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Martinez-Perez O, Prats Rodriguez P, Muner Hernandez M, Encinas Pardilla MB, Perez Perez N, Vila Hernandez MR, Villalba Yarza A, Nieto Velasco O, Del Barrio Fernandez PG, Forcen Acebal L, Orizales Lago CM, Martinez Varea A, Muñoz Abellana B, Suarez Arana M, Fuentes Ricoy L, Martinez Diago C, Janeiro Freire MJ, Alférez Alvarez-Mallo M, Casanova Pedraz C, Alomar Mateu O, Lesmes Heredia C, Wizner de Alva JC, Bernardo Vega R, Macia Badia M, Alvarez Colomo C, Sanchez Muñoz A, Pratcorona Alicart L, Alonso Saiz R, Lopez Rodriguez M, Del Carmen Barbancho Lopez M, Meca Casbas MR, Vaquerizo Ruiz O, Moran Antolin E, Nuñez Valera MJ, Fernandez Fernandez C, Tubau Navarra A, Cano Garcia AM, Baena Luque C, Soldevilla Perez S, Gastaca Abasolo I, Adanez Garcia J, Teulon Gonzalez M, Puertas Prieto A, Ostos Serna R, Del Pilar Guadix Martin M, Catalina Coello M, Ferriols Perez E, Caño Aguilar A, De la Cruz Conty ML, Sainz Bueno JA. The association between SARS-CoV-2 infection and preterm delivery: a prospective study with a multivariable analysis. BMC Pregnancy Childbirth 2021; 21:273. [PMID: 33794829 PMCID: PMC8016158 DOI: 10.1186/s12884-021-03742-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 03/22/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND To determine whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, the cause of COVID-19 disease) exposure in pregnancy, compared to non-exposure, is associated with infection-related obstetric morbidity. METHODS We conducted a multicentre prospective study in pregnancy based on a universal antenatal screening program for SARS-CoV-2 infection. Throughout Spain 45 hospitals tested all women at admission on delivery ward using polymerase-chain-reaction (PCR) for COVID-19 since late March 2020. The cohort of positive mothers and the concurrent sample of negative mothers was followed up until 6-weeks post-partum. Multivariable logistic regression analysis, adjusting for known confounding variables, determined the adjusted odds ratio (aOR) with 95% confidence intervals (95% CI) of the association of SARS-CoV-2 infection and obstetric outcomes. MAIN OUTCOME MEASURES Preterm delivery (primary), premature rupture of membranes and neonatal intensive care unit admissions. RESULTS Among 1009 screened pregnancies, 246 were SARS-CoV-2 positive. Compared to negative mothers (763 cases), SARS-CoV-2 infection increased the odds of preterm birth (34 vs 51, 13.8% vs 6.7%, aOR 2.12, 95% CI 1.32-3.36, p = 0.002); iatrogenic preterm delivery was more frequent in infected women (4.9% vs 1.3%, p = 0.001), while the occurrence of spontaneous preterm deliveries was statistically similar (6.1% vs 4.7%). An increased risk of premature rupture of membranes at term (39 vs 75, 15.8% vs 9.8%, aOR 1.70, 95% CI 1.11-2.57, p = 0.013) and neonatal intensive care unit admissions (23 vs 18, 9.3% vs 2.4%, aOR 4.62, 95% CI 2.43-8.94, p < 0.001) was also observed in positive mothers. CONCLUSION This prospective multicentre study demonstrated that pregnant women infected with SARS-CoV-2 have more infection-related obstetric morbidity. This hypothesis merits evaluation of a causal association in further research.
