Maternal and perinatal outcomes following pre-Delta, Delta, and Omicron SARS-CoV-2 variants infection among unvaccinated pregnant women in France and Switzerland: a prospective cohort study using the COVI-PREG registry

Guillaume Favre¹, Emeline Maisonneuve^{1

2}, Léo Pomar^{1

3}, Charlotte Daire¹, Christophe Poncelet⁴, Thibaud Quibel⁵, Cécile Monod⁶, Begoña Martinez de Tejada⁷, Leonhard Schäffer⁸, Andrea Papadia⁹, Anda Petronela Radan¹⁰, Monya Todesco-Bernasconi¹¹, Yves Ville¹², Cora Alexandra Voekt¹³, Béatrice Eggel-Hort¹⁴, Romina Capoccia-Brugger¹⁵, Silke Johann¹⁶, Claudia Grawe¹⁷, Sophie Defert¹⁸, Nicolas Mottet¹⁹, Christian R Kahlert²⁰, Charles Garabedian²¹, Loïc Sentilhes²², Brigitte Weber²³, Steffi Leu²⁴, Dirk Bassler²⁵, Karine Lepigeon¹, Ursula Winterfeld²⁶, Alice Panchaud^{2

27}, David Baud¹; French and Swiss COVI-PREG group

Collaborators, Affiliations

Collaborators

French and Swiss COVI-PREG group:
Irene Hoesli, Sonia Campelo, Véronique Othenin-Girard, Anett Hernadi, Maria Luisa Gasparri, Antonilli Morena, Christian Polli, Edoardo Taddei, Karoline Aebi-Popp, Luigi Raio, Daniel Surbek, Mirjam Moser, Laurent Salomon, Johana Sichitiu, Julien Stirnemann, Jérôme Dimet, Tina Fischer, Louise Ghesquiere, Amaury Brot, Clémence Houssin, Aurélien Mattuizzi, Stefanie Sturm, Caroline Eggemann, Edouard Ha, Jérôme Mathis, Marie-Claude Rossier, Andrea Bloch, Martin Kaufmann, Carina Britschgi, Panagiotis Kanellos, Bénédicte Breton, Carolin Blume, Stylianos Kalimeris, Arnaud Toussaint, Guillaume Ducarme, Chloé Moreau, Hélène Pelerin, Mohamed Derouich, Cecile Le Parco, Gaetan Plantefeve, Anis Feki, Gaston Grant, Kathrin Bütikofer, Ina Hoffmann, Jessica Maisel, Elke Barbara Prentl, Brigitte Frey Tirri, Grit Vetter, Lucie Sedille, Michel Boulvain, Annina Haessig

Affiliations

¹ Materno-fetal and Obstetrics Research Unit, Department "Femme-Mère-Enfant", University Hospital, Lausanne, Switzerland.
² Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
³ School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland.
⁴ Department of Obstetrics and Gynecology, Pontoise Hospital, Pontoise, France.
⁵ Department of Obstetrics and Gynecology, Poissy-Saint Germain Hospital, Poissy, France.
⁶ Department of Obstetrics, Basel University Hospital, Basel, Switzerland.
⁷ Obstetrics Division, Department of Pediatrics, Gynecology and Obstetrics, Geneva University Hospitals, Faculty of Medicine, Geneva, Switzerland.
⁸ Division of Obstetrics, Baden Cantonal Hospital, Baden, Switzerland.
⁹ Department of Gynecology and Obstetrics, Ente Ospedaliero Cantonale, Lugano, Switzerland.
¹⁰ Department of Obstetrics and Fetal-Maternal Medicine, University Hospital of Bern, University of Bern, Bern, Switzerland.
¹¹ Department of Obstetrics, Cantonal Hospital Aarau, Aarau, Switzerland.
¹² Necker-Enfants Malades Hospital, Department of Obstetrics, Paris, France.
¹³ Department of Obstetrics, Grabs Hospital, Grabs, Switzerland.
¹⁴ Obstetrics and Gynecology Unit, Sion Hospital, Sion, Switzerland.
¹⁵ Département de gynécologie-obstétrique, RHNE, Neuchâtel, Switzerland.
¹⁶ Department of Gynecology and Obstetrics, Hospital of the Upper Valais, Visp, Switzerland.
¹⁷ Department of Obstetrics, Gynecology Stadtspital Triemli, Zürich, Switzerland.
¹⁸ Department of Gynecology, Mont-de-Marsan Hospital, Mont-de-Marsan, France.
¹⁹ Department of Obstetrics and Gynecology, Besançon University Hospital, Besançon, France.
²⁰ Infectious Diseases and Hospital Epidemiology, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland.
²¹ Department of Obstetrics, CHU de Lille, Lille, France.
²² Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France.
²³ Department of Obstetrics and Gynecology, Obwald Cantonal Hospital, Sarnen, Switzerland.
²⁴ Department of Obstetrics and Gynecology, Nidwald Cantonal Hospital, Stans, Switzerland.
²⁵ Neonatal Department, University Hospital Zürich, Zürich, Switzerland.
²⁶ Swiss Teratogen Information Service, Clinical Pharmacology Unit, Lausanne University Hospital and University of Lausanne, Switzerland.
²⁷ Service of Pharmacy, Lausanne University Hospital and University of Lausanne, Switzerland.

