SARS-CoV-2 Infection During Pregnancy.

BACKGROUND: Using data from the German CRONOS registry, we assessed the risk of a complicated course of COVID-19 in women with a SARS-CoV-2-infection during pregnancy, with particular consideration of gestational age, vaccination status, and pandemic dynamics. METHODS: Data acquired in two separate periods (March 2020 to August 2021; January to June 2022) for CRONOS, a prospective, hospital-based observational study (DRKS00021208), were studied with logistic regression models. Odds ratios comparing 32 with 22 weeks of gestation were calculated for relevant COVID-19-specific events occurring within 4 weeks of a positive test result. RESULTS: Data from 3481 women were evaluated. The risk of all of the defined COVID-19-specific events was low among women who became ill with COVID-19 during the first trimester and rose with increasing gestational age into the early third trimester. For example, the odds ratio for hospitalization because of a COVID-19 infection, comparing 32 versus 22 weeks of gestation, was 1.4 (95% confidence interval [1.2; 1.7]). This risk was lower in the second period of data acquisition than in the first (OR 0.66; 95% CI [0.50; 0.88]), and it was even lower if the pregnant patient had been vaccinated against COVID-19 (OR 0.27; 95% CI [0.18; 0.41]). CONCLUSION: These findings can serve as a basis for counseling about prophylactic or therapeutic measures, such as the administration of monoclonal antibodies. They underscore the efficacy of vaccination for pregnant women even during the omicron phase of the pandemic.

Antibody Response and Maternofetal Antibody Transfer in SARS-CoV-2-Positive Pregnant Women: A Multicenter Observational Study.

Introduction Awareness of SARS-CoV-2 infection in pregnant women and the potential risk for infection of their neonates is increasing. The aim of this study was to examine the immune status of affected women and evaluate the dynamics of placental antibody transfer. Materials and Methods The study included 176 women with SARS-CoV-2 infection during pregnancy who delivered between April 2020 and December 2021 at eight obstetric maternity sites. Demographic data, maternal and neonatal characteristics were summarized. Antibody testing for IgA and IgG in maternal blood sera and umbilical cord samples was evaluated and IgG transfer ratios were calculated. Values were related to the time of infection during pregnancy and birth. Results The percentage of IgG positive women increased from 29.0% (95% CI 23.8 - 37.8) at presentation with a positive PCR test result to 75.7% (95% CI 71.6 - 79.8), the percentage of IgG positive umbilical cord blood samples increased from 17.1% (95% CI 13.0 - 21.3) to 76.4% (95% CI 72.2 - 80.7) at more than six weeks after infection. Regression lines differed significantly between maternal and fetal IgG responses (p < 0.0001). Newborns react with a latency of about one week; umbilical cord blood antibody concentrations are highly correlated with maternal concentration levels (ρ = 0.8042; p < 0.0001). IgG transplacental transfer ratios were dependent on infection-to-birth interval. Two of the umbilical cord blood samples tested positive for IgA. Conclusions These findings confirm vertical SARS-CoV-2 transmission is rare; however, antibodies are transferred to the fetus soon after infection during pregnancy. Since transplacental antibody transfer might have a protective value for neonatal immunization this information may be helpful when counseling affected women.

Antibody Response and Maternofetal Antibody Transfer in SARS-CoV-2-Positive Pregnant Women: A Multicenter Observational Study Immunantwort und Antikörper-Transfer zwischen Mutter und Kind bei schwangeren Frauen mit SARS-CoV-2-Infektion: eine multizentrische Beobachtungsstudie

