SARS-CoV-2 infection during pregnancy and the risk of adverse maternal outcomes in the Republic of Georgia: a national birth registry-based cohort study (preprint)

Importance Georgia experienced an increase in maternal mortality (MM) during the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic, which warrants further investigation.Objective This study aimed to assess associations between SARS-CoV-2 infection during pregnancy and MM, post-delivery intensive care unit (ICU) admission, and caesarean section (CS) delivery.Methods We performed a national birth registry-based cohort study including pregnant women who delivered between February 28, 2020 and August 31, 2022. Data was linked with Coronavirus disease (COVID-19) testing, vital, and immunization registries. Pregnant women were classified into three groups: confirmed SARS-CoV-2 infection from conception through 31 days before delivery, confirmed infection in the 30 days before or at delivery, and women negative for SARS-CoV-2 infection or without any test results (reference group). Multivariable logistic regression was used to calculate adjusted odds ratios (aOR) and 95% confidence intervals (CIs).Results Among 111,278 pregnant women, 16,661 had confirmed infection during pregnancy; 7,304 were fully vaccinated against COVID-19. Compared to the reference group, those with confirmed infection in the 30 days before or at delivery experienced increased odds of MM (aOR: 45.5, 95% CI, 23.1–89.3), post-delivery ICU admission (aOR: 5.62, 95% CI, 4.37–7.22), and CS delivery (aOR: 1.12, 95% CI, 1.03–1.21).Conclusions Hence, pregnant women in Georgia with confirmed SARS-CoV-2 infection in the 30 days before or at delivery conferred an alarmingly higher risk of MM and post-delivery ICU admission. Additionally, results highlight that most women were not vaccinated against COVID-19. These findings should signal to stakeholders that adherence to public health preventive measures needs to be improved.

The impact of COVID-19-related restrictions on pregnancy and abortion rates in the Republic of Georgia (preprint)

Background:The Republic of Georgia implemented COVID-19-related restrictions starting on 31 March 2020, when it imposed a 1-month strict lockdown, after which the country continued with some form of restrictions for 1 year. These restrictions created barriers to healthcare access, affected healthcare services, caused severe economic degradation, and changed people’s behavior. The aim of this study was to explore the impact of COVID-19-related restrictions on pregnancy and abortion rates in Georgia. Methods: Information on pregnancy, abortion, and related variables was extracted from the Georgian Birth Registry from January 2018 through April 2022. The final study sample included 232,594 pregnancies and 86,729 abortions. We used interrupted time series analysis to study the impact of COVID-19-related restrictions. Results: There were slightly decreasing trends in pregnancy and abortion rates in the pre-pandemic period. During the 1-month strict lockdown, pregnancy and abortion rates decreased in all investigated age groups. There were no substantial differences in pregnancy or abortion rates in the pandemic period compared to the pre-pandemic period. The precision of all estimates suggested that both small increases and decreases in pregnancy and abortion rates are reasonably compatible with our data. Conclusions: Despite the 1-year-long COVID-19-related restrictions, our results did not indicate substantial long-term changes in pregnancy or abortion rates during the study period for any age group. This may indicate that the restrictions did not substantially influence access to contraception, abortion services, or women’s behavior.