Effects of COVID-19 on maternal and neonatal outcomes

COVID-19 infection increases preterm births and maternal in-hospital deaths, according to a recent study.

Early in the COVID-19 pandemic, there was little information on outcomes of COVID-19 infection in pregnant individuals, but previous data on perinatal respiratory viral diseases led to concern. Risks of maternal death and preterm birth are increased among pregnant individuals with influenza, and severe illness may develop in infants with a respiratory illness early in life.

Multiple healthcare organizations have recommended a panel for protecting newborns from COVID-19, but challenges have arisen because of frequently changing healthcare structures in the United States. The National Registry for the Surveillance and Epidemiology of Perinatal COVID-19 (NPC-19) was launched in March 2020 to address these challenges.

From April 6, 2020, to March 19, 2021, NPC-19 gathered information on pregnant people and their newborns. This information was released in a report published in the February 2023 issue of Pediatrics.

Pregnancies where the mother first tested positive for COVID-19 14 days before delivery through 10 days after delivery were included in the study. Stillbirths and neonatal deaths in the delivery room were excluded. Preterm birth was defined as less than 37 weeks’ gestation. There were 7524 pregnant people and 7648 newborns in the final cohort.

Of the study population, 44.4% were Hispanic, and 35.3% of infants were delivered through cesarean delivery. No symptoms were reported at delivery for 78.1% of patients.

Respiratory support for those hospitalized for COVID-19 before delivery included supplemental oxygen in 44.1%, mechanical ventilation in 27.6%, extracorporeal membrane oxygenation in 3.9%, and continuous positive airway pressure in 2.4%. Eighteen mothers experienced death before hospital discharge.

Testing occurred by the third day after birth for most newborns, with more frequent testing occurring in preterm newborns. Untested newborns were more often born to asymptomatic non-Hispanic White mothers.

Preterm birth was seen in 15.6% of newborns and was more common among those with positive polymerase chain reaction testing. Pregnant people who delivered preterm were more often symptomatic, received COVID-specific therapies, or were hospitalized 14 days or less before delivery for COVID-19. 

No newborn deaths occurred from COVID-19. COVID-19 infection did not differ based on maternal race and ethnicity, but the risk of at least 1 newborn testing positive for COVID-19 was greater among symptomatic pregnant people. Overall, preterm births and maternal in-hospital deaths were more common in cases of COVID-19 infection.

Reference

Hudak ML, Flannery DD, Barnette K, et al.Maternal and newborn hospital outcomes of perinatal SARS-CoV-2 infection: anational registry. Pediatrics. 2023;151(2). doi:10.1542/peds.2022-059595