Abstract
To evaluate the strength of association between maternal and pregnancy characteristics and the risk of adverse perinatal outcomes in pregnancies with laboratory confirmed COVID-19. Secondary analysis of a multinational, cohort study on all consecutive pregnant women with laboratory-confirmed COVID-19 from February 1, 2020 to April 30, 2020 from 73 centers from 22 different countries. A confirmed case of COVID-19 was defined as a positive result on real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay of nasal and pharyngeal swab specimens. The primary outcome was a composite adverse fetal outcome, defined as the presence of either abortion (pregnancy loss before 22 weeks of gestations), stillbirth (intrauterine fetal death after 22 weeks of gestation), neonatal death (death of a live-born infant within the first 28 days of life), and perinatal death (either stillbirth or neonatal death). Logistic regression analysis was performed to evaluate parameters independently associated with the primary outcome. Logistic regression was reported as odds ratio (OR) with 95% confidence interval (CI). Mean gestational age at diagnosis was 30.6±9.5 weeks, with 8.0% of women being diagnosed in the first, 22.2% in the second and 69.8% in the third trimester of pregnancy. There were six miscarriage (2.3%), six intrauterine device (IUD) (2.3) and 5 (2.0%) neonatal deaths, with an overall rate of perinatal death of 4.2% (11/265), thus resulting into 17 cases experiencing and 226 not experiencing composite adverse fetal outcome. Neither stillbirths nor neonatal deaths had congenital anomalies found at antenatal or postnatal evaluation. Furthermore, none of the cases experiencing IUD had signs of impending demise at arterial or venous Doppler. Neonatal deaths were all considered as prematurity-related adverse events. Of the 250 live-born neonates, one (0.4%) was found positive at RT-PCR pharyngeal swabs performed after delivery. The mother was tested positive during the third trimester of pregnancy. The newborn was asymptomatic and had negative RT-PCR test after 14 days of life. At logistic regression analysis, gestational age at diagnosis (OR: 0.85, 95% CI 0.8-0.9 per week increase; p<0.001), birthweight (OR: 1.17, 95% CI 1.09-1.12.7 per 100 g decrease; p=0.012) and maternal ventilatory support, including either need for oxygen or CPAP (OR: 4.12, 95% CI 2.3-7.9; p=0.001) were independently associated with composite adverse fetal outcome. Early gestational age at infection, maternal ventilatory supports and low birthweight are the main determinants of adverse perinatal outcomes in fetuses with maternal COVID-19 infection. Conversely, the risk of vertical transmission seems negligible.
| Original language | English |
|---|---|
| Pages (from-to) | 950-958 |
| Number of pages | 9 |
| Journal | Journal of Perinatal Medicine |
| Volume | 48 |
| Issue number | 9 |
| DOIs | |
| State | Published - 1 Nov 2020 |
Bibliographical note
Publisher Copyright:© 2020 2020 Walter de Gruyter GmbH, Berlin/Boston.
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
Keywords
- Coronavirus
- perinatal morbidity
- perinatal mortality
