SARS-CoV-2 infection in early first-trimester miscarriages: a prospective observational study

Area of Science:

• Obstetrics and Gynecology
• Infectious Diseases
• Reproductive Health

Background:

• The potential impact of SARS-CoV-2 infection on early pregnancy outcomes, specifically first-trimester miscarriage, remains an area of investigation.
• Understanding this association is crucial for clinical management and public health guidance during the pandemic.

Purpose of the Study:

• To investigate the association between SARS-CoV-2 infection and the risk of first-trimester miscarriage.
• To compare the incidence of SARS-CoV-2 infection in women experiencing miscarriage versus those delivering.

Main Methods:

• A multicenter prospective study involving seven Spanish hospitals with universal SARS-CoV-2 PCR screening for miscarriages and deliveries.
• Comparative analysis using mixed-effects Poisson regression to compare infection rates between miscarriage and delivery cohorts.
• Univariable analyses to compare characteristics of SARS-CoV-2 positive and negative women who miscarried.

Main Results:

• Out of 301 miscarriages, 3.7% were associated with SARS-CoV-2 infection. Among 1936 deliveries, 2.3% were SARS-CoV-2 positive.
• No significant difference in SARS-CoV-2 infection incidence was found between women with miscarriages and those delivering (P = 0.233).
• Women with SARS-CoV-2 infection experiencing miscarriage had a higher rate of inevitable miscarriage (36.4% vs. 16.5%, P = 0.004) and required more surgical management (27.3% vs. 8.2%, P = 0.036).

Conclusions:

• No association was observed between SARS-CoV-2 infection and the overall risk of first-trimester miscarriage.
• A higher frequency of inevitable miscarriage was noted among SARS-CoV-2 infected women compared to non-infected women.
• These findings suggest that while SARS-CoV-2 may not increase miscarriage risk, it could influence the type and management of miscarriage.