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1.
Pediatrics ; 2022 Nov 01.
Article in English | MEDLINE | ID: covidwho-2098887

ABSTRACT

OBJECTIVES: To assess the 6-month incidence of laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, postnatal care, hospitalization, and mortality among infants born to people with laboratory-confirmed SARS-CoV-2 infection during pregnancy by timing of maternal infection. METHODS: Using a cohort of liveborn infants from pregnancies with SARS-CoV-2 infections in the year 2020 from 10 United States jurisdictions in the Surveillance for Emerging Threats to Mother and Babies Network, we describe weighted estimates of infant outcomes from birth through 6 months of age from electronic health and laboratory records. RESULTS: Of 6601 exposed infants with laboratory information through 6 months of age, 1.0% (95% confidence interval: 0.8-1.1) tested positive, 19.1% (17.5-20.6) tested negative, and 80.0% (78.4-81.6) were not known to be tested for SARS-CoV-2. Among those ≤14 days of age, SARS-CoV-2 infection occurred only with maternal infection ≤14 days before delivery. Of 3967 infants with medical record abstraction, breastmilk feeding initiation was lower when maternal infection occurred ≤14 days before delivery compared with >14 days (77.6% [72.5-82.6] versus 88.3% [84.7-92.0]). Six-month all-cause hospitalization was 4.1% (2.0-6.2). All-cause mortality was higher among infants born to people with infection ≤14 days (1.0% [0.4-1.6]) than >14 days (0.3% [0.1-0.5]) before delivery. CONCLUSIONS: Results are reassuring, with low incidences of most health outcomes examined. Incidence of infant SARS-CoV-2, breastmilk feeding initiation, and all-cause mortality differed by timing of maternal infection. Strategies to prevent infections and support pregnant people with coronavirus disease 2019 may improve infant outcomes.

2.
Am J Public Health ; 112(S8): S787-S796, 2022 10.
Article in English | MEDLINE | ID: covidwho-2089550

ABSTRACT

Objectives. To describe prevalence of breast milk feeding among people with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during pregnancy and examine associations between breast milk feeding, timing of maternal infection before delivery, and rooming-in status during delivery hospitalization. Methods. We performed a retrospective cohort study using data from Massachusetts, Minnesota, Nebraska, Pennsylvania, and Tennessee of whether people with confirmed SARS-CoV-2 infection during pregnancy in 2020 initiated breast milk feeding at birth. Results. Among 11 114 (weighted number) people with SARS-CoV-2 infection in pregnancy, 86.5% (95% confidence interval [CI] = 82.4%, 87.6%) initiated breast milk feeding during birth hospitalization. People with infection within 14 days before delivery had significantly lower prevalence of breast milk feeding (adjusted prevalence ratio [APR] = 0.88; 95% CI = 0.83, 0.94) than did those with infection at least 14 days before delivery. When stratified by rooming-in status, the association between timing of infection and breast milk feeding remained only among infants who did not room in with their mother (APR = 0.77; 95% CI = 0.68, 0.88). Conclusions. Pregnant and postpartum people with SARS-CoV-2 infection should have access to lactation support and be advised about the importance of breast milk feeding and how to safely feed their infants in the same room. (Am J Public Health. 2022;112(S8):S787-S796. https://doi.org/10.2105/AJPH.2022.307023).


Subject(s)
COVID-19 , Pregnancy Complications, Infectious , Pregnancy , Infant, Newborn , Female , Humans , COVID-19/epidemiology , Milk, Human , SARS-CoV-2 , Retrospective Studies , Breast Feeding , Pregnancy Complications, Infectious/epidemiology
3.
EuropePMC; 2022.
Preprint in English | EuropePMC | ID: ppcovidwho-336015

