The Burden of COVID-19 in Pregnant Women and Their Newborns

The risks associated with SARS-CoV-2 infection during pregnancy have been poorly defined throughout the pandemic. To elucidate this issue, researchers conducted a prospective, longitudinal, observational study involving 43 hospitals in 18 countries. Beginning in March 2020, 706 pregnant women with COVID-19 were compared with 1424 uninfected pregnant women matched for factors such as gestational age and antenatal care. Demographic characteristics were similar between groups (though overweight was more likely in women with COVID-19 than without [49% and 40%, respectively]).

Women with COVID-19 during pregnancy had higher risk for death than uninfected women, although small absolute numbers led to a wide confidence interval (maternal mortality ratio, 159/10,000 births; relative risk, 22.3; 95% confidence interval, 2.9–172.1). COVID-19 during pregnancy was associated with excess risk for infections requiring antibiotics (RR, 3.4), ICU admission (RR, 5.0), and preeclampsia or eclampsia (RR, 1.8). Infants born to women with COVID-19 were substantially more likely to have severe postnatal complications, including bronchopulmonary dysplasia, hypoxic-ischemic encephalopathy, and intraventricular hemorrhage. Notably, there was no association between breast-feeding and neonatal SARS-CoV-2 positivity.