Maternal and perinatal outcomes in women with advanced maternal age affected by SARS-COV-2 infection (Phase-2): The WAPM (World Association of Perinatal Medicine) Working Group on COVID-19.

Objective: To elucidate the role of advanced maternal age (AMA) in determining the outcome of pregnancies complicated by SARSCoV-2 infection. Methods: Multinational cohort study/included women with laboratory-confirmed SARS-CoV-2 infection from 76 centers in 27 different countries in Europe, United States, South America, Asia and Australia from 04 April 2020 till 28 October 2020. The primary outcome was a composite measure of maternal mortahty and morbidity including admission to intensive care unit (ICU), use of mechanical ventilation (defined as intubation, need for continuous positive airway pressure, extra-corporeal membrane oxygenation), severe respiratory/symptoms (including dyspnea and shortness of breath) or death. Results: Eight hundred and eighty/seven pregnant women were included in the study who were positive SARS-CoV-2 results by/RTPCR (reverse transcriptase-polymerase chain reaction) on their nasal and pharyngeal swab specimens (352 with and 652 with no AMA). The risk of composite adverse maternal outcome was higher in AMA group compared to that of under 35 years of age group, with an OR of 1.99 (95% CI 1.4-2.9;p=0.002). Likewise, women >35 years were also at higher risk of hospital admission (OR: 1.88,95% CI 1.4-2.5;pcO.OOl), presence of severe respiratory/symptoms (OR: 1.53, 95% CI 1.0-2.3;=0.04) and/or admission to ICU (OR: 2.00,95% CI 1,1-3.7;p=0.003);owever, no difference was observed in terms of perinatal outcome risk. Conclusion: Advanced maternal age is an independent risk factor for adverse maternal outcome in pregnancies complicated by/SARSCoV-2 infection. Accurate risk stratification of women presenting with suspected SARS-CoV-2 infection in pregnancy/is warranted in order to identify a subset of women who may/benefit from a personalized management, including elective hospitalization and/or prolonged surveillance in order to improve maternal outcome. (English) [ABSTRACT FROM AUTHOR] Amaç: SARS-CoV-2 enfeksiyonu ile komplike gebeliklerin sonucunu belirlemede ileri anne yaşının (ÍAY) rolüne ışık tutmak. Yöntem: Çok uluslu kohort çalışmasına, 4 Nisan 2020 ile 28 Ekim 2020 tarihleri arasında Avrupa, ABD, Güney Amerika, Asya ve Avustralya'daki 27 farkh ülkede bulunan 76 merkezden laboratuvar teyidi SARS-CoV-2 enfeksiyonlu kadınlar dahil edildi. Primer sonuç, yoğum bakım ünitesine (YBÜ) yatış, mekanik ventilasyon kullanımı (entübasyon, sürekli pozitif hava yolu basıncı ihtiyacı, ekstrakorporeal membran oksijenizasyonu olarak tanımlanmıştır), şiddetli respiratuvar semptomlar (dispne ve nefes darlığı dahil) veya ölüm dahil maternal mortalite ve morbiditenin bileşik ölçümüydü. Bulgular: Çahşmaya, nazal ve faringeal sürüntü örneklerinde RTPCR (ters transkriptaz polimeraz zincir reaksiyonu) ile pozitif SARS-CoV-2 sonuçlarına sahip 887 gebe çahşmaya dahil edildi (ileri anne yaşma sahip olan 352 olgu ve ileri anne yaşma sahip olmayan 652 olgu). Bileşik advers maternal sonuç riski, 35 yaş altındaki gruba kıyasla 1.99 OR (olasılık oram) ile (%95 CU 1.4-2.9;p=0.002) IAY grubunda daha yüksekti. Benzer şekilde 35 yaşından büyük kadınlarda da hastaneye yatış (OR: 1.88, %95 GA 1.4-2.5;p<0.001), şiddetli respiratuvar semptom varlığı (OR: 1.53, %95 GA 1.0-2.3;p=0.04) ve/veya YBÜ'yeyatış (OR: 2.00, %95 GA 1.1-3.7;p=0.003) riski daha yüksekti, ancak perinatal sonuç riski bakımından hiçbir fark bulunmadı. Sonuç: Íleri anne yaşı, SARS-CoV-2 enfeksiyonuyla komplike gebeliklerde advers maternal sonuç için bağımsız bir risk faktörüdür. Maternal sonucu iyileştirebilmek için, elektif hospitalizasyon ve/veya uzun süreli takip dahil kişiselleştirilmiş bir yönetimden faydalanabilecek kadınların alt kümesini tespit edebilmek amacıyla gebelikte SARS-CoV-2 enfeksiyonu olduğundan şüphelenilen kadınlarda doğru risk sınıflandırması gereklidir. (Turkish) [ABSTRACT FROM AUTHOR] Copyright of Perinatal Journal / Perinatoloji Dergisi is the property of Deomed Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Maternal and perinatal outcomes in high compared to low risk pregnancies complicated by severe acute respiratory syndrome coronavirus 2 infection (phase 2): the World Association of Perinatal Medicine working group on coronavirus disease 2019.

