The impact of acute and prior SARS-CoV-2 infection on maternal and neonatal outcomes in pregnant women: a single-center retrospective cohort study

Abstract

Abstract Background Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection during pregnancy have an adverse impact on perinatal outcomes, including cesarean section, preterm birth, fetal distress. However, it’s uncertain whether these adverse consequences are caused by acute viral infection or post-acute impact of viral infection. Methods We conducted a single-center retrospective cohort study among pregnant women with singleton pregnancy who delivered between 1 December 2022 and 1 February 2023 (n = 2472). The clinical data for mothers and neonates came from medical records on internal healthcare system. Follow-up time spanned from admission to discharge. We investigated the impact of acute and prior SARS-CoV-2 infection on maternal and neonatal outcome. Multivariable logistic models were used to assess the risk of adverse perinatal outcome in pregnant women with acute and prior SARS-CoV-2 infection. Results Compared to the non-infected pregnant women, acute SARS-CoV-2 infected pregnant women had significant higher rates of intrahepatic cholestasis of pregnancy (ICP) (26 women [4.4%] vs. 8 women [1.0%]; aOR, 4.9 [95% CI, 2.2–11.0]; P < 0 .001), preterm birth (༜37 wk) (53women [9.0%] vs. 45 women [5.7%]; aOR, 1.7 [95% CI, 1.1–2.7]; P < 0.05), fetal distress(106 women [18.1%] vs. 82 women [10.4%]; aOR,1.9 [95% CI, 1.4–2.6]; P < 0 .01), first-cesarean section (216 women [36.9%] vs. 239women [30.3%]; aOR, 1.4[95% CI, 1.1–1.8]; P < 0.01) and neonatal unit admission (69 neonates [12%] vs. 64 neonates [8.3%]; aOR, 1.6 [95% CI, 1.1–2.3]; P < 0.05), prior SARS-CoV-2 infection were associated with an increased risk of ICP (40 women [3.7%] vs. 8 women [1.0%]; aOR, 3.9 [95% CI, 1.8–8.5]; P < 0 .001). Conclusions Pregnant women with acute SARS-CoV-2 infection was associated with higher risk of ICP, preterm birth, fetal distress, first-cesarean section and neonatal unit admission. Prior SARS-CoV-2 infection in pregnant women was associated with higher risk ICP. These findings emphasize the need for optimization of strategies for prevention of SARS-CoV-2 infection in pregnant women, especially for acute infection at delivery.