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Reproductive sequelae of parental severe illness before the pandemic: implications for the COVID-19 pandemic
Alex M Kasman1, Hriday P Bhambhvani1, Shufeng Li1
1Department of Urology, Stanford University School of Medicine, Stanford, California.
Insights
Parental severe systemic infections before conception, such as sepsis or hypotension, increased risks for preterm birth and pregnancy loss in a pre-COVID-19 study. This association was observed when conception occurred shortly after the infection, affecting both mothers and fathers.
Area of Science:
- Reproductive Health
- Infectious Disease Epidemiology
- Perinatal Outcomes
Background:
- Severe systemic infections in parents may impact pregnancy outcomes.
- Understanding preconception infection risks is crucial for public health.
- Pre-COVID-19 data provides a baseline for evaluating infection impacts.
Purpose of the Study:
- To examine the association between parental severe systemic infections near conception and pregnancy outcomes.
- To investigate risks of preterm birth and pregnancy loss following parental infection.
Main Methods:
- Retrospective population-based cohort study using US healthcare claims data (2009-2016).
- Included nearly one million pregnancies with paired mother-father data.
- Analyzed preconception exposure (0-6 months prior) to severe systemic infections.
Main Results:
- Parental severe systemic infection (sepsis, hypotension) near conception was linked to increased risks of preterm birth and pregnancy loss.
- Maternal intensive care and sepsis were associated with higher risks of pregnancy loss and preterm birth.
- Paternal sepsis and hypotension exposure also correlated with increased pregnancy loss risk.
Conclusions:
- Preconception severe systemic infections in either parent are associated with adverse pregnancy outcomes.
- The timing of conception after parental infection is a critical factor.
- Findings highlight the importance of parental health prior to conception.
Objective:
To investigate, with pre-COVID-19 data, whether parental exposure to severe systemic infections near the time of conception is associated with pregnancy outcomes.
Design:
Retrospective cohort study.
Setting:
Population-based study covering births within the United States from 2009 to 2016.
Participants:
The IBM MarketScan Research database covers reimbursed health care claims data on inpatient and outpatient encounters that are privately insured through employment-sponsored health insurance. Our analytic sample included pregnancies to paired fathers and mothers.
Interventions(S):
Parental preconception exposure (0-6 months before conception) to severe systemic infection (e.g., sepsis, hypotension, respiratory failure, critical care evaluation).
Main Outcome Measure(S):
Preterm birth (i.e., live birth before 37 weeks) and pregnancy loss.
Result(S):
A total of 999,866 pregnancies were recorded with 214,057 pregnancy losses (21.4%) and 51,759 preterm births (5.2%). Mothers receiving intensive care in the preconception period had increased risk of pregnancy loss, as did fathers. Mothers with preconception sepsis had higher risk of preterm birth and pregnancy loss, and paternal sepsis exposure was associated with an increased risk of pregnancy loss. Similar results were noted for hypotension. In addition, a dose response was observed for both mothers and fathers between preconception time in intensive care and the risk of preterm birth and pregnancy loss.
Conclusion(S):
In a pre-COVID-19 cohort, parental preconception severe systemic infection was associated with increased odds of preterm birth and pregnancy loss when conception was soon after the illness.
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