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Risk factors associated with adverse fetal outcomes in pregnancies affected by Coronavirus disease 2019 (COVID-19) : A secondary analysis of the WAPM study on COVID-19. / Di Mascio, Daniele; Sen, Cihat; Saccone, Gabriele; Galindo, Alberto; Grünebaum, Amos; Yoshimatsu, Jun; Stanojevic, Milan; Kurjak, Asim; Chervenak, Frank; Suárez, María José Rodríguez; Gambacorti-Passerini, Zita Maria; De Los Angeles Anaya Baz, María; Galán, Esther Vanessa Aguilar; López, Yolanda Cuñarro; De León Luis, Juan Antonio; Hernández, Ignacio Cueto; Herraiz, Ignacio; Villalain, Cecilia; Venturella, Roberta; Rizzo, Giuseppe; Mappa, Ilenia; Gerosolima, Giovanni; Hellmeyer, Lars; Königbauer, Josefine; Ameli, Giada; Frusca, Tiziana; Volpe, Nicola; Schera, Giovanni Battista Luca; Fieni, Stefania; Esposito, Eutalia; Simonazzi, Giuliana; Di Donna, Gaetana; Youssef, Aly; Della Gatta, Anna Nunzia; Di Donna, Mariano Catello; Chiantera, Vito; Buono, Natalina; Sozzi, Giulio; Greco, Pantaleo; Morano, Danila; Bianchi, Beatrice; Marino, Maria Giulia Lombana; Laraud, Federica; Ramone, Arianna; Cagnacci, Angelo; Barra, Fabio; Gustavino, Claudio; Ferrero, Simone; Ghezzi, Fabio; Cromi, Antonella; Laganà, Antonio Simone; Longo, Valentina Laurita; Stollagli, Francesca; Sirico, Angelo; Lanzone, Antonio; Driul, Lorenza; Fabiana Cecchini, D.; Xodo, Serena; Rodriguez, Brian; Mercado-Olivares, Felipe; Elkafrawi, Deena; Sisti, Giovanni; Esposito, Rosanna; Coviello, Antonio; Cerbone, Marco; Morlando, Maddalena; Schiattarella, Antonio; Colacurci, Nicola; De Franciscis, Pasquale; Cataneo, Ilaria; Lenzi, Marinella; Sandri, Fabrizio; Buscemi, Riccardo; Gattei, Giorgia; Della Sala, Francesca; Valori, Eleonora; Rovellotti, Maria Cristina; Done, Elisa; Faron, Gilles; Gucciardo, Leonardo; Esposito, Valentina; Vena, Flaminia; Giancotti, Antonella; Brunelli, Roberto; Muzii, Ludovico; Nappi, Luigi; Sorrentino, Felice; Vasciaveo, Lorenzo; Liberati, Marco; Buca, Danilo; Leombroni, Martina; Di Sebastiano, Francesca; Di Tizio, Luciano; Gazzolo, Diego; Franchi, Massimo; Ianniciello, Quintino Cesare; Garzon, Simone; Petriglia, Giuliano; Borrello, Leonardo; Nieto-Calvache, Albaro Josè; Burgos-Luna, Juan Manuel; Kadji, Caroline; Carlin, Andrew; Bevilacqua, Elisa; Moucho, Marina; Pinto, Pedro Viana; Figueiredo, Rita; Roselló, José Morales; Loscalzo, Gabriela; Martinez-Varea, Alicia; Diago, Vincente; Lopez, Jesús S.Jimenez; Aykanat, Alicia Yeliz; Cosma, Stefano; Carosso, Andrea; Benedetto, Chiara; Bermejo, Amanda; Feuerschuette, Otto Henrique May; Uyaniklar, Ozlem; Ocakouglu, Sakine Rahimli; Atak, Zeliha; Gündüz, Reyhan; Haberal, Esra Tustas; Froessler, Bernd; Parange, Anupam; Palm, Peter; Samardjiski, Igor; Taccaliti, Chiara; Okuyan, Erhan; Daskalakis, George; De Sa, Renato Augusto Moreira; Pittaro, Alejandro; Gonzalez-Duran, Maria Luisa; Guisan, Ana Concheiro; Genç, Şerife Özlem; Zlatohlávková, Blanka; Piqueras, Anna Luengo; Oliva, Dolores Esteban; Cil, Aylin Pelin; Api, Olus; Antsaklis, Panos; Ples, Liana; Kyvernitakis, Ioannis; Maul, Holger; Malan, Marcel; Lila, Albert; Granese, Roberta; Ercoli, Alfredo; Zoccali, Giuseppe; Villasco, Andrea; Biglia, Nicoletta; Madalina, Ciuhodaru; Costa, Elena; Daelemans, Caroline; Pintiaux, Axelle; Cueto, Elisa; Hadar, Eran; Dollinger, Sarah; Sinai, Noa A.Brzezinski; Huertas, Erasmo; Arango, Pedro; Sanchez, Amadeo; Schvartzman, Javier Alfonso; Cojocaru, Liviu; Turan, Sifa; Turan, Ozhan; Di Dedda, Maria Carmela; Molpeceres, Rebeca Garrote; Zdjelar, Snezana; Premru-Srsen, Tanja; Cerar, Lilijana Kornhauser; Druškoviè, Mirjam; De Robertis, Valentina; Stefanovic, Vedran; Nupponen, Irmeli; Nelskylä, Kaisa; Khodjaeva, Zulfiya; Gorina, Ksenia A.; Sukhikh, Gennady T.; Maruotti, Giuseppe Maria; Visentin, Silvia; Cosmi, Erich; Ferrari, Jacopo; Gatti, Alessandra; Luvero, Daniela; Angioli, Roberto; Puri, Ludovica; Palumbo, Marco; D'Urso, Giusella; Colaleo, Francesco; Rapisarda, Agnese Maria Chiara; Carbone, Ilma Floriana; Mollo, Antonio; Nazzaro, Giovanni; Locci, Mariavittoria; Guida, Maurizio; Di Spiezio Sardo, Attilio; Panici, Pierluigi Benedetti; Berghella, Vincenzo; Flacco, Maria Elena; Manzoli, Lamberto; Bifulco, Giuseppe; Scambia, Giovanni; Zullo, Fulvio; D'Antonio, Francesco.
