuscript.
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Abstract

Objective This study aimed to examine whether severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection during pregnancy is associated with increased odds of perinatal complications and viral transmission to the infant.

Study Design A retrospective cohort study of women who delivered at Kaiser Permanente Southern California hospitals (April 6, 2020–February 28, 2021) was performed using data extracted from electronic health records (EHRs). During this time polymerize chain reaction (PCR)-based tests for SARS-CoV-2 was universally offered to all pregnant women at labor and delivery admission, as well as earlier in the pregnancy, if they were displaying symptoms consistent with SARS-CoV-2 infection or a possible exposure to the virus. Adjusted odds ratio (aOR) was used to estimate the strength of associations between positive test results and adverse perinatal outcomes.

Results Of 35,123 women with a singleton pregnancy, 2,203 (6%) tested positive for SARS-CoV-2 infection with 596 (27%) testing positive during the first or second trimester and 1,607 (73%) during the third trimester. Women testing positive were younger than those who tested negative (29.7 [5.4] vs. 31.1 [5.3] years; mean [standard deviation (SD)]; p < .001). The SARS-CoV-2 infection tended to increase the odds of an abnormal fetal heart rate pattern (aOR: 1.10; 95% confidence interval [CI]: 1.00, 1.21; p = 0.058), spontaneous preterm birth (aOR: 1.28; 95% CI: 1.03, 1.58; p = 0.024), congenital anomalies (aOR: 1.69; 95% CI: 1.15, 2.50; p = 0.008), and maternal intensive care unit admission at delivery (aOR: 7.44; 95% CI: 4.06, 13.62; p < 0.001) but not preeclampsia/eclampsia (aOR: 1.14; 95% CI: 0.98, 1.33; p = 0.080). Eighteen (0.8%) neonates of mothers who tested positive also had a positive SARS-CoV-2 test after 24 hours of birth, but all were asymptomatic during the neonatal period.

Conclusion These findings suggest that prenatal SARS-CoV-2 infection increases the odds of some adverse perinatal outcomes. The likelihood of vertical transmission from the mother to the fetus was low (0.3%), suggesting that pregnancy complications resulting from SARS-CoV-2 infection pose more risk to the baby than transplacental viral transmission.

Key Points

  • SARS-CoV-2 infection is associated with increased odds of adverse perinatal outcomes.

  • The odds of specific adverse outcomes were greater when a mother was infected earlier in pregnancy.

  • The proportion of vertical transmission from mother to fetus was 0.3%

Keywords

COVID-19 - SARS-CoV-2 - infection - pregnancy - outcomes - pandemic


Publication History

Received: 15 June 2021

Accepted: 17 February 2022

Article published online:
23 June 2022

© 2022. Thieme. All rights reserved.

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