Maternal and neonatal outcomes following SARS-CoV-2 infection

Abstract

Infection with SARS-CoV-2 causing COVID-19 in pregnancy is known to confer risks to both the pregnant patient and fetus. A review of the current literature demonstrates that pregnant individuals with SARS-CoV-2 infection are at risk for higher composite morbidity, intensive care unit admission, ventilatory support, pre-eclampsia, preterm birth, and neonatal intensive care unit admissions compared to pregnant individuals without SARS-CoV-2. Worse obstetric morbidity and mortality generally correlate with the severity of COVID-19. Comorbidities such as diabetes increase the risk of severe COVID-19. An increased risk of stillbirth appears to be predominantly confined to pregnancies affected in the Delta variant time period. Further, vaccination against SARS-CoV-2 has been demonstrated to be safe and effective in pregnancy and while breastfeeding. Therefore, continued counseling encouraging vaccination remains imperative. The long-term maternal and neonatal consequences of pregnancies affected by SARS-CoV-2 remain unknown, and therefore continued research in this regard is warranted.

Keywords: COVID-19; Morbidity; Mortality; Outcomes; Pregnancy; SARS-CoV-2.

Fig. 1

Percentage of pregnant people ages 18–49 years old who completed a primary vaccination series of the COVID-19 vaccine before and during pregnancy by week ending dates from January 2021 to February 2023. Adapted from data reported to the CDC via Vaccine Safety Data Link. Centers for Disease Control and Prevention. COVID Data Tracker. Atlanta GUDoHaHS, CDC; 2023, https://covid.cdc.gov/covid-data-tracker.

Fig. 2

Pregnancy outcomes associated with COVID-19. Impact of the virus strain and benefits of vaccination are shown. RR – relative risk; PIH – pregnancy induced hypertension; PPH – postpartum hemorhage, a – adjusted; OR – odds ratio; CI- confidence interval; Image courtesy Satyan Lakshminrusimha.

Fig. 3

Prevalence of the primary composite outcome of maternal death or serious morbidity from common obstetric complications, with 95% CIs, by month. Before pandemic is represented in light grey, and during pandemic is represented in dark grey. Dashed lines denote the overall prevalence of the primary outcome for March through December of each calendar year. Reprinted with permission from Metz et al. Association between giving birth during the early coronavirus disease 2019 (COVID-19) pandemic and serious maternal morbidity. Obstet Gynecol 2023.