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

Author:

Di Mascio Daniele1,Sen Cihat2,Saccone Gabriele3,Galindo Alberto4,Grünebaum Amos5,Yoshimatsu Jun6,Stanojevic Milan7,Kurjak Asım7,Chervenak Frank5,Rodríguez Suárez María José8,Gambacorti-Passerini Zita Maria9,Baz María de los Angeles Anaya910,Aguilar Galán Esther Vanessa910,López Yolanda Cuñarro11,De León Luis Juan Antonio11,Hernández Ignacio Cueto11,Herraiz Ignacio4,Villalain Cecilia4,Venturella Roberta12,Rizzo Giuseppe1314,Mappa Ilenia13,Gerosolima Giovanni15,Hellmeyer Lars16,Königbauer Josefine16,Ameli Giada16,Frusca Tiziana17,Volpe Nicola17,Luca Schera Giovanni Battista17,Fieni Stefania17,Esposito Eutalia18,Simonazzi Giuliana19,Di Donna Gaetana19,Youssef Aly19,Della Gatta Anna Nunzia19,Di Donna Mariano Catello20,Chiantera Vito20,Buono Natalina20,Sozzi Giulio20,Greco Pantaleo21,Morano Danila21,Bianchi Beatrice21,Lombana Marino Maria Giulia21,Laraud Federica22,Ramone Arianna22,Cagnacci Angelo22,Barra Fabio22,Gustavino Claudio22,Ferrero Simone22,Ghezzi Fabio23,Cromi Antonella23,Laganà Antonio Simone23,Laurita Longo Valentina242526,Stollagli Francesca25,Sirico Angelo24,Lanzone Antonio2425,Driul Lorenza27,Cecchini D Fabiana27,Xodo Serena27,Rodriguez Brian28,Mercado-Olivares Felipe28,Elkafrawi Deena28,Sisti Giovanni28,Esposito Rosanna3,Coviello Antonio3,Cerbone Marco3,Morlando Maddalena29,Schiattarella Antonio29,Colacurci Nicola29,De Franciscis Pasquale29,Cataneo Ilaria30,Lenzi Marinella30,Sandri Fabrizio30,Buscemi Riccardo31,Gattei Giorgia31,Sala Francesca della31,Valori Eleonora3132,Rovellotti Maria Cristina31,Done Elisa33,Faron Gilles33,Gucciardo Leonardo33,Esposito Valentina34,Vena Flaminia1,Giancotti Antonella1,Brunelli Roberto1,Muzii Ludovico1,Nappi Luigi35,Sorrentino Felice35,Vasciaveo Lorenzo35,Liberati Marco36,Buca Danilo36,Leombroni Martina36,Di Sebastiano Francesca36,Di Tizio Luciano36,Gazzolo Diego37,Franchi Massimo38,Ianniciello Quintino Cesare38,Garzon Simone38,Petriglia Giuliano39,Borrello Leonardo39,Nieto-Calvache Albaro Josè4041,Burgos-Luna Juan Manuel4041,Kadji Caroline42,Carlin Andrew42,Bevilacqua Elisa42,Moucho Marina43,Pinto Pedro Viana43,Figueiredo Rita43,Morales Roselló José44,Loscalzo Gabriela44,Martinez-Varea Alicia44,Diago Vincente44,Jimenez Lopez Jesús S45,Aykanat Alicia Yeliz46,Cosma Stefano47,Carosso Andrea47,Benedetto Chiara47,Bermejo Amanda48,May Feuerschuette Otto Henrique49,Uyaniklar Ozlem50,Ocakouglu Sakine Rahimli50,Atak Zeliha50,Gündüz Reyhan51,Haberal Esra Tustas52,Froessler Bernd53,Parange Anupam53,Palm Peter53,Samardjiski Igor54,Taccaliti Chiara55,Okuyan Erhan56,Daskalakis George57,Moreira de Sa Renato Augusto58,Pittaro Alejandro59,Gonzalez-Duran Maria Luisa60,Guisan Ana Concheiro60,Genç Şerife Özlem61,Zlatohlávková Blanka62,Piqueras Anna Luengo63,Oliva Dolores Esteban63,Cil Aylin Pelin64,Api Olus64,Antsaklis Panos57,Ples Liana65,Kyvernitakis Ioannis66,Maul Holger66,Malan Marcel66,Lila Albert67,Granese Roberta68,Ercoli Alfredo68,Zoccali Giuseppe68,Villasco Andrea69,Biglia Nicoletta69,Madalina Ciuhodaru70,Costa Elena71,Daelemans Caroline71,Pintiaux Axelle71,Cueto Elisa72,Hadar Eran73,Dollinger Sarah73,Brzezinski Sinai Noa A.73,Huertas Erasmo74,Arango Pedro74,Sanchez Amadeo74,Schvartzman Javier Alfonso75,Cojocaru Liviu76,Turan Sifa76,Turan Ozhan76,Di Dedda Maria Carmela77,Molpeceres Rebeca Garrote78,Zdjelar Snezana79,Premru-Srsen Tanja80,Cerar Lilijana Kornhauser80,Druškovič Mirjam80,De Robertis Valentina81,Stefanovic Vedran82,Nupponen Irmeli82,Nelskylä Kaisa82,Khodjaeva Zulfiya83,Gorina Ksenia A.83,Sukhikh Gennady T.83,Maruotti Giuseppe Maria3,Visentin Silvia84,Cosmi Erich84,Ferrari Jacopo84,Gatti Alessandra85,Luvero Daniela85,Angioli Roberto85,Puri Ludovica25,Palumbo Marco86,D’Urso Giusella86,Colaleo Francesco86,Chiara Rapisarda Agnese Maria86,Carbone Ilma Floriana87,Mollo Antonio88,Nazzaro Giovanni3,Locci Mariavittoria3,Guida Maurizio3,Di Spiezio Sardo Attilio3,Panici Pierluigi Benedetti1,Berghella Vincenzo89,Flacco Maria Elena90,Manzoli Lamberto90,Bifulco Giuseppe3,Scambia Giovanni24,Zullo Fulvio3,D’Antonio Francesco36

