Maternal and perinatal outcomes of pregnant women with SARS-CoV-2 infection at the time of birth in England: national cohort study

This English study (n=342,080 women, 3,527 with confirmed infection) found SARS-CoV-2 infection at time of birth was associated with an increased risk of foetal death (adjusted OR 2.21), preterm birth (2.17), preeclampsia/eclampsia (1.55), and emergency Cesarean delivery (1.63).

SPS commentary:

Increases in the risk of adverse neonatal outcome (aOR 1.45), need for specialist neonatal care (1.24) and prolonged neonatal admission following birth (1.61) were also observed for infants with mothers with laboratory-confirmed SARS-CoV-2 infection. However, there were no differences for the first two outcomes when the analysis was restricted to pregnancies delivered at term.

The authors say their findings are consistent with a recent international case-control study, however the overall numbers of foetal deaths are too small to impact the overall national rate of stillbirth in the UK, and it is therefore important to carefully contextualise these findings when counselling pregnant women. However, this finding should prompt reflection on the treatment of pregnant women with SARS-CoV-2, and may change the risk-benefit analysis for vaccination for women earlier in pregnancy.

They go on to acknowledge the limitations of their study, including lack of information on the severity of Covid-19 illness or maternal BMI. It is possible that the observed associations could have been partially accounted for by an imbalance in these factors between groups.

American Journal of Obstetrics and Gynecology