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Association of Maternal SARS-CoV-2 Infection in Pregnancy With Neonatal Outcomes

Norman, Mikael ; Navér, Lars ; Söderling, Jonas ; Ahlberg, Mia ; Hervius Askling, Helena ; Aronsson, Bernice ; Byström, Emma LU orcid ; Jonsson, Jerker ; Sengpiel, Verena and Ludvigsson, Jonas F , et al. (2021) In JAMA 325(20). p.2076-2086
Abstract

IMPORTANCE: The outcomes of newborn infants of women testing positive for SARS-CoV-2 in pregnancy is unclear.

OBJECTIVE: To evaluate neonatal outcomes in relation to maternal SARS-CoV-2 test positivity in pregnancy.

DESIGN, SETTING, AND PARTICIPANTS: Nationwide, prospective cohort study based on linkage of the Swedish Pregnancy Register, the Neonatal Quality Register, and the Register for Communicable Diseases. Ninety-two percent of all live births in Sweden between March 11, 2020, and January 31, 2021, were investigated for neonatal outcomes by March 8, 2021. Infants with malformations were excluded. Infants of women who tested positive for SARS-CoV-2 were matched, directly and using propensity scores, on maternal... (More)

IMPORTANCE: The outcomes of newborn infants of women testing positive for SARS-CoV-2 in pregnancy is unclear.

OBJECTIVE: To evaluate neonatal outcomes in relation to maternal SARS-CoV-2 test positivity in pregnancy.

DESIGN, SETTING, AND PARTICIPANTS: Nationwide, prospective cohort study based on linkage of the Swedish Pregnancy Register, the Neonatal Quality Register, and the Register for Communicable Diseases. Ninety-two percent of all live births in Sweden between March 11, 2020, and January 31, 2021, were investigated for neonatal outcomes by March 8, 2021. Infants with malformations were excluded. Infants of women who tested positive for SARS-CoV-2 were matched, directly and using propensity scores, on maternal characteristics with up to 4 comparator infants.

EXPOSURES: Maternal test positivity for SARS-CoV-2 in pregnancy.

MAIN OUTCOMES AND MEASURES: In-hospital mortality; neonatal resuscitation; admission for neonatal care; respiratory, circulatory, neurologic, infectious, gastrointestinal, metabolic, and hematologic disorders and their treatments; length of hospital stay; breastfeeding; and infant test positivity for SARS-CoV-2.

RESULTS: Of 88 159 infants (49.0% girls), 2323 (1.6%) were delivered by mothers who tested positive for SARS-CoV-2. The mean gestational age of infants of SARS-CoV-2-positive mothers was 39.2 (SD, 2.2) weeks vs 39.6 (SD, 1.8) weeks for comparator infants, and the proportions of preterm infants (gestational age <37 weeks) were 205/2323 (8.8%) among infants of SARS-CoV-2-positive mothers and 4719/85 836 (5.5%) among comparator infants. After matching on maternal characteristics, maternal SARS-CoV-2 test positivity was significantly associated with admission for neonatal care (11.7% vs 8.4%; odds ratio [OR], 1.47; 95% CI, 1.26-1.70) and with neonatal morbidities such as respiratory distress syndrome (1.2% vs 0.5%; OR, 2.40; 95% CI, 1.50-3.84), any neonatal respiratory disorder (2.8% vs 2.0%; OR, 1.42; 95% CI, 1.07-1.90), and hyperbilirubinemia (3.6% vs 2.5%; OR, 1.47; 95% CI, 1.13-1.90). Mortality (0.30% vs 0.12%; OR, 2.55; 95% CI, 0.99-6.57), breastfeeding rates at discharge (94.4% vs 95.1%; OR, 0.84; 95% CI, 0.67-1.05), and length of stay in neonatal care (median, 6 days in both groups; difference, 0 days; 95% CI, -2 to 7 days) did not differ significantly between the groups. Twenty-one infants (0.90%) of SARS-CoV-2-positive mothers tested positive for SARS-CoV-2 in the neonatal period; 12 did not have neonatal morbidity, 9 had diagnoses with unclear relation to SARS-CoV-2, and none had congenital pneumonia.

CONCLUSIONS AND RELEVANCE: In a nationwide cohort of infants in Sweden, maternal SARS-CoV-2 infection in pregnancy was significantly associated with small increases in some neonatal morbidities. Given the small numbers of events for many of the outcomes and the large number of statistical comparisons, the findings should be interpreted as exploratory.