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Affiliation(s)
- Oscar Martinez-Perez
- Department Gynaecology and Obstetrics, Puerta de Hierro University Hospital of Majadahonda, Majadahonda, Madrid, Spain.
| | - Pilar Prats Rodriguez
- Department Reproductive Medicine and Gynaecology, Obstetrics, Dexeus University Hospital, Barcelona, Catalunya, Spain
| | - Marta Muner Hernandez
- Department Gynaecology and Obstetrics, La Paz University Hospital. Madrid, Madrid, Spain
| | - Maria Begoña Encinas Pardilla
- Department Gynaecology and Obstetrics, Puerta de Hierro University Hospital of Majadahonda, Majadahonda, Madrid, Spain
| | - Noelia Perez Perez
- Department Gynaecology and Obstetrics, San Carlos University Hospital. Madrid, Madrid, Spain
| | | | - Ana Villalba Yarza
- Department Gynaecology and Obstetrics, University Hospital of Salamanca, Salamanca, Castilla y León, Spain
| | - Olga Nieto Velasco
- Department Obstetrics and Gynaecology, Quironsalud Madrid University Hospital. Madrid, Madrid, Spain
| | | | - Laura Forcen Acebal
- Department Gynaecology and Obstetrics, Doce de Octubre University Hospital, Comunidad de Madrid, Madrid, Spain
| | | | - Alicia Martinez Varea
- Department Gynaecology and Obstetrics, La Fe University and Polytechnic Hospital, Comunidad Valenciana, Valencia, Spain
| | - Begoña Muñoz Abellana
- Department Obstetrics and Gynaecology, Sant Joan de Reus University Hospital, Reus, Catalunya, Spain
| | - Maria Suarez Arana
- Department Gynaecology and Obstetrics, Regional University Hospital of Malaga, Malaga, Andalucía, Spain
| | - Laura Fuentes Ricoy
- Department Obstetrics and Gynaecology, University Hospital of Ferrol, Ferrol, A Coruña, Spain
| | - Clara Martinez Diago
- Department Gynaecology and Obstetrics, Doctor Josep Trueta University Hospital of Girona, Girona, Catalunya, Spain
| | | | | | - Cristina Casanova Pedraz
- Department Gynaecology and Obstetrics, University Hospital of Torrejon, Torrejon de Ardoz, Madrid, Spain
| | - Onofre Alomar Mateu
- Department Obstetrics and Gynaecology, Regional Hospital of Inca, Inca, Illes Balears, Spain
| | | | | | - Rut Bernardo Vega
- Department Gynaecology and Obstetrics, Rio Hortega University Hospital, Valladolid, Castilla y León, Spain
| | - Montserrat Macia Badia
- Department Gynaecology and Obstetrics, Arnau de Vilanova University Hospital, Lleida, Catalunya, Spain
| | - Cristina Alvarez Colomo
- Department Gynaecology and Obstetrics, Valladolid University Hospital, Valladolid, Castilla y León, Spain
| | - Antonio Sanchez Muñoz
- Department Gynaecology and Obstetrics, General University Hospital of Ciudad Real, Ciudad Real, Castilla-La Mancha, Spain
| | - Laia Pratcorona Alicart
- Department Obstetrics and Gynaecology, Germans Trias i Pujol University Hospital, Barcelona, Catalunya, Spain
| | - Ruben Alonso Saiz
- Department Gynaecology and Obstetrics, University Hospital of Burgos, Burgos, Castilla y León, Spain
| | - Monica Lopez Rodriguez
- Department Obstetrics and Gynaecology, Joan XXIII University Hospital of Tarragona, Tarragona, Catalunya, Spain
| | | | - Marta Ruth Meca Casbas
- Department Obstetrics and Gynaecology, Poniente Hospital of Almería, El Ejido, Andalucía, Spain
| | - Oscar Vaquerizo Ruiz
- Department Obstetrics and Gynaecology, University Hospital of Cabueñes, Gijon, Asturias, Spain
| | - Eva Moran Antolin
- Department Obstetrics and Gynaecology, Son Espases University Hospital, Palma de Mallorca, Illes Balears, Spain
| | - Maria Jose Nuñez Valera
- Department Obstetrics and Gynaecology, Virgen de la Luz Hospital, Cuenca, Castilla-La Mancha, Spain
| | - Camino Fernandez Fernandez
- Department Gynaecology and Obstetrics, University Assistance Complex of Leon, Leon, Castilla y Leon, Spain
| | - Albert Tubau Navarra
- Department Obstetrics and Gynaecology, Son Llatzer University Hospital, Palma de Mallorca, Illes Balears, Spain
| | | | - Carmen Baena Luque
- Department Gynaecology and Obstetrics, Infanta Margarita Hospital, Andalucía, Cabra, Spain
| | - Susana Soldevilla Perez
- Department Obstetrics and Gynaecology, University Hospital of Jerez de la Frontera, Jerez de la Frontera, Andalucía, Spain
| | - Irene Gastaca Abasolo
