Six-Month Outcomes of Infants Born to People With SARS-CoV-2 in Pregnancy

Abstract

Objectives: To assess the 6-month incidence of laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, postnatal care, hospitalization, and mortality among infants born to people with laboratory-confirmed SARS-CoV-2 infection during pregnancy by timing of maternal infection.

Methods: Using a cohort of liveborn infants from pregnancies with SARS-CoV-2 infections in the year 2020 from 10 United States jurisdictions in the Surveillance for Emerging Threats to Mother and Babies Network, we describe weighted estimates of infant outcomes from birth through 6 months of age from electronic health and laboratory records.

Results: Of 6601 exposed infants with laboratory information through 6 months of age, 1.0% (95% confidence interval: 0.8-1.1) tested positive, 19.1% (17.5-20.6) tested negative, and 80.0% (78.4-81.6) were not known to be tested for SARS-CoV-2. Among those ≤14 days of age, SARS-CoV-2 infection occurred only with maternal infection ≤14 days before delivery. Of 3967 infants with medical record abstraction, breastmilk feeding initiation was lower when maternal infection occurred ≤14 days before delivery compared with >14 days (77.6% [72.5-82.6] versus 88.3% [84.7-92.0]). Six-month all-cause hospitalization was 4.1% (2.0-6.2). All-cause mortality was higher among infants born to people with infection ≤14 days (1.0% [0.4-1.6]) than >14 days (0.3% [0.1-0.5]) before delivery.

Conclusions: Results are reassuring, with low incidences of most health outcomes examined. Incidence of infant SARS-CoV-2, breastmilk feeding initiation, and all-cause mortality differed by timing of maternal infection. Strategies to prevent infections and support pregnant people with coronavirus disease 2019 may improve infant outcomes.

FIGURE 1

Infants born live to pregnant people with SARS-CoV-2 infection in pregnancy from January to December 2020: 10 SET-NET jurisdictions. ^a Jurisdictions include the city of Houston (TX), the territory of Puerto Rico, and the states of Kansas, Minnesota, Nebraska, New Jersey, New York (excluding New York City), South Carolina, Tennessee, and Washington. ^b Had both completed infant follow-up medical record abstraction and complete infant laboratory information. ^c Includes positive, negative, and equivocal results.

FIGURE 2

Survival curve representing infant laboratory-positive SARS-CoV-2 testing from birth to 6 months of age by timing of maternal SARS-CoV-2 infection during pregnancy among all infants, n = 640. The y-axis is scaled from 0 to 0.05 to show the small differences between each stratum. The proportion positive represents the first positive SARS-CoV-2 PCR testing from birth through 6 months of age, excluding 196 infants born <34 weeks’ gestation.