PMID: 36628358
PMCID: PMC9815480
DOI: 10.1016/j.lanepe.2022.100569

Maternal and perinatal outcomes following pre-Delta, Delta, and Omicron SARS-CoV-2 variants infection among unvaccinated pregnant women in France and Switzerland: a prospective cohort study using the COVI-PREG registry

Guillaume Favre et al. Lancet Reg Health Eur. 2023 Mar.

. 2023 Mar:26:100569.

doi: 10.1016/j.lanepe.2022.100569. Epub 2023 Jan 5.

Authors

Collaborators

French and Swiss COVI-PREG group:
Irene Hoesli, Sonia Campelo, Véronique Othenin-Girard, Anett Hernadi, Maria Luisa Gasparri, Antonilli Morena, Christian Polli, Edoardo Taddei, Karoline Aebi-Popp, Luigi Raio, Daniel Surbek, Mirjam Moser, Laurent Salomon, Johana Sichitiu, Julien Stirnemann, Jérôme Dimet, Tina Fischer, Louise Ghesquiere, Amaury Brot, Clémence Houssin, Aurélien Mattuizzi, Stefanie Sturm, Caroline Eggemann, Edouard Ha, Jérôme Mathis, Marie-Claude Rossier, Andrea Bloch, Martin Kaufmann, Carina Britschgi, Panagiotis Kanellos, Bénédicte Breton, Carolin Blume, Stylianos Kalimeris, Arnaud Toussaint, Guillaume Ducarme, Chloé Moreau, Hélène Pelerin, Mohamed Derouich, Cecile Le Parco, Gaetan Plantefeve, Anis Feki, Gaston Grant, Kathrin Bütikofer, Ina Hoffmann, Jessica Maisel, Elke Barbara Prentl, Brigitte Frey Tirri, Grit Vetter, Lucie Sedille, Michel Boulvain, Annina Haessig

Affiliations

¹ Materno-fetal and Obstetrics Research Unit, Department "Femme-Mère-Enfant", University Hospital, Lausanne, Switzerland.
² Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
³ School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland.
⁴ Department of Obstetrics and Gynecology, Pontoise Hospital, Pontoise, France.
⁵ Department of Obstetrics and Gynecology, Poissy-Saint Germain Hospital, Poissy, France.
⁶ Department of Obstetrics, Basel University Hospital, Basel, Switzerland.
⁷ Obstetrics Division, Department of Pediatrics, Gynecology and Obstetrics, Geneva University Hospitals, Faculty of Medicine, Geneva, Switzerland.
⁸ Division of Obstetrics, Baden Cantonal Hospital, Baden, Switzerland.
⁹ Department of Gynecology and Obstetrics, Ente Ospedaliero Cantonale, Lugano, Switzerland.
¹⁰ Department of Obstetrics and Fetal-Maternal Medicine, University Hospital of Bern, University of Bern, Bern, Switzerland.
¹¹ Department of Obstetrics, Cantonal Hospital Aarau, Aarau, Switzerland.
¹² Necker-Enfants Malades Hospital, Department of Obstetrics, Paris, France.
¹³ Department of Obstetrics, Grabs Hospital, Grabs, Switzerland.
¹⁴ Obstetrics and Gynecology Unit, Sion Hospital, Sion, Switzerland.
¹⁵ Département de gynécologie-obstétrique, RHNE, Neuchâtel, Switzerland.
¹⁶ Department of Gynecology and Obstetrics, Hospital of the Upper Valais, Visp, Switzerland.
¹⁷ Department of Obstetrics, Gynecology Stadtspital Triemli, Zürich, Switzerland.
¹⁸ Department of Gynecology, Mont-de-Marsan Hospital, Mont-de-Marsan, France.
¹⁹ Department of Obstetrics and Gynecology, Besançon University Hospital, Besançon, France.
²⁰ Infectious Diseases and Hospital Epidemiology, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland.
²¹ Department of Obstetrics, CHU de Lille, Lille, France.
²² Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France.
²³ Department of Obstetrics and Gynecology, Obwald Cantonal Hospital, Sarnen, Switzerland.
²⁴ Department of Obstetrics and Gynecology, Nidwald Cantonal Hospital, Stans, Switzerland.
²⁵ Neonatal Department, University Hospital Zürich, Zürich, Switzerland.
²⁶ Swiss Teratogen Information Service, Clinical Pharmacology Unit, Lausanne University Hospital and University of Lausanne, Switzerland.
²⁷ Service of Pharmacy, Lausanne University Hospital and University of Lausanne, Switzerland.