ABSTRACT

Background: People with SARS-CoV-2 infection during pregnancy are at increased risk for adverse pregnancy outcomes, such as preterm birth and stillbirth. Few studies have assessed whether the risk of adverse pregnancy and infant outcomes varies by trimester of infection. Objectives: We describe clinical characteristics (i.e., treatment among pregnant people with moderate to critical illness) and pregnancy and infant outcomes in pregnant people with laboratory-confirmed SARS-CoV-2 infection by trimester of infection. Study Design: The Surveillance for Emerging Threats to Mothers and Babies Network (SET-NET) collects longitudinal data on people with confirmed SARS-CoV-2 infection during pregnancy and their infants. This analysis included people reported to SET-NET with infection in 2020, with known timing of infection and pregnancy outcome. Outcomes are described by trimester of infection. Pregnancy outcomes examined were live birth and pregnancy loss (<20 weeks gestation and ≥20 weeks gestation). Infant outcomes included preterm birth (<37 weeks gestation), small for gestational age (SGA), birth defects, and neonatal intensive care unit (NICU) admission. Adjusted prevalence ratios (aPR) were calculated for pregnancy and selected infant outcomes by trimester of infection, controlling for age, race/ethnicity and health insurance. Among those with moderate-to-critical COVID-19 illness, demographic and clinical characteristics of pregnant people by COVID-19 specific treatment status were described. Results: : Among 44,914 people with SARS-CoV-2 infection in pregnancy, 35,200 (78.3%) people with known timing of infection and pregnancy outcome were included. There were 35,574 liveborn infants and 193 pregnancy losses (<20 weeks (n=52) and ≥20 weeks (n=141)) reported. Half (50.8%) of pregnant people had infection in the third trimester, 30.8% in the second, and 18.3% in the first. Third trimester infection was associated with a higher frequency of preterm birth compared to first or second trimester infection combined (17.8% vs. 11.8%;aPR 1.44 95% CI: 1.35-1.54). For term infants, those born to people with third trimester infection were more likely to be admitted to the NICU compared to those born to people with first or second trimester infections (6.7% vs. 4.5%, aPR 1.29, 95% CI: 1.16-1.36). Approximately five percent of infants were born SGA, with a higher frequency among infants born to people with third trimester infection (aPR 1.16, 95% CI: 1.06-1.27). Prevalence of birth defects was 553.4/10,000 live births, with no difference by trimester of infection. Of 1,732 pregnant people with moderate-to-critical illness, 24.4% (422 cases) were reported to have received any treatment, with 15.3% (265) receiving COVID-19 specific treatment. The most common COVID-19 treatments were remdesivir (57.0%), dexamethasone (45.8%), and azithromycin with hydroxychloroquine (15.4%). Conclusions: : There were no signals for increased birth defects or SGA among infants in this population relative to national baseline estimates, regardless of timing of infection. However, the prevalence of preterm birth in people with SARS-CoV-2 infection in pregnancy in our analysis was higher relative to national baseline data (10.0-10.2%), particularly among people with third trimester infection. Consequences of COVID-19 during pregnancy, including preterm birth, support recommended COVID-19 prevention strategies, including vaccination for people who are pregnant or may become pregnant. The findings in this report further highlight gaps in COVID-19 treatment for pregnant people.

4.
Paediatr Perinat Epidemiol ; 36(4): 476-484, 2022 07.
Article in English | MEDLINE | ID: covidwho-1794581

ABSTRACT

BACKGROUND: Multiple reports have described neonatal SARS-CoV-2 infection, including likely in utero transmission and early postnatal infection, but published estimates of neonatal infection range by geography and design type. OBJECTIVES: To describe maternal, pregnancy and neonatal characteristics among neonates born to people with SARS-CoV-2 infection during pregnancy by neonatal SARS-CoV-2 testing results. METHODS: Using aggregated data from the Surveillance for Emerging Threats to Mothers and Babies Network (SET-NET) describing infections from 20 January 2020 to 31 December 2020, we identified neonates who were (1) born to people who were SARS-CoV-2 positive by RT-PCR at any time during their pregnancy, and (2) tested for SARS-CoV-2 by RT-PCR during the birth hospitalisation. RESULTS: Among 28,771 neonates born to people with SARS-CoV-2 infection during pregnancy, 3816 (13%) underwent PCR testing and 138 neonates (3.6%) were PCR positive. Ninety-four per cent of neonates testing positive were born to people with infection identified ≤14 days of delivery. Neonatal SARS-CoV-2 infection was more frequent among neonates born preterm (5.7%) compared to term (3.4%). Neonates testing positive were born to both symptomatic and asymptomatic pregnant people. CONCLUSIONS: Jurisdictions reported SARS-CoV-2 RT-PCR results for only 13% of neonates known to be born to people with SARS-CoV-2 infection during pregnancy. These results provide evidence of neonatal infection identified through multi-state systematic surveillance data collection and describe characteristics of neonates with SARS-CoV-2 infection. While perinatal SARS-CoV-2 infection was uncommon among tested neonates born to people with SARS-CoV-2 infection during pregnancy, nearly all cases of tested neonatal infection occurred in pregnant people infected around the time of delivery and was more frequent among neonates born preterm. These findings support the recommendation for neonatal SARS-CoV-2 RT-PCR testing, especially for people with acute infection around the time of delivery.


