Annette K Regan1,2,3, Onyebuchi A Arah2,4,5, Deshayne B Fell6,7, Sheena G Sullivan2,8,9. 1. School of Nursing and Health Professions, University of San Francisco, Orange, California, USA. 2. Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, USA. 3. OptumLabs, Eden Prairie, Minnesota, USA. 4. Department of Statistics, College of Letters and Science, University of California Los Angeles, Los Angeles, California, USA. 5. Department of Public Health, Aarhus University, Aarhus, Denmark. 6. School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada. 7. Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada. 8. World Health Organization Collaborating Centre for Reference and Research on Influenza, Royal Melbourne Hospital, Melbourne, Victoria, Australia. 9. Department of Infectious Diseases, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia.
Abstract
BACKGROUND: Although severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been associated with increased risk of adverse perinatal health outcomes, few large-scale, community-based epidemiological studies have been conducted. METHODS: We conducted a national cohort study using deidentified administrative claims data for 78 283 pregnancies with estimated conception before 30 April 2020 and pregnancy end after 11 March 2020. We identified SARS-CoV-2 infections using diagnostic and laboratory testing data, and compared the risk of pregnancy outcomes using Cox proportional hazard models treating coronavirus disease 2019 (COVID-19) as a time-varying exposure and adjusting for baseline covariates. RESULTS: Of the pregnancies, 2655 (3.4%) had a documented SARS-CoV-2 infection. COVID-19 during pregnancy was not associated with risk of miscarriage, antepartum hemorrhage, or stillbirth, but was associated with 2-3 fold higher risk of induced abortion (adjusted hazard ratio [aHR], 2.60; 95% confidence interval [CI], 1.17-5.78), cesarean delivery (aHR, 1.99; 95% CI, 1.71-2.31), clinician-initiated preterm birth (aHR, 2.88; 95% CI, 1.93-4.30), spontaneous preterm birth (aHR, 1.79; 95% CI, 1.37-2.34), and fetal growth restriction (aHR, 2.04; 95% CI, 1.72-2.43). CONCLUSIONS: Prenatal SARS-CoV-2 infection was associated with increased risk of adverse pregnancy outcomes. Prevention could have fetal health benefits.
BACKGROUND: Although severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been associated with increased risk of adverse perinatal health outcomes, few large-scale, community-based epidemiological studies have been conducted. METHODS: We conducted a national cohort study using deidentified administrative claims data for 78 283 pregnancies with estimated conception before 30 April 2020 and pregnancy end after 11 March 2020. We identified SARS-CoV-2 infections using diagnostic and laboratory testing data, and compared the risk of pregnancy outcomes using Cox proportional hazard models treating coronavirus disease 2019 (COVID-19) as a time-varying exposure and adjusting for baseline covariates. RESULTS: Of the pregnancies, 2655 (3.4%) had a documented SARS-CoV-2 infection. COVID-19 during pregnancy was not associated with risk of miscarriage, antepartum hemorrhage, or stillbirth, but was associated with 2-3 fold higher risk of induced abortion (adjusted hazard ratio [aHR], 2.60; 95% confidence interval [CI], 1.17-5.78), cesarean delivery (aHR, 1.99; 95% CI, 1.71-2.31), clinician-initiated preterm birth (aHR, 2.88; 95% CI, 1.93-4.30), spontaneous preterm birth (aHR, 1.79; 95% CI, 1.37-2.34), and fetal growth restriction (aHR, 2.04; 95% CI, 1.72-2.43). CONCLUSIONS: Prenatal SARS-CoV-2 infection was associated with increased risk of adverse pregnancy outcomes. Prevention could have fetal health benefits.
Authors: Deshayne B Fell; Sheryll Dimanlig-Cruz; Annette K Regan; Siri E Håberg; Christopher A Gravel; Laura Oakley; Gillian D Alton; Eszter Török; Tavleen Dhinsa; Prakesh S Shah; Kumanan Wilson; Ann E Sprague; Darine El-Chaâr; Mark C Walker; Jon Barrett; Nannette Okun; Sarah A Buchan; Jeffrey C Kwong; Sarah E Wilson; Sandra I Dunn; Shannon E MacDonald; Shelley D Dougan Journal: BMJ Date: 2022-08-17