Clinical Implications of SARS-CoV-2 Infection in the Viable Preterm Period
28 May 2020
03 June 2020
02 July 2020 (online)
Objective This study aimed to determine the rate of preterm birth (PTB) during hospitalization among women diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) between 23 and 37 weeks of gestation and whether this rate differs by gestational age at diagnosis of infection.
Study Design Retrospective, cross-sectional study of all women diagnosed with SARS-CoV-2 infection between 23 and 37 weeks of gestation within a large integrated health system from March 13 to April 24, 2020. Cases with severe fetal structural malformations detected prior to infection were excluded. Women were stratified into two groups based on gestational age at diagnosis: early preterm (230/7 to 336/7 weeks) versus late preterm (34 to 366/7 weeks). We compared the rate of PTB during hospitalization with infection between the two groups. Statistical analysis included use of Wilcoxon rank sum and Fisher exact tests, as well as a multivariable logistic regression. Statistical significance was defined as a p-value <0.05.
Results Of the 65 patients included, 36 (53.7%) were diagnosed in the early preterm period and 29 (46.3%) were diagnosed in the late preterm period. Baseline demographics were similar between groups. The rate of PTB during hospitalization with infection was significantly lower among women diagnosed in the early preterm period compared with late preterm (7/36 [19.4%] vs. 18/29 [62%], p-value = 0.001). Of the 25 patients who delivered during hospitalization with infection, the majority were indicated deliveries (64%, 16/25). There were no deliveries <33 weeks of gestation for worsening coronavirus disease 2019 and severity of disease did not alter the likelihood of delivery during hospitalization with SARS-CoV-2 infection (adjusted odds ratio [aOR]: 0.64; 95% confidence interval [CI]: 0.24–1.59). Increased maternal age was associated with a lower likelihood of delivery during hospitalization with SARS-CoV-2 infection (aOR: 0.77; 95% CI: 0.58–0.96), while later gestational age at diagnosis of infection was associated with a higher likelihood of delivery during hospitalization (aOR: 2.9; 95% CI: 1.67–8.09).
Conclusion The likelihood of PTB during hospitalization with SARS-CoV-2 infection is significantly lower among women diagnosed in the early preterm period compared with late preterm. Most women with SARS-CoV-2 infection in the early preterm period recovered and were discharged home. The majority of PTB were indicated and not due to spontaneous preterm labor.
Preterm delivery is less likely among women diagnosed in the early preterm compared with late preterm.
Most women infected in the early preterm period recovered and were discharged home undelivered.
The majority of preterm birth were indicated and not due to spontaneous preterm labor.
- 1 World Health Organization. WHO coronavirus disease (COVID-19) situation report – 51. Available at: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200311-sitrep-51-covid-19.pdf?sfvrsn=1ba62e57_10 . Accessed May 14, 2020
- 2 World Health Organization. WHO coronavirus disease (COVID-19) situation report – 115. Available at: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200514-covid-19-sitrep-115.pdf?sfvrsn=3fce8d3c_6 . Accessed May 14, 2020
- 3 World Health Organization. WHO coronavirus disease 2019 (COVID-19) situation report – 46. Available at: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200306-sitrep-46-covid-19.pdf?sfvrsn=96b04adf_4 . Accessed May 14, 2020
- 4 United Nations Children's Fund (UNICEF). Committing to child survival: a promise renewed. Progress Report 2014. New York, NY: UNICEF; 2014
- 5 United Nations Inter-agency Group for Child Mortality Estimation (UN IGME). Levels & trends in child mortality. Report 2014. New York, NY: UNICEF; 2014
- 6 Savitz DA, Blackmore CA, Thorp JM. Epidemiologic characteristics of preterm delivery: etiologic heterogeneity. Am J Obstet Gynecol 1991; 164 (02) 467-471
- 7 Martin JA, Hamilton BE, Sutton PD, Ventura SJ, Mathews TJ, Osterman MJ. Births: final data for 2008. Natl Vital Stat Rep 2010; 59 (01) 1-72 , 3–71
- 8 Hamilton BE, Hoyert DL, Martin JA, Strobino DM, Guyer B. Annual summary of vital statistics: 2010-2011. Pediatrics 2013; 131 (03) 548-558
- 9 Breslin N, Baptiste C, Gyamfi-Bannerman C. , et al. Coronarvirus disease 2019 infection among asymptomatic and symptomatic pregnant women: two weeks of confirmed presentations to an affiliated pair of New York City hospitals. Am J Obstet Gynecol MFM 2020 Doi: 10.1016/j.ajogmf.2020.100118
- 10 Lokken EM, Walker CL, Delaney S. , et al. Clinical characteristics of 46 pregnant women with a SARS-CoV-2 infection in Washington state. Am J Obstet Gynecol 2020 ;S0002-9378(20)30558-5;
- 11 Pierce-Williams RAM, Burd J, Felder L. , et al. Clinical course of severe and critical COVID-19 in hospitalized pregnancies: a US cohort study. Am J Obstet Gynecol MFM 2020 Doi: 10.1016/j.ajogmf.2020.100134
- 12 Yan J, Guo J, Fan C. , et al. Coronavirus disease 2019 (COVID-19) in pregnant women: a report based on 116 cases. Am J Obstet Gynecol 2020 Doi: 10.1016/j.ajog.2020.04.014
- 13 Richardson S, Hirsch JS, Narasimhan M. , et al; and the Northwell COVID-19 Research Consortium. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area. JAMA 2020 Doi: 10.1001/jama.2020.6775
- 14 Blitz MJ, Grünebaum A, Tekbali A. , et al. Intensive care unit admissions for pregnant and non-pregnant women with COVID-19. Am J Obstet Gynecol 2020 ;S0002-9378(20)30528-7 Doi: 10.1016/j.ajog.2020.05.004
- 15 Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese center for disease control and prevention. JAMA 2020 Doi: 10.1001/jama.2020.2648
- 16 Chen H, Guo J, Wang C. , et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet 2020; 395 (10226): 809-815
- 17 Goldenberg RL, Culhane JF, Iams JD, Romero R. Epidemiology and causes of preterm birth. Lancet 2008; 371 (9606): 75-84
- 18 Zhou F, Yu T, Du R. , et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020; 395 (10229): 1054-1062
- 19 Saigal S, Doyle LW. An overview of mortality and sequelae of preterm birth from infancy to adulthood. Lancet 2008; 371 (9608): 261-269