Introduction Awareness of SARS-CoV-2 infection in pregnant women and the potential risk for infection of their neonates is increasing. The aim of this study was to examine the immune status of affected women and evaluate the dynamics of placental antibody transfer. Materials and Methods The study included 176 women with SARS-CoV-2 infection during pregnancy who delivered between April 2020 and December 2021 at eight obstetric maternity sites. Demographic data, maternal and neonatal characteristics were summarized. Antibody testing for IgA and IgG in maternal blood sera and umbilical cord samples was evaluated and IgG transfer ratios were calculated. Values were related to the time of infection during pregnancy and birth. Results The percentage of IgG positive women increased from 29.0% (95% CI 23.8 – 37.8) at presentation with a positive PCR test result to 75.7% (95% CI 71.6 – 79.8), the percentage of IgG positive umbilical cord blood samples increased from 17.1% (95% CI 13.0 – 21.3) to 76.4% (95% CI 72.2 – 80.7) at more than six weeks after infection. Regression lines differed significantly between maternal and fetal IgG responses (p < 0.0001). Newborns react with a latency of about one week;umbilical cord blood antibody concentrations are highly correlated with maternal concentration levels (ρ = 0.8042;p < 0.0001). IgG transplacental transfer ratios were dependent on infection-to-birth interval. Two of the umbilical cord blood samples tested positive for IgA. Conclusions These findings confirm vertical SARS-CoV-2 transmission is rare;however, antibodies are transferred to the fetus soon after infection during pregnancy. Since transplacental antibody transfer might have a protective value for neonatal immunization this information may be helpful when counseling affected women.

[COVID-19 and pregnancy]. / COVID-19 und Schwangerschaft: Fallserie mit der Komorbidität Diabetes aus der Registerstudie "Covid-19 Related Obstetric and Neonatal Outcome Study" (CRONOS).

From March 3 to October 13, 2020, 27 cases with diabetes comorbidity have been recorded in the CRONOS registry (Covid-19 Related Obstetric and Neonatal Outcome Study in Germany) among 262 registered women with SARS-CoV­2 infection during their pregnancy. Of those, 21 presented with gestational diabetes, 5 with type 2 diabetes and 1 with type 1 diabetes. About half of the women were asymptomatic and were diagnosed via general screening at hospital admission. The most common symptoms were nasal congestion, cough, tiredness, malaise and changes in smell and taste. The majority of pregnant women showed a mild to moderate course, three women were admitted to the intensive care unit and none required invasive ventilation. In the type 2 diabetes group, there were two cases with late fetal death (37 and 40 weeks of gestation) and one with a malformation, an association with diabetes being most likely. Pregnant women with diabetes mellitus represent a special subgroup; 1 in 10 women in this small cohort required intensive care monitoring due to COVID-19. In addition, this case series underscores the need for unrestricted access to pregnancy care, especially in times of pandemic, for optimal perinatal outcome.

COVID-19 und Schwangerschaft

ZusammenfassungVom 03.03.–13.10.2020 wurden im CRONOS-Register („COVID-19 Related Obstetric and Neonatal Outcome Study in Germany“) 27 Fälle mit der Komorbidität Diabetes unter 262 registrierten Schwangeren mit intragravide gesicherter SARS-CoV-2(„severe acute respiratory syndrome coronavirus type 2“)-Infektion erfasst. Von diesen hatten 21 Gestationsdiabetes, 5 Typ-2-Diabetes und 1 Typ-1-Diabetes. Etwa die Hälfte der Frauen war asymptomatisch und wurde durch ein generelles SARS-CoV-2-Screening bei Krankenhausaufnahme entdeckt. Die häufigsten Symptome waren Schnupfen, Husten, Müdigkeit, Malaise und verändertes Geruchs- und Geschmacksempfinden. Die Mehrzahl der Schwangeren zeigte einen milden bis moderaten Verlauf, 3 Frauen wurden auf die Intensivstation aufgenommen;keine musste invasiv beatmet werden. In der Gruppe mit Typ-2-Diabetes traten 2 Fälle mit spätem intrauterinem Fruchttod (37 und 40 Schwangerschaftswochen [SSW]) und 1 Fall mit einer Fehlbildung auf, wobei eine Assoziation mit dem Diabetes am wahrscheinlichsten ist. Schwangere mit Diabetes mellitus stellen eine besonderes zu berücksichtigende Subgruppe dar;1 von 10 Frauen in dieser kleinen Kohorte bedurfte einer intensivmedizinischen Überwachung aufgrund COVID-19. Darüber hinaus unterstreicht diese Fallserie die Notwendigkeit eines uneingeschränkten Zugangs zu einer intensiven Schwangerenbetreuung für ein optimales perinatales Outcome insbesondere in Zeiten der Pandemie.