Affiliation:

1. Department of Maternal and Child Health and Urological Sciences , Sapienza University of Rome , Rome , Italy

2. Perinatal Medicine Foundation and Department of Perinatal Medicine , Memorial Hospital , Istanbul , Turkey

3. Department of Neuroscience , Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II , Naples , Italy

4. Fetal Medicine Unit, Maternal and Child Health and Development Network, University Hospital 12 de Octubre, Complutense University of Madrid Department of Obstetrics and Gynaecology , Madrid , Spain

5. Department of Obstetrics and Gynaecology , Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell , Hempstead , NY , USA

6. Department of Perinatology and Gynaecology , National Cerebral and Cardiovascular Center , Osaka , Japan

7. Department of Obstetrics and Gynaecology , Medical School University of Zagreb, Sveti Duh University Hospital , Zagreb , Croatia

8. Hospital Universitario Central de Asturias , Asturias , Spain

9. Department of Obstetrics and Gynaecology , Ciudad Real University General Hospital , Ciudad Real , Spain

10. University of Castilla-La Mancha , Ciudad Real , Spain

11. Fetal Medicine Unit, Maternal and Child Health anad Development Network, Gregorio Marañón Hospital, Complutense University of Madrid , Department of Obstetrics and Gynaecology , Madrid , Spain

12. Department of Obstetrics and Gynaecology , School of Medicin, Magna Graecia University of Catanzaro , Catanzaro , Italy

