The following is a summary of “First- or second-trimester SARS-CoV-2 infection and subsequent pregnancy outcomes,” published in the FEBRUARY 2023 issue of Obstetrics and Gynecology by Hughes, et al.

Pregnant women who contract SARS-CoV-2 are at risk of experiencing negative pregnancy outcomes such as preterm birth and fetal death. However, it was unknown whether this risk was limited to the period of acute illness or if it persists later in pregnancy. Therefore, for a study, researchers sought to investigate whether the risk of SARS-CoV-2 infection during pregnancy remained after the acute phase.

The study was designed as a retrospective cohort analysis of pregnant patients with and without SARS-CoV-2 infection delivered at 17 hospitals across the United States between March 2020 and December 2020. 

Patients who tested positive for SARS-CoV-2 at or before 28 weeks of gestation and were subsequently hospitalized for delivery were compared with those who did not test positive during the same period. The study excluded deliveries occurring <20 weeks of gestation. The study examined several outcomes, including fetal or neonatal death, preterm birth at <37 and <34 weeks of gestation, hypertensive disorders of pregnancy (HDP), major congenital malformations, and size for gestational age of <5th or <10th percentiles at birth based on published standards. The collected data on HDP included both HDP and preeclampsia with severe features, both overall and with delivery at <37 weeks of gestation.

Between March 2020 and December 2020, 2,326 pregnant patients tested positive for SARS-CoV-2 and delivered at least 20 weeks of gestation. Among them, 402 patients (delivering 414 fetuses or neonates) had tested positive before 28 weeks of gestation and before their admission for delivery. These patients were compared with 11,705 patients who tested negative for SARS-CoV-2. In adjusted analyses, patients who tested positive for SARS-CoV-2 before 28 weeks of gestation had a subsequent increased risk of fetal or neonatal death (2.9% vs. 1.5%; adjusted relative risk, 1.97; 95% CI, 1.01–3.85), preterm birth at <37 weeks of gestation (19.6% vs. 13.8%; adjusted relative risk, 1.29; 95% CI, 1.02–1.63), and hypertensive disorders of pregnancy with delivery at <37 weeks of gestation (7.2% vs. 4.1%; adjusted relative risk, 1.74; 95% CI, 1.19–2.55). However, there was no difference in the rates of preterm birth at <34 weeks of gestation, any major congenital malformation, and size for gestational age of <5th or <10th percentiles. Furthermore, there was no significant difference in the rate of gestational hypertension overall or preeclampsia with severe features. 

Based on the findings, the study concluded that there is a modest increase (adjusted relative risk, 1.29–1.97) in the risk of adverse pregnancy outcomes after SARS-CoV-2 infection

Reference: ajog.org/article/S0002-9378(22)00641-X/fulltext