BACKGROUND: It has still to be ascertained whether severe acute respiratory syndrome coronavirus 2 infection in pregnancy is associated with worse maternal and fetal outcomes compared to low risk gestations. OBJECTIVE: This study aimed to evaluate maternal and perinatal outcomes in high- and low-risk pregnancies complicated by severe acute respiratory syndrome coronavirus 2 infection. STUDY DESIGN: This was a multinational retrospective cohort study involving women with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection from 76 centers from 25 countries in Europe, the United States, South America, Asia, and Australia from April 4, 2020, to October 28, 2020. The primary outcome was a composite measure of maternal mortality and morbidity, including admission to the intensive care unit, use of mechanical ventilation, or death. The secondary outcome was a composite measure of adverse perinatal outcome, including miscarriage, fetal loss, neonatal and perinatal death, and admission to the neonatal intensive care unit. All outcomes were assessed in high- and low-risk pregnancies. Pregnancies were considered high risk in case of either preexisting chronic medical conditions in pregnancy or obstetrical disorders occurring in pregnancy. The Fisher exact test and logistic regression analysis were used to analyze the data. RESULTS: A total of 887 singleton pregnancies who tested positive for severe acute respiratory syndrome coronavirus 2 infection using reverse transcription-polymerase chain reaction of nasal and pharyngeal swab specimens were included in the study. The risk of composite adverse maternal outcomes was higher in high-risk pregnancies than in low-risk pregnancies (odds ratio, 1.52; 95% confidence interval, 1.03-2.24; P=.035). In addition, women carrying high-risk pregnancies were at higher risk of hospital admission (odds ratio, 1.48; 95% confidence interval, 1.07-2.04; P=.002), presence of severe respiratory symptoms (odds ratio, 2.13; 95% confidence interval, 0.41-3.21; P=.001), admission to the intensive care unit (odds ratio, 2.63; 95% confidence interval, 1.42-4.88), and invasive mechanical ventilation (odds ratio, 2.65; 95% confidence interval, 1.19-5.94; P=.002). When exploring perinatal outcomes, high-risk pregnancies were at high risk of adverse perinatal outcomes (odds ratio, 1.78; 95% confidence interval, 0.15-2.72; P=.009). However, such association was mainly because of the higher incidence of miscarriage in high-risk pregnancies compared with that in low-risk pregnancies (5.3% vs 1.6%, P=.008); furthermore, there was no difference in other explored outcomes between the 2 study groups. At logistic regression analysis, maternal age (odds ratio, 1.12; 95% confidence interval, 1.02-1.22; P=.023) and high-risk pregnancy (odds ratio, 4.21; 95% confidence interval, 3.90-5.11; P<.001) were independently associated with adverse maternal outcomes. CONCLUSION: High-risk pregnancies complicated by severe acute respiratory syndrome coronavirus 2 infection were at higher risk of adverse maternal outcomes than low-risk pregnancies complicated by severe acute respiratory syndrome coronavirus 2 infection.

Seroprevalence analysis of SARS-CoV-2 in pregnant women along the first pandemic outbreak and perinatal outcome.

OBJECTIVES: To evaluate the progression of the seroprevalence of SARS-CoV-2 in the pregnant population of the south of Madrid during the first wave of the COVID-19 pandemic. Secondarily we aimed to evaluate maternal and perinatal outcomes. STUDY DESIGN: Retrospective cohort study conducted at Hospital Universitario 12 de Octubre during weeks 10 to 19 of 2020, coinciding with the Spanish lockdown. We tested 769 serum samples obtained from routine serological testing during the first and third trimesters of pregnancy for specific IgG anti SARS-CoV-2 RBD and S proteins. RT-PCR tests were performed in suspected cases according to clinical practice. We compared maternal and perinatal outcomes in those with delivered pregnancies (n = 578) according to the presence or absence of specific IgG antibodies. Those with positive IgG were subdivided by the presence or absence of Covid-19 related symptoms at any time and the results of RT-PCR testing if performed. Therefore, we had 4 study groups: G1 (IgG negative), G2 (IgG positive, asymptomatic, RT-PCR testing negative or not done), G3 (IgG positive, symptomatic, RT-PCR testing negative or not done), and G4 (IgG positive, symptomatic, RT-PCR positive). RESULTS: Seropositivity increased from 0% to 21.4% (95% CI 11.8-31.0) during the study period, of which 27.9% had an asymptomatic course. Overall outcomes were favorable with a significant increased rate of preterm birth in G4 vs G1 (21.4% vs 6.7%) and cesarean/operative delivery (50% vs 26.9%). Asymptomatic and mild cases did not have differences regarding pregnancy course when compared to seronegative women. There were no documented cases of vertical or horizontal transmission. CONCLUSION: Seroprevalence in pregnant women in southern Madrid went up to 21.4% of which 27.9% had an asymptomatic course. Overall perinatal results were favorable, especially in those asymptomatic.

