COVID-19 while pregnant increased many infant health problems by 1.5X – April 29, 2021

Association of Maternal SARS-CoV-2 Infection in Pregnancy With Neonatal Outcomes

JAMA. doi:10.1001/jama.2021.5775
Mikael Norman, MD1,2,3; Lars Navér, MD1,2; Jonas Söderling, PhD4; et alMia Ahlberg, PhD4,5; Helena Hervius Askling, MD6; Bernice Aronsson, MD7; Emma Byström, MSc7; Jerker Jonsson, MD7; Verena Sengpiel, MD8,9; Jonas F. Ludvigsson, MD10,11; Stellan Håkansson, MD3,12; Olof Stephansson, MD4,5

 Download the PDF from Vitamin D Life

Key Points

• Question What are the outcomes in newborn infants of mothers testing positive for SARS-CoV-2 in pregnancy?
• Findings In this nationwide, prospective cohort study that included 88 159 infants from Sweden, SARS-CoV-2 infection in pregnancy was significantly associated with higher risk of any neonatal respiratory disorder (2.8% vs 2.0%; odds ratio, 1.42) and some other neonatal morbidities, but not neonatal mortality (0.30% vs 0.12%; odds ratio, 2.55).
• Meaning Maternal SARS-CoV-2 infection in pregnancy was significantly associated with small increases in the absolute risk of respiratory disorders and some other neonatal morbidities.

Importance The outcomes of newborn infants of women testing positive for SARS-CoV-2 in pregnancy is unclear.

Objective To evaluate neonatal outcomes in relation to maternal SARS-CoV-2 test positivity in pregnancy.

Design, Setting, and Participants Nationwide, prospective cohort study based on linkage of the Swedish Pregnancy Register, the Neonatal Quality Register, and the Register for Communicable Diseases. Ninety-two percent of all live births in Sweden between March 11, 2020, and January 31, 2021, were investigated for neonatal outcomes by March 8, 2021. Infants with malformations were excluded. Infants of women who tested positive for SARS-CoV-2 were matched, directly and using propensity scores, on maternal characteristics with up to 4 comparator infants.

Exposures Maternal test positivity for SARS-CoV-2 in pregnancy.

Main Outcomes and Measures In-hospital mortality; neonatal resuscitation; admission for neonatal care; respiratory, circulatory, neurologic, infectious, gastrointestinal, metabolic, and hematologic disorders and their treatments; length of hospital stay; breastfeeding; and infant test positivity for SARS-CoV-2.

Results Of 88 159 infants (49.0% girls), 2323 (1.6%) were delivered by mothers who tested positive for SARS-CoV-2. The mean gestational age of infants of SARS-CoV-2–positive mothers was 39.2 (SD, 2.2) weeks vs 39.6 (SD, 1.8) weeks for comparator infants, and the proportions of

• preterm infants (gestational age <37 weeks) were 205/2323 (8.8%) among infants of SARS-CoV-2–positive mothers and 4719/85 836 (5.5%) among comparator infants.

After matching on maternal characteristics, maternal SARS-CoV-2 test positivity was significantly associated with

• admission for neonatal care (11.7% vs 8.4%; odds ratio [OR], 1.47; 95% CI, 1.26-1.70) and with
• neonatal morbidities such as respiratory distress syndrome (1.2% vs 0.5%; OR, 2.40; 95% CI, 1.50-3.84), any
• neonatal respiratory disorder (2.8% vs 2.0%; OR, 1.42; 95% CI, 1.07-1.90), and
• hyperbilirubinemia (3.6% vs 2.5%; OR, 1.47; 95% CI, 1.13-1.90).

Mortality (0.30% vs 0.12%; OR, 2.55; 95% CI, 0.99-6.57), breastfeeding rates at discharge (94.4% vs 95.1%; OR, 0.84; 95% CI, 0.67-1.05), and length of stay in neonatal care (median, 6 days in both groups; difference, 0 days; 95% CI, −2 to 7 days) did not differ significantly between the groups. Twenty-one infants (0.90%) of SARS-CoV-2–positive mothers tested positive for SARS-CoV-2 in the neonatal period; 12 did not have neonatal morbidity, 9 had diagnoses with unclear relation to SARS-CoV-2, and none had congenital pneumonia.

Conclusions and Relevance In a nationwide cohort of infants in Sweden, maternal SARS-CoV-2 infection in pregnancy was significantly associated with small increases in some neonatal morbidities. Given the small numbers of events for many of the outcomes and the large number of statistical comparisons, the findings should be interpreted as exploratory.