Journal article
Risk for stillbirth among pregnant individuals with SARS-CoV-2 infection varied by gestational age
American journal of obstetrics and gynecology, Vol.229(3), pp.288.e1-288.e13
09/2023
DOI: 10.1016/j.ajog.2023.02.022
PMCID: PMC9970919
PMID: 36858096
Abstract
Despite previous research findings on higher risks of stillbirth among pregnant individuals with SARS-CoV-2 infection, it is unclear whether the gestational timing of viral infection modulates this risk.
This study aimed to examine the association between timing of SARS-CoV-2 infection during pregnancy and risk of stillbirth.
This retrospective cohort study used multilevel logistic regression analyses of nationwide electronic health records in the United States. Data were from 75 healthcare systems and institutes across 50 states. A total of 191,403 pregnancies of 190,738 individuals of reproductive age (15-49 years) who had childbirth between March 1, 2020 and May 31, 2021 were identified and included. The main outcome was stillbirth at ≥20 weeks of gestation. Exposures were the timing of SARS-CoV-2 infection: early pregnancy (<20 weeks), midpregnancy (21-27 weeks), the third trimester (28-43 weeks), any time before delivery, and never infected (reference).
We identified 2342 (1.3%) pregnancies with COVID-19 in early pregnancy, 2075 (1.2%) in midpregnancy, and 12,697 (6.9%) in the third trimester. After adjusting for maternal and clinical characteristics, increased odds of stillbirth were observed among pregnant individuals with SARS-CoV-2 infection only in early pregnancy (odds ratio, 1.75, 95% confidence interval, 1.25-2.46) and midpregnancy (odds ratio, 2.09; 95% confidence interval, 1.49-2.93), as opposed to pregnant individuals who were never infected. Older age, Black race, hypertension, acute respiratory distress syndrome or acute respiratory failure, and placental abruption were found to be consistently associated with stillbirth across different trimesters.
Increased risk of stillbirth was associated with COVID-19 only when pregnant individuals were infected during early and midpregnancy, and not at any time before the delivery or during the third trimester, suggesting the potential vulnerability of the fetus to SARS-CoV-2 infection in early pregnancy. Our findings underscore the importance of proactive COVID-19 prevention and timely medical intervention for individuals infected with SARS-CoV-2 during early and midpregnancy.
Details
- Title: Subtitle
- Risk for stillbirth among pregnant individuals with SARS-CoV-2 infection varied by gestational age
- Creators
- Tianchu Lyu - University of South CarolinaChen Liang - University of South CarolinaJihong Liu - University of South CarolinaPeiyin Hung - University of South CarolinaJiajia Zhang - University of South CarolinaBerry Campbell - University of South CarolinaNadia Ghumman - University of South CarolinaBankole Olatosi - University of South CarolinaNeset Hikmet - University of South CarolinaManting Zhang - Nanjing Medical UniversityHonggang Yi - Nanjing Medical UniversityXiaoming Li - University of South CarolinaNational COVID Cohort Collaborative Consortium
- Contributors
- Charisse R Madlock-Brown (Contributor) - University of Iowa, Nursing
- Resource Type
- Journal article
- Publication Details
- American journal of obstetrics and gynecology, Vol.229(3), pp.288.e1-288.e13
- DOI
- 10.1016/j.ajog.2023.02.022
- PMID
- 36858096
- PMCID
- PMC9970919
- NLM abbreviation
- Am J Obstet Gynecol
- ISSN
- 0002-9378
- eISSN
- 1097-6868
- Grant note
- U54 GM115458 / NIGMS NIH HHS R01 AI127203 / NIAID NIH HHS
- Language
- English
- Electronic publication date
- 02/28/2023
- Date published
- 09/2023
- Academic Unit
- Nursing
- Record Identifier
- 9984446984702771
Metrics
13 Record Views