PMID: 36628358
PMCID: PMC9815480
DOI: 10.1016/j.lanepe.2022.100569

Abstract

Background: SARS-CoV-2 positive pregnant women are at higher risk of adverse outcomes, but little evidence is available on how variants impact that risk. We aim to evaluate maternal and perinatal outcomes among unvaccinated pregnant women that tested positive for SARS-CoV-2, stratified by pre-Delta, Delta, and Omicron periods.

Methods: This prospective study enrolled women from March 2020 to September 2022. Exposure to the different SARS-CoV-2 variants was defined by their periods of predominance. The primary outcome was severe maternal adverse outcome defined as either intensive care unit admission, acute respiratory distress syndrome, advanced oxygen supplementation, or maternal death. The secondary outcomes were preterm birth and other perinatal outcomes.

Findings: Overall, 1402, 262, and 391 SARS-CoV-2 positive pregnant women were enrolled during the pre-Delta, Delta, and Omicron periods respectively. Severe maternal adverse outcome was reported in 3.4% (n = 947/1402; 95% confidence intervals (95%CI) 2.5-4.5), 6.5% (n = 7/262; 95%CI 3.8-10.2), and 1.0% (n = 4/391; 95%CI 0.3-2.6) of women during the pre-Delta, Delta, and Omicron periods. The risk of severe maternal adverse outcome was higher during the Delta vs pre-Delta period (adjusted risk ratio (aRR) = 1.8; 95%CI 1.1-3.2) and lower during the Omicron vs pre-Delta period (aRR = 0.3; 95%CI, 0.1-0.8). The risks of hospitalization for COVID-19 were 12.6% (n = 176/1402; 95%CI 10.9-14.4), 17.2% (n = 45/262; 95%CI 12.8-22.3), and 12.5% (n = 49/391; 95%CI 9.4-16.2), during the pre-Delta, Delta, and Omicron period, respectively. Pregnancy complications occurred after SARS-CoV-2 exposure in 30.0% (n = 363/1212; 95%CI 27.4-32.6), 35.2% (n = 83/236; 95%CI 29.1-41.6), and 30.3% (n = 105/347; 95%CI 25.5-35.4) of patients during the pre-Delta, Delta, and Omicron periods, respectively. Stillbirths were reported in 0.5% (n = 6/1159; 95%CI 0.2-1.1), 2.8% (n = 6/210; 95%CI 1.0-6.0), and 0.9% (n = 2/213; 95%CI 0.1-3.4) or patients during the pre-Delta, Delta, and Omicron periods respectively.

Interpretation: The Delta period was associated with a higher risk of severe maternal adverse outcome and the Omicron period with a lower risk of severe adverse outcome compared to pre-Delta era. The reported risk of hospitalization was high during the Omicron period and should not be trivialized.

Funding: Swiss Federal Office of Public Health, Fondation CHUV.

Keywords: COVID-19; Omicron; Pregnancy; Pregnant women; SARS-CoV-2; Variant.

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Conflict of interest statement

All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf. Alice Panchaud received grants from the 10.13039/501100002329Swiss Federal Office of Public Health and the 10.13039/501100006392CHUV Foundation; she also received grants from Vifor, the European Medicine Agency (EMA/2017/09/PE and EMA/2017/09/PE/11), the Fonds Paritaire RBP IV and a 10.13039/100010661H2020 grant (ConcePTION WP 3-4), outside the submitted work. Begoña Martinez de Tejada reported receiving financial support from the General Health Division in Geneva, Switzerland, and being a medical advisor for Effik consulting fees and lectures) and Pierre Fabre (consulting fees), outside the submitted work; she also reported having a research agreement for clinical devices with Pregnolia and having been paid as a legal expert in several malpractice cases, outside the submitted work. All other authors declare no conflicts of interest.

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Maternal and perinatal outcomes following pre-Delta, Delta, and Omicron SARS-CoV-2 variants infection among unvaccinated pregnant women in France and Switzerland: a prospective cohort study using the COVI-PREG registry

Collaborators

Affiliations

Maternal and perinatal outcomes following pre-Delta, Delta, and Omicron SARS-CoV-2 variants infection among unvaccinated pregnant women in France and Switzerland: a prospective cohort study using the COVI-PREG registry

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

References

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