Risk factors associated with adverse fetal outcomes in pregnancies affected by Coronavirus disease 2019 (COVID-19): a secondary analysis of the WAPM study on COVID-19.

Objectives To evaluate the strength of association between maternal and pregnancy characteristics and the risk of adverse perinatal outcomes in pregnancies with laboratory confirmed COVID-19. Methods Secondary analysis of a multinational, cohort study on all consecutive pregnant women with laboratory-confirmed COVID-19 from February 1, 2020 to April 30, 2020 from 73 centers from 22 different countries. A confirmed case of COVID-19 was defined as a positive result on real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay of nasal and pharyngeal swab specimens. The primary outcome was a composite adverse fetal outcome, defined as the presence of either abortion (pregnancy loss before 22 weeks of gestations), stillbirth (intrauterine fetal death after 22 weeks of gestation), neonatal death (death of a live-born infant within the first 28 days of life), and perinatal death (either stillbirth or neonatal death). Logistic regression analysis was performed to evaluate parameters independently associated with the primary outcome. Logistic regression was reported as odds ratio (OR) with 95% confidence interval (CI). Results Mean gestational age at diagnosis was 30.6±9.5 weeks, with 8.0% of women being diagnosed in the first, 22.2% in the second and 69.8% in the third trimester of pregnancy. There were six miscarriage (2.3%), six intrauterine device (IUD) (2.3) and 5 (2.0%) neonatal deaths, with an overall rate of perinatal death of 4.2% (11/265), thus resulting into 17 cases experiencing and 226 not experiencing composite adverse fetal outcome. Neither stillbirths nor neonatal deaths had congenital anomalies found at antenatal or postnatal evaluation. Furthermore, none of the cases experiencing IUD had signs of impending demise at arterial or venous Doppler. Neonatal deaths were all considered as prematurity-related adverse events. Of the 250 live-born neonates, one (0.4%) was found positive at RT-PCR pharyngeal swabs performed after delivery. The mother was tested positive during the third trimester of pregnancy. The newborn was asymptomatic and had negative RT-PCR test after 14 days of life. At logistic regression analysis, gestational age at diagnosis (OR: 0.85, 95% CI 0.8-0.9 per week increase; p<0.001), birthweight (OR: 1.17, 95% CI 1.09-1.12.7 per 100 g decrease; p=0.012) and maternal ventilatory support, including either need for oxygen or CPAP (OR: 4.12, 95% CI 2.3-7.9; p=0.001) were independently associated with composite adverse fetal outcome. Conclusions Early gestational age at infection, maternal ventilatory supports and low birthweight are the main determinants of adverse perinatal outcomes in fetuses with maternal COVID-19 infection. Conversely, the risk of vertical transmission seems negligible.

Universal screening for SARS-CoV-2 before labor admission during Covid-19 pandemic in Madrid.

Objectives Asymptomatic women admitted to labor may act as silent spreaders of COVID-19. Therefore, universal screening at admission has been proposed. The objective of the study was to evaluate the performance of universal screening for SARS-CoV-2 using quantitative reverse transcription polymerase-chain-reaction (qRT-PCR) tests in women admitted to labor. Methods Observational retrospective study of a cohort of pregnant women admitted to labor and delivery between April 8 and May 2, 2020 in a large maternity in Madrid. SARS-CoV-2 screening with qRT-PCR from combined nasopharyngeal and oropharyngeal swabs was carried out systematically. Screening performance was described. Results We attended 212 deliveries. Nine cases with COVID-19 diagnosis before admission were excluded. In the remaining 203 women, seven referred COVID-19-related symptoms but only one had a positive qRT-PCR. Among the 194 asymptomatic women, only one case (0.5%) was positive. Conclusions The percentage of positive tests in asymptomatic women admitted to delivery was only 0.5% during the post-peak period.