- Department Obstetrics and Gynaecology, Txagorritxu University Hospital of Araba, Vitoria-Gasteiz, País Vasco, Spain
| | - Jose Adanez Garcia
- Department Obstetrics and Gynaecology, Central University Hospital of Asturias, Oviedo, Asturias, Spain
| | - Maria Teulon Gonzalez
- Department Gynaecology and Obstetrics, University Hospital of Fuenlabrada, Fuenlabrada, Madrid, Spain
| | - Alberto Puertas Prieto
- Department Obstetrics and Gynaecology, Virgen de las Nieves University Hospital, Granada, Andalucía, Spain
| | - Rosa Ostos Serna
- Department Gynaecology and Obstetrics, Virgen de Valme University Hospital, Sevilla, Andalucía, Spain
| | | | - Monica Catalina Coello
- Department Gynaecology and Obstetrics, Virgen de la Concha Hospital, Zamora, Castilla y León, Spain
| | - Elena Ferriols Perez
- Department Gynaecology and Obstetrics, Parc de Salut Mar University Hospital, Barcelona, Catalunya, Spain
| | - Africa Caño Aguilar
- Department Obstetrics and Gynaecology, San Cecilio University Hospital of Granada, Granada, Andalucía, Spain
| | - Maria Luisa De la Cruz Conty
- Fundación de Investigación Biomédica, Puerta de Hierro University Hospital of Majadahonda, Majadahonda, Madrid, Spain
| | - Jose Antonio Sainz Bueno
- Department Gynaecology and Obstetrics, University of Seville, G. Chacon (Viamed Santa Angela de la Cruz Hospital), Sevilla, Andalucia, Spain
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Cruz-Lemini M, Ferriols Perez E, de la Cruz Conty ML, Caño Aguilar A, Encinas Pardilla MB, Prats Rodríguez P, Muner Hernando M, Forcen Acebal L, Pintado Recarte P, Medina Mallen MDC, Perez Perez N, Canet Rodriguez J, Villalba Yarza A, Nieto Velasco O, del Barrio Fernandez PG, Orizales Lago CM, Marcos Puig B, Muñoz Abellana B, Fuentes Ricoy L, Rodriguez Vicente A, Janeiro Freire MJ, Alferez Alvarez-Mallo M, Casanova Pedraz C, Alomar Mateu O, Lesmes Heredia C, Wizner de Alva JC, Posadas San Juan A, Macia Badia M, Alvarez Colomo C, Sanchez Muñoz A, Pratcorona Alicart L, Alonso Saiz R, Lopez Rodriguez M, Barbancho Lopez MC, Meca Casbas MR, Vaquerizo Ruiz O, Moran Antolin E, Nuñez Valera MJ, Fernandez Fernandez C, Tubau Navarra A, Cano Garcia AM, Soldevilla Perez S, Gattaca Abasolo I, Adanez Garcia J, Puertas Prieto A, Ostos Serna R, Guadix Martin MDP, Catalina Coello M, Espuelas Malon S, Sainz Bueno JA, Granell Escobar MR, Cruz Melguizo S, Martinez Perez O. Obstetric Outcomes of SARS-CoV-2 Infection in Asymptomatic Pregnant Women. Viruses 2021; 13:v13010112. [PMID: 33467629 PMCID: PMC7830626 DOI: 10.3390/v13010112] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/10/2021] [Accepted: 01/11/2021] [Indexed: 01/06/2023] Open
Abstract
Around two percent of asymptomatic women in labor test positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Spain. Families and care providers face childbirth with uncertainty. We determined if SARS-CoV-2 infection at delivery among asymptomatic mothers had different obstetric outcomes compared to negative patients. This was a multicenter prospective study based on universal antenatal screening for SARS-CoV-2 infection. A total of 42 hospitals tested women admitted for delivery using polymerase chain reaction, from March to May 2020. We included positive mothers and a sample of negative mothers asymptomatic throughout the antenatal period, with 6-week postpartum follow-up. Association between SARS-CoV-2 and obstetric outcomes was evaluated by multivariate logistic regression analyses. In total, 174 asymptomatic SARS-CoV-2 positive pregnancies were compared with 430 asymptomatic negative pregnancies. No differences were observed between both groups in key maternal and neonatal outcomes at delivery and follow-up, with the exception of prelabor rupture of membranes at term (adjusted odds ratio 1.88, 95% confidence interval 1.13-3.11; p = 0.015). Asymptomatic SARS-CoV-2 positive mothers have higher odds of prelabor rupture of membranes at term, without an increase in perinatal complications, compared to negative mothers. Pregnant women testing positive for SARS-CoV-2 at admission for delivery should be reassured by their healthcare workers in the absence of symptoms.