13. University of Roma Tor Vergata, Division of Maternal Fetal Medicine, Ospedale Cristo Re Roma , Rome , Italy

14. Department of Obstetrics and Gynaecology The First I.M . Sechenov Moscow State Medical University , Moscow , Russia

15. Department of Obstetrics and Gynaecology , Ospedale AOSG Moscati , Avellino , Italy

16. Department of Gynaecology and Obstetrics , Vivantes Klinikum im Friedrichshain , Berlin , Germany

17. Department of Obstetrics and Gynaecology , University of Parma , Parma , Italy

18. Department of Obstetrics and Gynaecology , Ospedale di San Leonardo , Castellammare di Stabia , Italy

19. Department of Obstetrics and Gynaecology , University of Bologna, Sant’Orsola- Malpighi University Hospital , Bologna , Italy

20. Department of Gynaecologic Oncology , University of Palermo , Palermo , Sicilia , Italy

21. Department of Medical Sciences , Section of Obstetrics and Gynaecology, Azienda Ospedaliera-Universitaria Sant’ Anna, University of Ferrara , Ferrara , Italy

22. Academic Unit of Obstetrics and Gynaecology, IRCCS Ospedale Policlinico , San Martino , Genova , Italy

23. Department of Obstetrics and Gynaecology , “Filippo Del Ponte” Hospita University of Insubria , Varese , Italy

24. Department of Obstetrics and Gynaecology , Fondazione Policlinico Universitario A Gemelli IRCCS - Università Cattolica del Sacro Cuore , Rome , Italy

25. Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore , Rome , Italy

26. Queen Margaret University,Institute for Global Health and Development , Edinburgh , UK

27. Clinic of Obstetrics and Gynaecology, University of Udine , Udine , Italy

28. Department of Obstetrics and Gynaecology , New York Health and Hospitals/Lincoln Bronx , The Bronx , NY , USA

29. Department of Woman, Child and General and Specialized Surgery , University of Campania Luigi Vanvitelli , Naples , Italy

30. Unit of Obstetrics and Gynaecology, Ospedale Maggiore , Bologna , Italy

31. Department of Translational Medicine , University of Eastern Piedmont , Novara , Italy

32. Hospital Castelli , Verbania , Italy

33. UZ Brussel, Universitair Ziekenhuis , Brussel , Belgium

34. University of Milan , Milan , Italy

35. Department of Obstetrics and Gynaecology, Department of Medical and Surgical Sciences , University of Foggia , Foggia , Italy

36. Centre for High Risk Pregnancy and Fetal Care, University of Chieti , Department of Obstetrics and Gynaecology , Chieti , Italy

37. Neonatal Intensive Care Unit, University of Chieti , Chieti Italy

38. Department of Obstetrics and Gynaecology , AOUI Verona, University of Verona , Verona , Italy

39. Maternal and Child Health Department , Santa Maria Hospital , Terni , Italy

40. Fundación Valle del Lili,Tertiary Obstetric Unit , Cali , Colombia

41. Postgraduate Department , Universidad Icesi , Cali , Colombia

42. Department of Obstetrics and Gynaecology , University Hospital Brugmann, Université Libre de Bruxelles , Brussels , Belgium

