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. 2021 Apr 1;21(1):273.
doi: 10.1186/s12884-021-03742-4.

The association between SARS-CoV-2 infection and preterm delivery: a prospective study with a multivariable analysis

Oscar Martinez-Perez  1 , Pilar Prats Rodriguez  2 , Marta Muner Hernandez  3 , Maria Begoña Encinas Pardilla  4 , Noelia Perez Perez  5 , Maria Rosa Vila Hernandez  6 , Ana Villalba Yarza  7 , Olga Nieto Velasco  8 , Pablo Guillermo Del Barrio Fernandez  9 , Laura Forcen Acebal  10 , Carmen Maria Orizales Lago  11 , Alicia Martinez Varea  12 , Begoña Muñoz Abellana  13 , Maria Suarez Arana  14 , Laura Fuentes Ricoy  15 , Clara Martinez Diago  16 , Maria Jesus Janeiro Freire  17 , Macarena Alférez Alvarez-Mallo  18 , Cristina Casanova Pedraz  19 , Onofre Alomar Mateu  20 , Cristina Lesmes Heredia  21 , Juan Carlos Wizner de Alva  22 , Rut Bernardo Vega  23 , Montserrat Macia Badia  24 , Cristina Alvarez Colomo  25 , Antonio Sanchez Muñoz  26 , Laia Pratcorona Alicart  27 , Ruben Alonso Saiz  28 , Monica Lopez Rodriguez  29 , Maria Del Carmen Barbancho Lopez  30 , Marta Ruth Meca Casbas  31 , Oscar Vaquerizo Ruiz  32 , Eva Moran Antolin  33 , Maria Jose Nuñez Valera  34 , Camino Fernandez Fernandez  35 , Albert Tubau Navarra  36 , Alejandra Maria Cano Garcia  37 , Carmen Baena Luque  38 , Susana Soldevilla Perez  39 , Irene Gastaca Abasolo  40 , Jose Adanez Garcia  41 , Maria Teulon Gonzalez  42 , Alberto Puertas Prieto  43 , Rosa Ostos Serna  44 , Maria Del Pilar Guadix Martin  45 , Monica Catalina Coello  46 , Elena Ferriols Perez  47 , Africa Caño Aguilar  48 , Maria Luisa De la Cruz Conty  49 , Jose Antonio Sainz Bueno  50 ; Spanish Obstetric Emergency Group
Affiliations

The association between SARS-CoV-2 infection and preterm delivery: a prospective study with a multivariable analysis

Oscar Martinez-Perez et al. BMC Pregnancy Childbirth. .

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.

Keywords: COVID-19; Coronavirus; Intensive care units, neonatal; Pregnancy; Premature birth; Premature rupture of membranes; SARS-CoV-2.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Study Flow chart
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