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Affiliation(s)
- Monica Cruz-Lemini
- Department of Gynecology and Obstetrics, Women and Perinatal Health Research Group, Biomedical Research Institute (IIB-Sant Pau), Santa Creu i Sant Pau University Hospital, 08025 Barcelona, Spain; (M.C.-L.); (M.d.C.M.M.)
| | - Elena Ferriols Perez
- Department of Gynecology and Obstetrics, Parc de Salut Mar University Hospital, 08003 Barcelona, Spain; (E.F.P.); (S.E.M.)
| | | | - Africa Caño Aguilar
- Department of Gynecology and Obstetrics, San Cecilio University Hospital of Granada, 18016 Granada, Spain;
| | - Maria Begoña Encinas Pardilla
- Department of Gynecology and Obstetrics, Puerta de Hierro University Hospital of Majadahonda, 28222 Madrid, Spain; (M.B.E.P.); (S.C.M.)
| | - Pilar Prats Rodríguez
- Department of Gynecology and Obstetrics, Dexeus University Hospital, 08028 Barcelona, Spain;
| | - Marta Muner Hernando
- Department of Gynecology and Obstetrics, La Paz University Hospital, 28046 Madrid, Spain;
| | - Laura Forcen Acebal
- Department of Gynecology and Obstetrics, Doce de Octubre University Hospital, 28041 Madrid, Spain;
| | - Pilar Pintado Recarte
- Department of Gynecology and Obstetrics, Gregorio Marañon University Hospital, 28007 Madrid, Spain;
| | - Maria del Carmen Medina Mallen
- Department of Gynecology and Obstetrics, Women and Perinatal Health Research Group, Biomedical Research Institute (IIB-Sant Pau), Santa Creu i Sant Pau University Hospital, 08025 Barcelona, Spain; (M.C.-L.); (M.d.C.M.M.)