Subject(s)
COVID-19 , Pregnancy Complications, Infectious , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19 Testing , Female , Humans , Infant, Newborn , Infectious Disease Transmission, Vertical , Pregnancy , Pregnancy Complications, Infectious/diagnosis , Pregnancy Complications, Infectious/epidemiology , Pregnancy Outcome/epidemiology , SARS-CoV-2
5.
EuropePMC; 2022.
Preprint in English | EuropePMC | ID: ppcovidwho-331559

ABSTRACT

Objective: To describe prevalence of breastmilk feeding among people with SARS-CoV-2 infection during pregnancy and examine associations between breastmilk feeding, timing of maternal infection before delivery, and rooming-in status during delivery hospitalization. Methods Retrospective cohort using data from five states reporting initiation of breastmilk feeding of infants at birth among people with confirmed SARS-CoV-2 infection during pregnancy in 2020. Results Among 9760 (weighted N) people with SARS-CoV-2 infection in pregnancy, 86.0% (95% confidence interval [CI]: 83.3%-88.7%) initiated breastmilk feeding during birth hospitalization. People with infection ≤ 14 days before delivery had significantly lower prevalence of breastmilk feeding (adjusted prevalence ratio [aPR] 0.90, 95% CI: 0.82, 0.97) compared to those with infection > 14 days before delivery. When stratified by rooming-in status, the association between timing of infection and breastmilk feeding remained only among infants who did not room-in with their mother (aPR 0.78, 95% CI: 0.66, 0.92). Conclusion Pregnant and postpartum people with SARS-CoV-2 infection should be advised about the importance of breastmilk feeding, how to safely feed their infants in the same room, and have access to lactation support.

6.
EuropePMC; 2022.
Preprint in English | EuropePMC | ID: ppcovidwho-330969

ABSTRACT

Background: Pregnant persons with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection are at increased risk of preterm birth, and evidence suggests this risk may be higher among pregnant persons with severe coronavirus disease 2019 (COVID-19) or among those infected later in pregnancy. However, the relationship between trimester of SARS-CoV-2 infection, severity of COVID-19, and preterm birth is not fully understood. Objective: This study examined the relationship between trimester of SARS-CoV-2 infection, illness severity, and risk for preterm birth after adjusting for maternal age, selected underlying conditions, and pregnancy complications. Study Design: Using a cohort of 6,396 pregnant persons with SARS-CoV-2 infection in 2020 identified through the Surveillance for Emerging Threats to Mothers and Babies Network, we analyzed data for those with infection at <37 weeks gestation who delivered a singleton liveborn infant. Illness severity groups (asymptomatic infection, mild, moderate-to-severe, and critical) were adapted from National Institutes of Health and World Health Organization criteria. Risk ratios for preterm birth (<37 weeks) were calculated for illness severity categories (referent=mild), trimester of SARS-CoV-2 infection (referent=first trimester), and illness severity stratified by trimester of infection adjusted for age, selected underlying medical conditions, and pregnancy complications. Results: : Pregnant persons with critical COVID-19, compared to mild COVID-19, in the second (aRR 3.9;95% CI: 1.7-9.0) or third (aRR 4.6;95% CI: 3.2-6.6) trimester were at increased risk of preterm birth. Among persons infected in the second or third trimester, those with critical COVID-19 delivered sooner after infection compared with persons with mild COVID-19 (p<0.001 for second trimester and p=0.02 for third trimester). Nearly half of those with moderate-to-severe or critical COVID-19 delivered by cesarean, with most critical COVID-19 cesarean deliveries as emergent (76.6% weighted [65/96 unweighted]). Conclusion: When infection occurred in the second or third trimester, critical COVID-19 was associated with increased risk of preterm birth, and those with critical COVID-19 delivered sooner after infection compared to those with mild COVID-19. These findings can be used to guide prevention strategies, including vaccination, and inform clinical practices for pregnant persons, particularly those presenting with critical COVID-19 later in pregnancy.