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type
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publication status
published
subject
keywords
Adult, Breast Feeding/statistics & numerical data, COVID-19/complications, Female, Gestational Age, Hospital Mortality, Humans, Hyperbilirubinemia/epidemiology, Infant, Extremely Premature, Infant, Newborn, Infant, Newborn, Diseases/epidemiology, Infant, Premature, Length of Stay/statistics & numerical data, Live Birth/epidemiology, Male, Outcome Assessment, Health Care, Pregnancy, Pregnancy Complications, Infectious/diagnosis, Pregnancy Outcome, Prenatal Care/statistics & numerical data, Propensity Score, Prospective Studies, Respiratory Distress Syndrome, Newborn/epidemiology, Resuscitation/statistics & numerical data, SARS-CoV-2/isolation & purification, Sweden/epidemiology
in
JAMA
volume
325
issue
20
pages
2076 - 2086
publisher
American Medical Association
external identifiers
  • scopus:85105197657
  • pmid:33914014
ISSN
0098-7484
DOI
10.1001/jama.2021.5775
language
English
LU publication?
no
id
55c1c8da-8cd2-45c5-9ad9-905c0a04020e
date added to LUP
2024-04-29 11:30:31
date last changed
2024-05-14 05:17:54
@article{55c1c8da-8cd2-45c5-9ad9-905c0a04020e,
  abstract     = {{<p>IMPORTANCE: The outcomes of newborn infants of women testing positive for SARS-CoV-2 in pregnancy is unclear.</p><p>OBJECTIVE: To evaluate neonatal outcomes in relation to maternal SARS-CoV-2 test positivity in pregnancy.</p><p>DESIGN, SETTING, AND PARTICIPANTS: Nationwide, prospective cohort study based on linkage of the Swedish Pregnancy Register, the Neonatal Quality Register, and the Register for Communicable Diseases. Ninety-two percent of all live births in Sweden between March 11, 2020, and January 31, 2021, were investigated for neonatal outcomes by March 8, 2021. Infants with malformations were excluded. Infants of women who tested positive for SARS-CoV-2 were matched, directly and using propensity scores, on maternal characteristics with up to 4 comparator infants.</p><p>EXPOSURES: Maternal test positivity for SARS-CoV-2 in pregnancy.</p><p>MAIN OUTCOMES AND MEASURES: In-hospital mortality; neonatal resuscitation; admission for neonatal care; respiratory, circulatory, neurologic, infectious, gastrointestinal, metabolic, and hematologic disorders and their treatments; length of hospital stay; breastfeeding; and infant test positivity for SARS-CoV-2.</p><p>RESULTS: Of 88 159 infants (49.0% girls), 2323 (1.6%) were delivered by mothers who tested positive for SARS-CoV-2. The mean gestational age of infants of SARS-CoV-2-positive mothers was 39.2 (SD, 2.2) weeks vs 39.6 (SD, 1.8) weeks for comparator infants, and the proportions of preterm infants (gestational age &lt;37 weeks) were 205/2323 (8.8%) among infants of SARS-CoV-2-positive mothers and 4719/85 836 (5.5%) among comparator infants. After matching on maternal characteristics, maternal SARS-CoV-2 test positivity was significantly associated with admission for neonatal care (11.7% vs 8.4%; odds ratio [OR], 1.47; 95% CI, 1.26-1.70) and with neonatal morbidities such as respiratory distress syndrome (1.2% vs 0.5%; OR, 2.40; 95% CI, 1.50-3.84), any neonatal respiratory disorder (2.8% vs 2.0%; OR, 1.42; 95% CI, 1.07-1.90), and hyperbilirubinemia (3.6% vs 2.5%; OR, 1.47; 95% CI, 1.13-1.90). Mortality (0.30% vs 0.12%; OR, 2.55; 95% CI, 0.99-6.57), breastfeeding rates at discharge (94.4% vs 95.1%; OR, 0.84; 95% CI, 0.67-1.05), and length of stay in neonatal care (median, 6 days in both groups; difference, 0 days; 95% CI, -2 to 7 days) did not differ significantly between the groups. Twenty-one infants (0.90%) of SARS-CoV-2-positive mothers tested positive for SARS-CoV-2 in the neonatal period; 12 did not have neonatal morbidity, 9 had diagnoses with unclear relation to SARS-CoV-2, and none had congenital pneumonia.</p><p>CONCLUSIONS AND RELEVANCE: In a nationwide cohort of infants in Sweden, maternal SARS-CoV-2 infection in pregnancy was significantly associated with small increases in some neonatal morbidities. Given the small numbers of events for many of the outcomes and the large number of statistical comparisons, the findings should be interpreted as exploratory.</p>}},
  author       = {{Norman, Mikael and Navér, Lars and Söderling, Jonas and Ahlberg, Mia and Hervius Askling, Helena and Aronsson, Bernice and Byström, Emma and Jonsson, Jerker and Sengpiel, Verena and Ludvigsson, Jonas F and Håkansson, Stellan and Stephansson, Olof}},
  issn         = {{0098-7484}},
  keywords     = {{Adult; Breast Feeding/statistics & numerical data; COVID-19/complications; Female; Gestational Age; Hospital Mortality; Humans; Hyperbilirubinemia/epidemiology; Infant, Extremely Premature; Infant, Newborn; Infant, Newborn, Diseases/epidemiology; Infant, Premature; Length of Stay/statistics & numerical data; Live Birth/epidemiology; Male; Outcome Assessment, Health Care; Pregnancy; Pregnancy Complications, Infectious/diagnosis; Pregnancy Outcome; Prenatal Care/statistics & numerical data; Propensity Score; Prospective Studies; Respiratory Distress Syndrome, Newborn/epidemiology; Resuscitation/statistics & numerical data; SARS-CoV-2/isolation & purification; Sweden/epidemiology}},
  language     = {{eng}},
  month        = {{05}},
  number       = {{20}},
  pages        = {{2076--2086}},
  publisher    = {{American Medical Association}},
  series       = {{JAMA}},
  title        = {{Association of Maternal SARS-CoV-2 Infection in Pregnancy With Neonatal Outcomes}},
  url          = {{http://dx.doi.org/10.1001/jama.2021.5775}},
  doi          = {{10.1001/jama.2021.5775}},
  volume       = {{325}},
  year         = {{2021}},
}