Comparing the Risk of Maternal Complications and Adverse Infant Outcomes Among Pregnancies With and Without
COVID
‐19 in the Sentinel System
Mayura U. Shinde, Austin Cosgrove, Maria E. Kempner, Jennifer G. Lyons, Andrew B. Petrone, Elizabeth Messenger‐Jones, Maria Lewis, Yueqin Zhao, Leyla Sahin, José J. Hernández‐Muñoz, Sengwee Toh, Wei Hua ABSTRACT
Background
SARS‐CoV‐2 infection during pregnancy may increase the risk of adverse pregnancy outcomes, but knowledge about the timing of COVID‐19 infection during pregnancy on these outcomes is limited.
Objectives
We implemented the CONSIGN protocol to examine the impact of COVID‐19 on pregnancy‐related complications and adverse infant outcomes.
Study Design
We identified eligible females with live‐birth deliveries who had a COVID‐19 diagnosis or a positive‐confirmed test for SARS‐CoV‐2. Pregnancies with COVID‐19 were propensity score (PS) matched 1:1 to pregnancies without COVID‐19 during the 6 months prior to or during pregnancy.
Results
From 2020 to 2023, we identified 69 901 pregnancies with COVID‐19 and 1:1 matched pregnancies without COVID‐19. Most pregnancies with COVID‐19 were diagnosed in the third trimester (49%, 33 979/69 901) and < 5% (1860/69 901) were classified as severe. Pregnancies with severe COVID‐19 in the first trimester had a higher rate of preterm delivery, and pregnancies with severe COVID‐19 in the second trimester had a higher rate of cesarean section compared to those without COVID‐19. No increased risk of adverse infant outcomes was observed among 22 865 linked mother‐infant pairs with COVID‐19 although a slightly increased risk of low birth weight was noted among pregnancies exposed to severe COVID‐19 in the third trimester.
Conclusion
Among nearly 70 000 live‐birth pregnancies with COVID‐19, severe COVID‐19 was associated with cesarean section and preterm delivery. No association with adverse infant outcomes was noted. Our study enabled assessment of the timing and severity of COVID‐19 on adverse pregnancy outcomes, although changing treatment and prevention recommendations might impact trends of these outcomes.