7.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-318348

ABSTRACT

Background: Multiple reports have described neonatal SARS-CoV-2 infection, including likely in utero transmission and early postnatal infection. Most neonatal infections reported to date have been asymptomatic or mild disease;however, severe cases, including respiratory failure requiring intensive care unit admission, have been described. Objectives: To describe maternal, pregnancy and infant characteristics among neonates born to women with SARS-CoV-2 infection during pregnancy by neonatal SARS-CoV-2 testing results. Methods: : Using aggregated data from the Surveillance for Emerging Threats to Mothers and Babies Network (SET-NET) from March 29, 2020–August 6, 2021, we identified neonates who were: 1) born to women who were SARS-CoV-2 positive by RT-PCR at any time during their pregnancy, and 2) tested for SARS-CoV-2 by RT-PCR during the birth hospitalization. Results: : Among 25,896 neonates of mothers with SARS-CoV-2-infection, 3,381 (13%) underwent PCR testing. One hundred thirty-six neonates (4%) were PCR-positive. Neonates testing positive were born to both symptomatic and asymptomatic women, and 95% were born to women with infection identified ≤ with 14 days of delivery. Conclusions: : While perinatal SARS-CoV-2 infection was uncommon among neonates born to women with SARS-CoV-2 infection during pregnancy, nearly all cases of neonatal infection occurred in pregnant women infected around the time of delivery. These findings underline the need for infection prevention and control measures in delivery and outpatient pediatric settings, as well as counselling for persons who acquire COVID-19 during pregnancy about potential risk to their neonates. Moreover, pregnant people and those wanting to become pregnant should be vaccinated against COVID-19 in order to protect themselves and their infants.

8.
2021.
Preprint in English | Other preprints | ID: ppcovidwho-294751

ABSTRACT

Background Pregnant women with coronavirus disease 2019 (COVID-19) are at increased risk for severe illness compared with nonpregnant women. Data to assess risk factors for illness severity among pregnant women with COVID-19 are limited. This study aimed to determine risk factors associated with COVID-19 illness severity among pregnant women with SARS-CoV-2 infection. Methods Pregnant women with SARS-CoV-2 infection confirmed by molecular testing were reported during March 29, 2020–January 8, 2021 through the Surveillance for Emerging Threats to Mothers and Babies Network (SET-NET). Criteria for illness severity (asymptomatic, mild, moderate-to-severe, or critical) were adapted from National Institutes of Health and World Health Organization criteria. Crude and adjusted risk ratios for moderate-to-severe or critical COVID-19 illness were calculated for selected demographic and clinical characteristics. Results Among 5,963 pregnant women with SARS-CoV-2 infection, moderate-to-severe or critical COVID-19 illness was associated with age 30–39 years, Black/Non-Hispanic race/ethnicity, healthcare occupation, pre-pregnancy obesity, chronic lung disease, chronic hypertension, cardiovascular disease, and pregestational diabetes mellitus. Risk of moderate-to-severe or critical illness increased with the number of underlying medical or pregnancy-related conditions. Conclusions Pregnant women with moderate-to-severe or critical COVID-19 illness were more likely to be older and have underlying medical conditions compared to pregnant women with asymptomatic infection or mild COVID-19 illness. This information might help pregnant women understand their risk for moderate-to-severe or critical COVID-19 illness and inform targeted public health messaging. Summary Among pregnant women with COVID-19, older age and underlying medical conditions were risk factors for increased illness severity. These findings can be used to inform pregnant women about their risk for severe COVID-19 illness and public health messaging.