In: Journal of Perinatal Medicine, Vol. 48, No. 9, 01.11.2020, p. 950-958.Research output: Contribution to journal › Article › peer-review
TY - JOUR
T1 - Risk factors associated with adverse fetal outcomes in pregnancies affected by Coronavirus disease 2019 (COVID-19)
T2 - A secondary analysis of the WAPM study on COVID-19
AU - Di Mascio, Daniele
AU - Sen, Cihat
AU - Saccone, Gabriele
AU - Galindo, Alberto
AU - Grünebaum, Amos
AU - Yoshimatsu, Jun
AU - Stanojevic, Milan
AU - Kurjak, Asim
AU - Chervenak, Frank
AU - Suárez, María José Rodríguez
AU - Gambacorti-Passerini, Zita Maria
AU - De Los Angeles Anaya Baz, María
AU - Galán, Esther Vanessa Aguilar
AU - López, Yolanda Cuñarro
AU - De León Luis, Juan Antonio
AU - Hernández, Ignacio Cueto
AU - Herraiz, Ignacio
AU - Villalain, Cecilia
AU - Venturella, Roberta
AU - Rizzo, Giuseppe
AU - Mappa, Ilenia
AU - Gerosolima, Giovanni
AU - Hellmeyer, Lars
AU - Königbauer, Josefine
AU - Ameli, Giada
AU - Frusca, Tiziana
AU - Volpe, Nicola
AU - Schera, Giovanni Battista Luca
AU - Fieni, Stefania
AU - Esposito, Eutalia
AU - Simonazzi, Giuliana
AU - Di Donna, Gaetana
AU - Youssef, Aly
AU - Della Gatta, Anna Nunzia
AU - Di Donna, Mariano Catello
AU - Chiantera, Vito
AU - Buono, Natalina
AU - Sozzi, Giulio
AU - Greco, Pantaleo
AU - Morano, Danila
AU - Bianchi, Beatrice
AU - Marino, Maria Giulia Lombana
AU - Laraud, Federica
AU - Ramone, Arianna
AU - Cagnacci, Angelo
AU - Barra, Fabio
AU - Gustavino, Claudio
AU - Ferrero, Simone
AU - Ghezzi, Fabio
AU - Cromi, Antonella
AU - Laganà, Antonio Simone
AU - Longo, Valentina Laurita
AU - Stollagli, Francesca
AU - Sirico, Angelo
AU - Lanzone, Antonio
AU - Driul, Lorenza
AU - Fabiana Cecchini, D.
AU - Xodo, Serena
AU - Rodriguez, Brian
AU - Mercado-Olivares, Felipe
AU - Elkafrawi, Deena
AU - Sisti, Giovanni
AU - Esposito, Rosanna
AU - Coviello, Antonio
AU - Cerbone, Marco
AU - Morlando, Maddalena
AU - Schiattarella, Antonio
AU - Colacurci, Nicola
AU - De Franciscis, Pasquale
AU - Cataneo, Ilaria
AU - Lenzi, Marinella
AU - Sandri, Fabrizio
AU - Buscemi, Riccardo
AU - Gattei, Giorgia
AU - Della Sala, Francesca
AU - Valori, Eleonora
AU - Rovellotti, Maria Cristina
AU - Done, Elisa
AU - Faron, Gilles
AU - Gucciardo, Leonardo
AU - Esposito, Valentina
AU - Vena, Flaminia
AU - Giancotti, Antonella
AU - Brunelli, Roberto
AU - Muzii, Ludovico
AU - Nappi, Luigi
AU - Sorrentino, Felice
AU - Vasciaveo, Lorenzo
AU - Liberati, Marco
AU - Buca, Danilo
AU - Leombroni, Martina
AU - Di Sebastiano, Francesca
AU - Di Tizio, Luciano
AU - Gazzolo, Diego
AU - Franchi, Massimo
AU - Ianniciello, Quintino Cesare
AU - Garzon, Simone
AU - Petriglia, Giuliano
AU - Borrello, Leonardo
AU - Nieto-Calvache, Albaro Josè
AU - Burgos-Luna, Juan Manuel
AU - Kadji, Caroline
AU - Carlin, Andrew
AU - Bevilacqua, Elisa
AU - Moucho, Marina
AU - Pinto, Pedro Viana
AU - Figueiredo, Rita
AU - Roselló, José Morales
AU - Loscalzo, Gabriela
AU - Martinez-Varea, Alicia
AU - Diago, Vincente
AU - Lopez, Jesús S.Jimenez
AU - Aykanat, Alicia Yeliz
AU - Cosma, Stefano
AU - Carosso, Andrea
AU - Benedetto, Chiara
AU - Bermejo, Amanda
AU - Feuerschuette, Otto Henrique May
AU - Uyaniklar, Ozlem
AU - Ocakouglu, Sakine Rahimli
AU - Atak, Zeliha
AU - Gündüz, Reyhan
AU - Haberal, Esra Tustas
AU - Froessler, Bernd
AU - Parange, Anupam
AU - Palm, Peter
AU - Samardjiski, Igor
AU - Taccaliti, Chiara
AU - Okuyan, Erhan
AU - Daskalakis, George
AU - De Sa, Renato Augusto Moreira
AU - Pittaro, Alejandro
AU - Gonzalez-Duran, Maria Luisa
AU - Guisan, Ana Concheiro
AU - Genç, Şerife Özlem
AU - Zlatohlávková, Blanka
AU - Piqueras, Anna Luengo
AU - Oliva, Dolores Esteban
AU - Cil, Aylin Pelin
AU - Api, Olus
AU - Antsaklis, Panos
AU - Ples, Liana
