Maternal SARS-COV-2 infection and prematurity: the Southern Michigan COVID-19 collaborative
Ray Bahado-Singh1, Adi L Tarca2,3,4, Yasmin G Hasbini5
1Department of Obstetrics and Gynecology, William Beaumont Hospital - Royal Oak, Royal Oak, MI, USA.
Summary
COVID-19 infection increases preterm birth risk, particularly for early and medically indicated deliveries. Disease severity and symptoms significantly elevate the likelihood of premature birth in pregnant individuals.
Area of Science:
- Obstetrics and Gynecology
- Infectious Diseases
- Epidemiology
Background:
- The association between COVID-19 and preterm birth requires further investigation due to confounding factors in previous studies.
- Understanding COVID-19's impact on various preterm birth subcategories is crucial for maternal and neonatal health outcomes.
Purpose of the Study:
- To determine the impact of COVID-19 on overall preterm birth (PTB) rates.
- To analyze the effect of COVID-19 on specific PTB categories: early prematurity, spontaneous PTB, medically indicated PTB, and preterm labor (PTL).
- To assess the influence of confounders like COVID-19 risk factors, pre-existing PTB risks, symptomatology, and disease severity on prematurity rates.
Main Methods:
- A retrospective cohort study involving pregnant women from March to October 2020 across 14 Michigan obstetric centers.
- Cases were pregnant women diagnosed with COVID-19, matched with uninfected controls delivering in the same unit within 30 days.
- Outcomes included frequencies of overall and subcategorized preterm birth, with extensive control for potential confounders.
Main Results:
- Prematurity rates were 8.9% in controls, 9.4% in asymptomatic COVID-19 cases, 26.5% in symptomatic cases, and 58.8% in ICU-admitted cases.
- COVID-19 cases showed increased risk for overall prematurity (aRR=1.62) and early prematurity (<34 weeks, aRR=1.8).
- Medically indicated preterm birth, linked to preeclampsia (aRR=2.46) or other conditions (aRR=2.32), primarily drove the increased risk. Symptomatic cases also had higher risks for preterm labor and spontaneous preterm birth due to premature rupture of membranes.
Conclusions:
- COVID-19 is an independent risk factor for preterm birth.
- Medically indicated delivery, particularly due to preeclampsia, is the main driver of increased preterm birth rates in COVID-19 positive pregnancies.
- Symptomatic status and disease severity are significant factors influencing preterm birth outcomes in COVID-19 patients.
Keywords:
Coronavirus disease 2019 (COVID-19)SARS-CoV-2preeclampsiapregnancypremature laborpreterm birthpreterm prelabor rupture of membranes