9.
Clin Infect Dis ; 73(Suppl 1): S17-S23, 2021 07 15.
Article in English | MEDLINE | ID: covidwho-1364779

ABSTRACT

BACKGROUND: Pregnant women with coronavirus disease 2019 (COVID-19) are at increased risk for severe illness compared with nonpregnant women. Data to assess risk factors for illness severity among pregnant women with COVID-19 are limited. This study aimed to determine risk factors associated with COVID-19 illness severity among pregnant women with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. METHODS: Pregnant women with SARS-CoV-2 infection confirmed by molecular testing were reported during 29 March 2020-5 March 2021 through the Surveillance for Emerging Threats to Mothers and Babies Network (SET-NET). Criteria for illness severity (asymptomatic, mild, moderate-to-severe, or critical) were adapted from National Institutes of Health and World Health Organization criteria. Crude and adjusted risk ratios for moderate-to-severe or critical COVID-19 illness were calculated for selected demographic and clinical characteristics. RESULTS: Among 7950 pregnant women with SARS-CoV-2 infection, moderate-to-severe or critical COVID-19 illness was associated with age 25 years and older, healthcare occupation, prepregnancy obesity, chronic lung disease, chronic hypertension, and pregestational diabetes mellitus. Risk of moderate-to-severe or critical illness increased with the number of underlying medical or pregnancy-related conditions. CONCLUSIONS: Older age and having underlying medical conditions were associated with increased risk of moderate-to-severe or critical COVID-19 illness among pregnant women. This information might help pregnant women understand their risk for moderate-to-severe or critical COVID-19 illness and can inform targeted public health messaging.


Subject(s)
COVID-19 , Pregnancy Complications, Infectious , Adult , Aged , Female , Humans , Mothers , Pregnancy , Pregnancy Complications, Infectious/epidemiology , Pregnant Women , Risk Factors , SARS-CoV-2
10.
MMWR Morb Mortal Wkly Rep ; 69(44): 1635-1640, 2020 Nov 06.
Article in English | MEDLINE | ID: covidwho-914861

ABSTRACT

Pregnant women with coronavirus disease 2019 (COVID-19) are at increased risk for severe illness and might be at risk for preterm birth (1-3). The full impact of infection with SARS-CoV-2, the virus that causes COVID-19, in pregnancy is unknown. Public health jurisdictions report information, including pregnancy status, on confirmed and probable COVID-19 cases to CDC through the National Notifiable Diseases Surveillance System.* Through the Surveillance for Emerging Threats to Mothers and Babies Network (SET-NET), 16 jurisdictions collected supplementary information on pregnancy and infant outcomes among 5,252 women with laboratory-confirmed SARS-CoV-2 infection reported during March 29-October 14, 2020. Among 3,912 live births with known gestational age, 12.9% were preterm (<37 weeks), higher than the reported 10.2% among the general U.S. population in 2019 (4). Among 610 infants (21.3%) with reported SARS-CoV-2 test results, perinatal infection was infrequent (2.6%) and occurred primarily among infants whose mother had SARS-CoV-2 infection identified within 1 week of delivery. Because the majority of pregnant women with COVID-19 reported thus far experienced infection in the third trimester, ongoing surveillance is needed to assess effects of infections in early pregnancy, as well the longer-term outcomes of exposed infants. These findings can inform neonatal testing recommendations, clinical practice, and public health action and can be used by health care providers to counsel pregnant women on the risks of SARS-CoV-2 infection, including preterm births. Pregnant women and their household members should follow recommended infection prevention measures, including wearing a mask, social distancing, and frequent handwashing when going out or interacting with others or if there is a person within the household who has had exposure to COVID-19.†.


Subject(s)
Betacoronavirus/isolation & purification , Coronavirus Infections/diagnosis , Pneumonia, Viral/diagnosis , Pregnancy Complications, Infectious/diagnosis , Pregnancy Outcome/epidemiology , Abortion, Spontaneous/epidemiology , Adult , COVID-19 , COVID-19 Testing , Clinical Laboratory Techniques , Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Female , Humans , Infant, Newborn , Infectious Disease Transmission, Vertical/statistics & numerical data , Laboratories , Pandemics , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , Pregnancy , Pregnancy Complications, Infectious/epidemiology , Premature Birth/epidemiology , Risk Assessment , SARS-CoV-2 , United States/epidemiology , Young Adult
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