The association between SARS-CoV-2 infection and preterm delivery: a prospective study with a multivariable analysis.
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Martinez-Perez Oscar, Prats Rodriguez Pilar, Muner Hernandez Marta, Encinas Pardilla Maria Begoña, Perez Perez Noelia, Vila Hernandez Maria Rosa, Villalba Yarza Ana, Nieto Velasco Olga, Del Barrio Fernandez Pablo Guillermo, Forcen Acebal Laura, Orizales Lago Carmen Maria, Martinez Varea Alicia, Muñoz Abellana Begoña, Suarez Arana Maria, Fuentes Ricoy Laura, Martinez Diago Clara, Janeiro Freire Maria Jesus, Alférez Alvarez-Mallo Macarena, Casanova Pedraz Cristina, Alomar Mateu Onofre, Lesmes Heredia Cristina, Wizner de Alva Juan Carlos, Bernardo Vega Rut, Macia Badia Montserrat, Alvarez Colomo Cristina, Sanchez Muñoz Antonio, Pratcorona Alicart Laia, Alonso Saiz Ruben, Lopez Rodriguez Monica, Del Carmen Barbancho Lopez Maria, Meca Casbas Marta Ruth, Vaquerizo Ruiz Oscar, Moran Antolin Eva, Nuñez Valera Maria Jose, Fernandez Fernandez Camino, Tubau Navarra Albert, Cano Garcia Alejandra Maria, Baena Luque Carmen, Soldevilla Perez Susana, Gastaca Abasolo Irene, Adanez Garcia Jose, Teulon Gonzalez Maria, Puertas Prieto Alberto, Ostos Serna Rosa, Del Pilar Guadix Martin Maria, Catalina Coello Monica, Ferriols Perez Elena, Caño Aguilar Africa, De la Cruz Conty Maria Luisa, Sainz Bueno Jose Antonio, Spanish Obstetric Emergency Group
Аннотация
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.