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. 2020 Dec;114(6):1242-1249.
doi: 10.1016/j.fertnstert.2020.09.153. Epub 2020 Sep 23.

Reproductive sequelae of parental severe illness before the pandemic: implications for the COVID-19 pandemic

Alex M Kasman  1 , Hriday P Bhambhvani  1 , Shufeng Li  1 , Chiyuan A Zhang  1 , David K Stevenson  2 , Gary M Shaw  2 , Julia F Simard  3 , Michael L Eisenberg  4
Affiliations

Reproductive sequelae of parental severe illness before the pandemic: implications for the COVID-19 pandemic

Alex M Kasman et al. Fertil Steril. 2020 Dec.

Abstract
in English, Spanish

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.

Secuelas reproductivas de enfermedad severa de los padres antes de la pandemia: implicaciones para la pandemia de COVID-19.

Objetivo: Investigar, con datos pre-COVID, si la exposición de los padres a infecciones sistémicas severas cerca del momento de la concepción está asociada a resultados gestacionales.

Diseño: Estudio retrospectivo de cohorte

Lugar: Estudio poblacional con cobertura de nacimientos en Estados Unidos entre 2009 y 2016.

Participantes: La base de datos de IBM MarketScan Research abarca datos de reclamos de salud reembolsados de pacientes hospitalizados y ambulatorios asegurados de forma privada a través de un programa de seguro médico patrocinado por el empleo. Nuestro análisis incluyó gestaciones de padres y madres emparejados.

Intervención(es): Exposición preconcepcional (0 a 6 meses antes de la concepción) de padres y madres a infección sistémica severa (ejemplo sepsis, hipotensión, fallo respiratorio, evaluación de cuidados críticos).

Medida(s) de resultado principal: Parto pretérmino (recién nacido vivo antes de 37 semanas) y pérdida gestacional.

Resultado(s): Un total de 999,866 gestaciones fueron registradas con 214,057 pérdidas gestacionales (21.4%) y 51,759 partos pretérmino (5.2%). Las madres que recibieron cuidados intensivos en el periodo preconcepcional presentaron un riesgo aumentado de pérdida gestacional, al igual que los padres. Las madres con sepsis preconcepcional tuvieron un riesgo mayor de nacimiento pretérmino y pérdida gestacional, y la exposición a sepsis en el padre se asoció a un riesgo aumentado de pérdida gestacional. Resultados similares se presentaron en hipotensión. Además, se observó una dosis-respuesta, tanto para los padres como para las madres, entre el tiempo en cuidados intensivos previo a la concepción y el riesgo de parto pretérmino y pérdida gestacional.

Conclusión(es): En una cohorte anterior al COVID-19, la infección sistémica grave en los padres antes de la concepción se asoció a un aumento de las posibilidades de parto pretérmino y pérdida gestacional cuando la concepción se produjo poco después de la enfermedad.

Keywords: COVID-19; critical illness; preconception health; pregnancy outcomes; severe illness.

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