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ARTICLE
Do timing and severity of gestational COVID-19 impact
perinatal and neonatal outcomes?
Júlia Candel-Pau
1,2
✉, Daniel Suqué-Tusell
1,2
, Sílvia Maya-Enero
1
, Carlos Ramon-Iglesias
1
, Beatriz Valle-del-Barrio
1
and
Maria Ángeles López-Vílchez
1
© The Author(s), under exclusive licence to Springer Nature America, Inc. 2024
OBJECTIVE: To examine the relationship between gestational COVID-19 and perinatal-neonatal outcomes.
STUDY DESIGN: Prospective cohort study. Neonates born at Hospital del Mar (Barcelona) between 2020 and 2022 were classified
into two cohorts according to their mother’s COVID-19 status during pregnancy. Prenatal and postnatal variables were compared
between the COVID-19 and the control cohort, and depending on timing and severity of maternal infection.
RESULTS: We included 2701 neonates and observed higher rates of respiratory distress (5.7% vs 3.3%, p=0.044) and pathological
jaundice (7.7% vs 4.1%, p=0.007) in the COVID-19 cohort, without differences between trimesters. We did not find statistically
significant differences in other perinatal outcomes. The logistic regression analyses showed that maternal COVID-19 was not a risk
factor for prematurity (OR:1.23;CI:0.75–2.03; p=0.407).
CONCLUSIONS: Infants born to mothers with COVID-19 during pregnancy in our hospital showed higher rates of respiratory
distress and pathological jaundice, without increased rates of prematurity or other morbidities.
Journal of Perinatology; https://doi.org/10.1038/s41372-024-02179-9
INTRODUCTION
During the COVID-19 pandemic many questions were raised
concerning the SARS-CoV-2 infection impact on pregnant women
and their newborns. Although pregnant women were considered a
risk group for severe COVID-19, children were quickly reconsidered as
a group with low morbimortality [1,2]. Current evidence suggests that
vertical transmission of SARS-CoV-2 is possible, although rare [3–6].
Postnatal transmission is more frequent, but causes low morbimor-
tality [7] and its incidence can be reduced by following the
recommendations of the Spanish Society of Neonatology (SENEO)
[8]. On the other hand, there is still controversy regarding the perinatal
and neonatal impact of gestational COVID-19 [4]. Some authors report
similar perinatal and neonatal outcomes in COVID-19 affected and
non-affected pregnancies [9–11]. However, many other studies have
reported higher rates of caesarean section [12–22]andprematurity
[12–24], as well as higher admission rates to the neonatal intensive
care unit (NICU) among neonates born to mothers with gestational
COVID-19 [13–18,22,23]. Moreover, increased risk of low Apgar
[14,21], stillbirth [14,23], low birth weight [13,14,16,18,22], and
hyperbilirubinemia [25,26] have also been described. Most of these
studies were conducted during the first months of the pandemic, and
it has been hypothesized that the higher rates could be related to
iatrogenic practices [15]. Regarding other relevant adverse outcomes,
only one systematic review and meta-analysis has reported higher
rates of respiratory distress (RD) requiring support among neonates
born to mothers with COVID-19, without confirmed neonatal COVID-
19 infection but with a possible relation to prematurity with increased
rates of respiratory distress syndrome (RDS) [21].
Given that coexistence with COVID-19 is likely to become
permanent, increasing scientific evidence is crucial to guide
clinical decision-making. Current knowledge about COVID-19 in
the perinatal stage is scarce and studies addressing the relation-
ship between maternal infection and its perinatal and neonatal
impact are heterogeneous and yield contradictory results [4],
differing significantly between countries [27].
We hypothesized that children born to mothers infected with
SARS-CoV-2 during pregnancy do not have worse perinatal or
neonatal outcomes than the rest of the population. The aim of this
study was to examine the clinical outcomes of neonates in a tertiary
hospital in Barcelona during the COVID-19 pandemic and their
relationship with maternal SARS-CoV-2 infection during pregnancy.
Considering the variation in biological events across trimesters of
pregnancy [17,28,29], we further aimed to analyze the influence of
gestational timing of maternal SARS-CoV-2 infection and its severity
on perinatal and neonatal outcomes. This analysis included factors
such as trimester of infection, presence of active maternal infection
at delivery, and severity of maternal symptoms.
MATERIALS AND METHODS
This was a prospective cohort study conducted at Hospital del Mar in
Barcelona, a tertiary care centre with approximately 1400 deliveries per
year. All neonates born in this hospital between March 2020 and May 2022
and their mothers were included. Exclusion criteria were parents’refusal to
participate in the study and transfer to another centre that prevented
follow-up.
Received: 17 July 2024 Revised: 6 November 2024 Accepted: 11 November 2024
1
Department of Neonatology, Service of Pediatrics, Hospital del Mar Barcelona, Universitat Pompeu Fabra, Passeig Marítim 25-29, 08003 Barcelona, Catalonia, Spain.
2
These
authors contributed equally: Júlia Candel-Pau, Daniel Suqué-Tusell ✉email: jcandelpau@psmar.cat
www.nature.com/jp
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