| | - Noelia Perez Perez
- Department of Gynecology and Obstetrics, San Carlos University Hospital, 28040 Madrid, Spain;
| | - Judit Canet Rodriguez
- Department of Gynecology and Obstetrics, Santa Caterina Hospital, 17190 Girona, Spain;
| | - Ana Villalba Yarza
- Department of Gynecology and Obstetrics, University Hospital of Salamanca, 37007 Salamanca, Spain;
| | - Olga Nieto Velasco
- Department of Gynecology and Obstetrics, Quironsalud Madrid University Hospital, 28223 Madrid, Spain;
| | | | | | - Beatriz Marcos Puig
- Department of Gynecology and Obstetrics, La Fe University and Polytechnic Hospital, 46026 Valencia, Spain;
| | - Begoña Muñoz Abellana
- Department of Gynecology and Obstetrics, Sant Joan de Reus University Hospital, 43204 Tarragona, Spain;
| | - Laura Fuentes Ricoy
- Department of Gynecology and Obstetrics, University Hospital of Ferrol, 15405 A Coruña, Spain;
| | - Agueda Rodriguez Vicente
- Department of Gynecology and Obstetrics, Doctor Josep Trueta University Hospital of Girona, 17007 Girona, Spain;
| | - Maria Jesus Janeiro Freire
- Department of Gynecology and Obstetrics, University Hospital Complex of A Coruña, 15006 A Coruña, Spain;
| | | | | | - Onofre Alomar Mateu
- Department of Gynecology and Obstetrics, Regional Hospital of Inca, 07300 Illes Balears, Spain;
| | | | | | - Alma Posadas San Juan
- Department of Gynecology and Obstetrics, Rio Hortega University Hospital, 47012 Valladolid, Spain;
| | - Montserrat Macia Badia
- Department of Gynecology and Obstetrics, Arnau de Vilanova University Hospital, 25198 Lleida, Spain;
| | - Cristina Alvarez Colomo
- Department of Gynecology and Obstetrics, Valladolid University Clinical Hospital, 47003 Valladolid, Spain;
| | - Antonio Sanchez Muñoz
- Department of Gynecology and Obstetrics, General University Hospital of Ciudad Real, 13005 Ciudad Real, Spain;
| | - Laia Pratcorona Alicart
- Department of Gynecology and Obstetrics, Germans Trias i Pujol University Hospital, 08916 Barcelona, Spain;
| | - Ruben Alonso Saiz
- Department of Gynecology and Obstetrics, University Hospital of Burgos, 09006 Burgos, Spain;
| | - Monica Lopez Rodriguez
- Department of Gynecology and Obstetrics, Joan XXIII University Hospital of Tarragona, 43005 Tarragona, Spain;
| | | | - Marta Ruth Meca Casbas
- Department of Gynecology and Obstetrics, Poniente Hospital of Almeria, 04700 Almeria, Spain;
| | - Oscar Vaquerizo Ruiz
- Department of Gynecology and Obstetrics, University Hospital of Cabueñes, 33394 Asturias, Spain;
| | - Eva Moran Antolin
- Department of Gynecology and Obstetrics, Son Espases University Hospital, 07120 Illes Balears, Spain;
| | | | | | - Albert Tubau Navarra
- Department of Gynecology and Obstetrics, Son Llatzer University Hospital, 07198 Illes Balears, Spain;
| | | | - Susana Soldevilla Perez
- Department of Gynecology and Obstetrics, University Hospital of Jerez de la Frontera, 11407 Cadiz, Spain;
| | - Irene Gattaca Abasolo
- Department of Gynecology and Obstetrics, Txagorritxu University Hospital of Araba, 01009 Araba, Spain;
| | - Jose Adanez Garcia
- Department of Gynecology and Obstetrics, Central University Hospital of Asturias, 33011 Asturias, Spain;
| | - Alberto Puertas Prieto
- Department of Gynecology and Obstetrics, Virgen de las Nieves University Hospital, 18014 Granada, Spain;
| | - Rosa Ostos Serna
- Department of Gynecology and Obstetrics, Virgen de Valme University Hospital, 41014 Sevilla, Spain;
| | | | - Monica Catalina Coello
- Department of Gynecology and Obstetrics, Virgen de la Concha Hospital, 49022 Zamora, Spain;
| | - Silvia Espuelas Malon
- Department of Gynecology and Obstetrics, Parc de Salut Mar University Hospital, 08003 Barcelona, Spain; (E.F.P.); (S.E.M.)
| | - Jose Antonio Sainz Bueno
- Department of Gynecology and Obstetrics, G. Chacon (Viamed Santa Angela de la Cruz Hospital), 41014 Sevilla, Spain;
| | | | - Sara Cruz Melguizo
- Department of Gynecology and Obstetrics, Puerta de Hierro University Hospital of Majadahonda, 28222 Madrid, Spain; (M.B.E.P.); (S.C.M.)
| | - Oscar Martinez Perez
- Department of Gynecology and Obstetrics, Puerta de Hierro University Hospital of Majadahonda, 28222 Madrid, Spain; (M.B.E.P.); (S.C.M.)
- Correspondence:
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