AU - Kyvernitakis, Ioannis
AU - Maul, Holger
AU - Malan, Marcel
AU - Lila, Albert
AU - Granese, Roberta
AU - Ercoli, Alfredo
AU - Zoccali, Giuseppe
AU - Villasco, Andrea
AU - Biglia, Nicoletta
AU - Madalina, Ciuhodaru
AU - Costa, Elena
AU - Daelemans, Caroline
AU - Pintiaux, Axelle
AU - Cueto, Elisa
AU - Hadar, Eran
AU - Dollinger, Sarah
AU - Sinai, Noa A.Brzezinski
AU - Huertas, Erasmo
AU - Arango, Pedro
AU - Sanchez, Amadeo
AU - Schvartzman, Javier Alfonso
AU - Cojocaru, Liviu
AU - Turan, Sifa
AU - Turan, Ozhan
AU - Di Dedda, Maria Carmela
AU - Molpeceres, Rebeca Garrote
AU - Zdjelar, Snezana
AU - Premru-Srsen, Tanja
AU - Cerar, Lilijana Kornhauser
AU - Druškoviè, Mirjam
AU - De Robertis, Valentina
AU - Stefanovic, Vedran
AU - Nupponen, Irmeli
AU - Nelskylä, Kaisa
AU - Khodjaeva, Zulfiya
AU - Gorina, Ksenia A.
AU - Sukhikh, Gennady T.
AU - Maruotti, Giuseppe Maria
AU - Visentin, Silvia
AU - Cosmi, Erich
AU - Ferrari, Jacopo
AU - Gatti, Alessandra
AU - Luvero, Daniela
AU - Angioli, Roberto
AU - Puri, Ludovica
AU - Palumbo, Marco
AU - D'Urso, Giusella
AU - Colaleo, Francesco
AU - Rapisarda, Agnese Maria Chiara
AU - Carbone, Ilma Floriana
AU - Mollo, Antonio
AU - Nazzaro, Giovanni
AU - Locci, Mariavittoria
AU - Guida, Maurizio
AU - Di Spiezio Sardo, Attilio
AU - Panici, Pierluigi Benedetti
AU - Berghella, Vincenzo
AU - Flacco, Maria Elena
AU - Manzoli, Lamberto
AU - Bifulco, Giuseppe
AU - Scambia, Giovanni
AU - Zullo, Fulvio
AU - D'Antonio, Francesco
N1 - Publisher Copyright: © 2020 2020 Walter de Gruyter GmbH, Berlin/Boston. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2020/11/1
Y1 - 2020/11/1
N2 - To evaluate the strength of association between maternal and pregnancy characteristics and the risk of adverse perinatal outcomes in pregnancies with laboratory confirmed COVID-19. Secondary analysis of a multinational, cohort study on all consecutive pregnant women with laboratory-confirmed COVID-19 from February 1, 2020 to April 30, 2020 from 73 centers from 22 different countries. A confirmed case of COVID-19 was defined as a positive result on real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay of nasal and pharyngeal swab specimens. The primary outcome was a composite adverse fetal outcome, defined as the presence of either abortion (pregnancy loss before 22 weeks of gestations), stillbirth (intrauterine fetal death after 22 weeks of gestation), neonatal death (death of a live-born infant within the first 28 days of life), and perinatal death (either stillbirth or neonatal death). Logistic regression analysis was performed to evaluate parameters independently associated with the primary outcome. Logistic regression was reported as odds ratio (OR) with 95% confidence interval (CI). Mean gestational age at diagnosis was 30.6±9.5 weeks, with 8.0% of women being diagnosed in the first, 22.2% in the second and 69.8% in the third trimester of pregnancy. There were six miscarriage (2.3%), six intrauterine device (IUD) (2.3) and 5 (2.0%) neonatal deaths, with an overall rate of perinatal death of 4.2% (11/265), thus resulting into 17 cases experiencing and 226 not experiencing composite adverse fetal outcome. Neither stillbirths nor neonatal deaths had congenital anomalies found at antenatal or postnatal evaluation. Furthermore, none of the cases experiencing IUD had signs of impending demise at arterial or venous Doppler. Neonatal deaths were all considered as prematurity-related adverse events. Of the 250 live-born neonates, one (0.4%) was found positive at RT-PCR pharyngeal swabs performed after delivery. The mother was tested positive during the third trimester of pregnancy. The newborn was asymptomatic and had negative RT-PCR test after 14 days of