BackgroundFew large, cohort studies report data on individuals maternal, fetal, perinatal, and neonatal outcomes associated with SARS-CoV-2 infection MESHD
in pregnancy. We report outcomes from a collaboration formed early during the pandemic between the investigators of two registries, the UK and global Pregnancy and Neonatal outcomes in COVID-19 MESHD
(PAN-COVID) study and the US American Academy of Pediatrics Section on Neonatal Perinatal Medicine (AAP SONPM) National Perinatal COVID-19 MESHD
MethodsPAN-COVID (suspected or confirmed SARS-CoV-2 infection MESHD
at any stage in pregnancy) and the AAP HGNC
SONPM registry (positive maternal testing for SARS-CoV-2 from 14 days before delivery to 3 days after delivery) studies collected data on maternal, fetal, perinatal and neonatal outcomes. PAN-COVID results are presented as all inclusions and those with confirmed SARS-CoV-2 infection MESHD
ResultsWe report 4004 women in pregnancy affected by suspected or confirmed SARS-CoV-2 infection MESHD
(1606 from PAN-COVID and 2398 from the AAP SONPM) from January 1st 2020 to July 25th 2020 (PAN-COVID) and August 8th ( AAP HGNC
SONPM). For obstetric outcomes in PAN-COVID and AAP HGNC
SONPM, respectively, maternal death occurred in 0.5% and 0.17%, early neonatal death MESHD
in 0.2% and 0.3%, and stillbirth MESHD
in 0.50% and 0.65% of women. Delivery was pre-term (<37 weeks gestation) in 12% of all women in PAN-COVID, in 16.2% of those women with confirmed infection in PAN-COVID and 16.2% of women in AAP HGNC
SONPM. Very preterm delivery (< 27 weeks gestation) occurred in 0.6% in PAN-COVID and 0.7% in AAP HGNC
Neonatal SARS-CoV-2 infection MESHD SARS-CoV-2 infection MESHD
was reported in 0.8% of PAN-COVID all inclusions, 2.0% in PAN-COVID confirmed infections and 1.8% in the AAP HGNC
SONPM study; the proportions of babies tested were 9.5%, 20.7% and 87.2% respectively.
The proportion of SGA babies was 8.2% in PAN-COVID all inclusions, 9.7% in PAN-COVID confirmed infection and 9.6% in AAP HGNC
SONPM. Gestational age adjusted mean z-scores were -0.03 for PAN-COVID and -0.18 for AAP SONPM.
ConclusionsThe findings from the UK and US SARS-CoV-2 in pregnancy registries were remarkably concordant. Pre-term delivery affected a higher proportion of women in pregnancy than expected from historical and contemporaneous national data. The proportions of women affected by stillbirth MESHD
, small for gestational age infants and early neonatal death MESHD
were comparable to historical and contemporaneous UK and US data. Although maternal death MESHD
was uncommon, the proportion was higher than expected from UK and US population data, likely explained by under-ascertainment of women affected by milder and asymptomatic infection in pregnancy. The data presented support strong guidance for enhanced precautions to prevent SARS-COV-2 infection MESHD
in pregnancy, particularly in the context of increased risks of preterm delivery and maternal mortality, and for priority vaccination of women planning pregnancy.
What is known about SARS-COV-2 infection MESHD
in pregnancy and neonates?Cohort, population surveillance studies and living systematic reviews have included limited numbers of women in pregnancy affected by COVID-19 MESHD
and report that most women and infants had good outcomes.
What this study addsPreterm deliveries occurred in a high proportion of women participating in these two registries in comparison to contemporaneous and historical national data in the UK and US. The majority of preterm deliveries occurred late preterm (between 32+0 and 36+6 weeks gestation).
SARS-COV-2 infection MESHD
in pregnancy did not appear to be associated with a clinically significant effect on the rate of stillbirth, fetal growth, or neonatal outcomes.
Although maternal death MESHD
was uncommon, the proportion was higher than expected from UK and US population data, likely explained by under-ascertainment of women affected by milder and asymptomatic infection in pregnancy.