43. Department of Obstetrics and Gynaecology , Centro Hospitalar e Universitário São João , Porto , Portugal

44. Servicio de Obstetricia y Ginecología, Hospital Universitario y Politécnico La Fe , Valencia , Spain

45. Hospital Regional Universitario de Málaga , Malaga , Spain

46. Department of Obstetrics and Gynaecology , Istanbul University-Cerrahpasa Medical School , Istanbul , Turkey

47. Department of Obstetrics and Gynaecology , Sant’Anna Hospital, University of Turin , Turin , Italy

48. Hospital Universitario de Móstoles , Mostoles , Spain

49. Departamento de Ginecologia e Obstetrícia , Hospital Universitário Polydoro Ernani , Santiago , Brazil

50. Bursa City Hospital , Bursa , Turkey

51. Department of Obstetrics and Gynaecology , University of Dicle , Diyarbakır , Turkey

52. Hisar Intercontinental Hospital , Istanbul , Turkey

53. Department of Anaesthesia , Lyell McEwin Hospital , Adelaide , Australia

54. University Clinic of Obstetrics and Gynaecology , Skopje , North Macedonia

55. Ospedale Generale Regionale “F. Miulli” , Acquaviva delle Fonti , Italy

56. Batman Maternity and Child Health Hospital , Batman , Turkey

57. Alexandra Hospital – National and Kapodistrian, University of Athens , Athens , Greece

58. Assistência Obstétrica do Grupo Perinatal , Rio de Janeiro , Brazil

59. Hospital Raul F. Larcade , Buenos Aires , Argentina

60. Alvaro Cunqueiro University Hospital of Vigo , Vigo , Spain

61. Karaman Public Hospital , Karaman , Turkey

62. Department of Obstetrics and Gynaecology , Division of Neonatology, General Hospital in Prague and First Faculty of Medicine,Charles University , Prague , Czech Republic

63. Hospital Universitari Germans Trias i Pujol , Barcelona , Spain

64. American Hospital , Istanbul , Turkey

65. Department of Obstetrics and Gynaecology , Saint John Hospital, UMF Carol Davila , Bucharest , Romania

66. Asklepios Hospital Barmbek , Hamburg , Germany

67. Regional Hospital Gjakova , Kosovo , Republic of Kosovo

68. Department of Obstetrics and Gynaecology , University of Messina , Messina , Italy

69. Academic Division of Obstetrics and Gynaecolog, Mauriziano Umberto I Hospital, University of Turin , Turin , Italy

70. Universitatea de Medicină și Farmacie Grigore T. Popa Iași , Iasi , Romania

71. Department of Obstetrics and Gynaecology , Hospital Erasme, Cliniques Universitaires de Bruxells , Brussels , Belgium

72. Hospital Virgen De La Luz , Cuenca , Spain

73. Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva and Sackler Faculty of Medicine, Tel-Aviv University , Tel-Aviv , Israel

74. Instituto Nacional Materno Perinatal , Lima , Peru

75. Centro de Educación Médica e Investigaciones Clínicas “Norberto Quirno” , Buenos Aires , Argentina

76. Department of Obstetrics, Gynaecology and Reproductive Science , University of Maryland Medical Center , Baltimore , MD , USA

77. Department Gynaecology and Obstetrics , Fornaroli Hospital , Magenta , Italy

78. University Clinic Hospital Of Valladolid , Valladolid , Spain

79. Kbc Dr Dragisa Misovic Dedinje Belgrade , Beograd , Serbia

80. Department of Perinatology , University Medical Center, Medical Faculty, University of Ljubljana , Ljubljana , Slovenia

81. Fetal Medicine Unit, Di Venere Hospital , Bari , Italy

82. Department of Obstetrics and Gynaecology , Neonatology and Intensive Care, Helsinki University Hospital and University of Helsinki , Helsinki , Finland

83. National Medical Research Center for Obstetrics, Gynaecology and Perinatology , Moscow , Russia

84. Department of Woman’ and Child’s Health , University of Padova , Padova , Italy

85. Campus Bio Medico, University of Rome , Rome , Italy

86. Department of General Surgery and Medical Surgical Specialties , University of Catania , Catania , Italy

87. Ospedale Maggiore Policlinico Milano , Milan , Italy

88. University of Salerno , Salerno , Italy

89. Maternal Fetal Medicine Division, Sidney Kimmel Medical College at Thomas Jefferson University , Obstetrics and Gynaecology Department , Philadelphia , PA , USA

90. Department of Medical Sciences , University of Ferrara , Ferrara , Italy

Abstract

Abstract Objectives 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. Methods 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). Results 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. Conclusions 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.

Publisher

Walter de Gruyter GmbH

Subject

Obstetrics and Gynaecology,Pediatrics, Perinatology, and Child Health

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3