life. At logistic regression analysis, gestational age at diagnosis (OR: 0.85, 95% CI 0.8-0.9 per week increase; p<0.001), birthweight (OR: 1.17, 95% CI 1.09-1.12.7 per 100 g decrease; p=0.012) and maternal ventilatory support, including either need for oxygen or CPAP (OR: 4.12, 95% CI 2.3-7.9; p=0.001) were independently associated with composite adverse fetal outcome. Early gestational age at infection, maternal ventilatory supports and low birthweight are the main determinants of adverse perinatal outcomes in fetuses with maternal COVID-19 infection. Conversely, the risk of vertical transmission seems negligible.
AB - To evaluate the strength of association between maternal and pregnancy characteristics and the risk of adverse perinatal outcomes in pregnancies with laboratory confirmed COVID-19. Secondary analysis of a multinational, cohort study on all consecutive pregnant women with laboratory-confirmed COVID-19 from February 1, 2020 to April 30, 2020 from 73 centers from 22 different countries. A confirmed case of COVID-19 was defined as a positive result on real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay of nasal and pharyngeal swab specimens. The primary outcome was a composite adverse fetal outcome, defined as the presence of either abortion (pregnancy loss before 22 weeks of gestations), stillbirth (intrauterine fetal death after 22 weeks of gestation), neonatal death (death of a live-born infant within the first 28 days of life), and perinatal death (either stillbirth or neonatal death). Logistic regression analysis was performed to evaluate parameters independently associated with the primary outcome. Logistic regression was reported as odds ratio (OR) with 95% confidence interval (CI). Mean gestational age at diagnosis was 30.6±9.5 weeks, with 8.0% of women being diagnosed in the first, 22.2% in the second and 69.8% in the third trimester of pregnancy. There were six miscarriage (2.3%), six intrauterine device (IUD) (2.3) and 5 (2.0%) neonatal deaths, with an overall rate of perinatal death of 4.2% (11/265), thus resulting into 17 cases experiencing and 226 not experiencing composite adverse fetal outcome. Neither stillbirths nor neonatal deaths had congenital anomalies found at antenatal or postnatal evaluation. Furthermore, none of the cases experiencing IUD had signs of impending demise at arterial or venous Doppler. Neonatal deaths were all considered as prematurity-related adverse events. Of the 250 live-born neonates, one (0.4%) was found positive at RT-PCR pharyngeal swabs performed after delivery. The mother was tested positive during the third trimester of pregnancy. The newborn was asymptomatic and had negative RT-PCR test after 14 days of life. At logistic regression analysis, gestational age at diagnosis (OR: 0.85, 95% CI 0.8-0.9 per week increase; p<0.001), birthweight (OR: 1.17, 95% CI 1.09-1.12.7 per 100 g decrease; p=0.012) and maternal ventilatory support, including either need for oxygen or CPAP (OR: 4.12, 95% CI 2.3-7.9; p=0.001) were independently associated with composite adverse fetal outcome. Early gestational age at infection, maternal ventilatory supports and low birthweight are the main determinants of adverse perinatal outcomes in fetuses with maternal COVID-19 infection. Conversely, the risk of vertical transmission seems negligible.
KW - Coronavirus
KW - perinatal morbidity
KW - perinatal mortality
UR - http://www.scopus.com/inward/record.url?scp=85092655173&partnerID=8YFLogxK
U2 - 10.1515/jpm-2020-0355
DO - 10.1515/jpm-2020-0355
M3 - Artículo
C2 - 32975205
AN - SCOPUS:85092655173
VL - 48
SP - 950
EP - 958
JO - Journal of Perinatal Medicine
JF - Journal of Perinatal Medicine
SN - 0300-5577
IS - 9
ER -