Active Intrapartum SARS-CoV-2 Infection and Pregnancy Outcomes

Marta C Nunes; Stephanie Jones; Renate Strehlau; Vuyelwa Baba; Zanele Ditse; Kelly da Silva; Lané Bothma; Natali Serafin; Vicky L Baillie; Gaurav Kwatra; Megan Burke; Amy Wise; Mary Adam; Philiswa Mlandu; Mpolokeng Melamu; Juliette Phelp; Wendy Fraser; Colleen Wright; Elizabeth Zell; Yasmin Adam; Shabir A Madhi

doi:10.1055/s-0042-1757274

Active Intrapartum SARS-CoV-2 Infection and Pregnancy Outcomes

Am J Perinatol. 2022 Dec;39(S 01):S42-S48. doi: 10.1055/s-0042-1757274. Epub 2022 Oct 28.

Authors

Marta C Nunes^{1

2}, Stephanie Jones^{1

2}, Renate Strehlau³, Vuyelwa Baba⁴, Zanele Ditse^{1

2}, Kelly da Silva^{1

2}, Lané Bothma¹, Natali Serafin^{1

2}, Vicky L Baillie^{1

2}, Gaurav Kwatra^{1

2}, Megan Burke³, Amy Wise⁵, Mary Adam⁴, Philiswa Mlandu⁴, Mpolokeng Melamu⁴, Juliette Phelp⁴, Wendy Fraser⁶, Colleen Wright^{6

7}, Elizabeth Zell⁸, Yasmin Adam⁴, Shabir A Madhi^{1

2

9}

Affiliations

¹ South African Medical Research Council, Vaccines, and Infectious Diseases Analytics (VIDA) Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
² Department of Science and Technology/National Research Foundation, South African Research Chair Initiative in Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
³ Nkanyezi Research Unit Sub-Division of VIDA, Department of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
⁴ Department of Obstetrics and Gynecology, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
⁵ Department of Obstetrics and Gynecology, Rahima Moosa Mother and Child Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
⁶ Lancet Laboratories, Johannesburg, Gauteng, South Africa.
⁷ Division of Anatomical Pathology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa.
⁸ Stat-Epi Associates, Inc., Ponte Vedra Beach, Florida.
⁹ African Leadership in Vaccinology Expertise, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.

PMID: 36307090
DOI: 10.1055/s-0042-1757274

Abstract

Objective: Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection during pregnancy has been associated with poor pregnancy outcomes. There is, however, not much information on the impact of the timing of SARS-CoV-2 infection on pregnancy outcomes, and studies from low-middle income settings are also scarce.

Study design: We conducted a cross-sectional study from April to December 2020, in South Africa, to assess the association of SARS-CoV-2 infection on a nasal swab at the time of labor with fetal death, preterm birth, low birth weight, or pregnancy-induced complications. When possible, maternal blood, cord blood, and placenta were collected. SARS-CoV-2 infection was investigated by a nucleic acid amplification test (NAAT).

Results: Overall, 3,117 women were tested for SARS-CoV-2 on a nasal swab, including 1,562 (50%) healthy women with uncomplicated term delivery. A positive NAAT was detected among 132 (4%) women. Adverse birth outcomes or pregnancy-related complications were not associated with SARS-CoV-2 infection at the time of labor. Among SARS-CoV-2-infected women, an NAAT-positive result was also obtained from 6 out of 98 (6%) maternal blood samples, 8 out of 93 (9%) cord-blood samples, 14 out of 54 (26%) placentas, and 3 out of 22 (14%) nasopharyngeal swabs from newborns collected within 72 hours of birth. Histological assessment of placental tissue revealed that women with SARS-CoV-2 nasal infection had a higher odds (3.82, 95% confidence interval: 1.20, 12.19) of chronic chorioamnionitis compared with those without SARS-CoV-2 infection.

Conclusion: Our study demonstrates that intrapartum, SARS-CoV-2 infection was not associated with evaluated poor outcomes. In utero fetal and placental infections and possible vertical and/or horizontal viral transfer to the newborn were detected among women with nasal SARS-CoV-2 infection.

Key points: · Intrapartum SARS-CoV-2 infection was not associated with evaluated poor outcomes.. · In utero fetal and placental infections were detected among women with nasal SARS-CoV-2 infection.. · Women with SARS-CoV-2 nasal infection had a higher odds of chronic chorioamnionitis..

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

COVID-19*
Chorioamnionitis* / pathology
Cross-Sectional Studies
Female
Humans
Infant, Newborn
Infectious Disease Transmission, Vertical
Male
Placenta / pathology
Pregnancy
Pregnancy Complications, Infectious*
Pregnancy Outcome
Premature Birth* / pathology
SARS-CoV-2