SARS-CoV-2 infection by trimester of pregnancy and adverse perinatal outcomes: a Mexican retrospective cohort study
Objective Conflicting evidence for the association between COVID-19 and adverse perinatal outcomes exists. This study examined the associations between maternal COVID-19 during pregnancy and adverse perinatal outcomes including preterm birth (PTB), low birth weight (LBW), small-for-gestational age (...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2024-04-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/14/4/e075928.full |
| _version_ | 1797213916208562176 |
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| author | Rakesh Ghosh Juan Pablo Gutierrez Stefano M Bertozzi Arturo Juárez-Flores Iván de Jesús Ascencio-Montiel |
| author_facet | Rakesh Ghosh Juan Pablo Gutierrez Stefano M Bertozzi Arturo Juárez-Flores Iván de Jesús Ascencio-Montiel |
| author_sort | Rakesh Ghosh |
| collection | DOAJ |
| description | Objective Conflicting evidence for the association between COVID-19 and adverse perinatal outcomes exists. This study examined the associations between maternal COVID-19 during pregnancy and adverse perinatal outcomes including preterm birth (PTB), low birth weight (LBW), small-for-gestational age (SGA), large-for-gestational age (LGA) and fetal death; as well as whether the associations differ by trimester of infection.Design and setting The study used a retrospective Mexican birth cohort from the Instituto Mexicano del Seguro Social (IMSS), Mexico, between January 2020 and November 2021.Participants We used the social security administrative dataset from IMSS that had COVID-19 information and linked it with the IMSS routine hospitalisation dataset, to identify deliveries in the study period with a test for SARS-CoV-2 during pregnancy.Outcome measures PTB, LBW, SGA, LGA and fetal death. We used targeted maximum likelihood estimators, to quantify associations (risk ratio, RR) and CIs. We fit models for the overall COVID-19 sample, and separately for those with mild or severe disease, and by trimester of infection. Additionally, we investigated potential bias induced by missing non-tested pregnancies.Results The overall sample comprised 17 340 singleton pregnancies, of which 30% tested positive. We found that those with mild COVID-19 had an RR of 0.89 (95% CI 0.80 to 0.99) for PTB and those with severe COVID-19 had an RR of 1.53 (95% CI 1.07 to 2.19) for LGA. COVID-19 in the first trimester was associated with fetal death, RR=2.36 (95% CI 1.04, 5.36). Results also demonstrate that missing non-tested pregnancies might induce bias in the associations.Conclusions In the overall sample, there was no evidence of an association between COVID-19 and adverse perinatal outcomes. However, the findings suggest that severe COVID-19 may increase the risk of some perinatal outcomes, with the first trimester potentially being a high-risk period. |
| first_indexed | 2024-04-24T11:05:52Z |
| format | Article |
| id | doaj.art-f535010dd4f84b04995436815245f6c9 |
| institution | Directory Open Access Journal |
| issn | 2044-6055 |
| language | English |
| last_indexed | 2024-04-24T11:05:52Z |
| publishDate | 2024-04-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj.art-f535010dd4f84b04995436815245f6c92024-04-11T17:50:10ZengBMJ Publishing GroupBMJ Open2044-60552024-04-0114410.1136/bmjopen-2023-075928SARS-CoV-2 infection by trimester of pregnancy and adverse perinatal outcomes: a Mexican retrospective cohort studyRakesh Ghosh0Juan Pablo Gutierrez1Stefano M Bertozzi2Arturo Juárez-Flores3Iván de Jesús Ascencio-Montiel4Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USACenter for Policy, Population & Health Research, National Autonomous University of Mexico, Mexico City, MexicoDivision of Health Policy and Management, University of California, Berkeley, Berkeley, California, USACenter for Policy, Population and Health Research, School of Medicine, Universidad Nacional Autónoma de México, Ciudad de México, MexicoInstituto Mexicano del Seguro Social, Ciudad de México, MexicoObjective Conflicting evidence for the association between COVID-19 and adverse perinatal outcomes exists. This study examined the associations between maternal COVID-19 during pregnancy and adverse perinatal outcomes including preterm birth (PTB), low birth weight (LBW), small-for-gestational age (SGA), large-for-gestational age (LGA) and fetal death; as well as whether the associations differ by trimester of infection.Design and setting The study used a retrospective Mexican birth cohort from the Instituto Mexicano del Seguro Social (IMSS), Mexico, between January 2020 and November 2021.Participants We used the social security administrative dataset from IMSS that had COVID-19 information and linked it with the IMSS routine hospitalisation dataset, to identify deliveries in the study period with a test for SARS-CoV-2 during pregnancy.Outcome measures PTB, LBW, SGA, LGA and fetal death. We used targeted maximum likelihood estimators, to quantify associations (risk ratio, RR) and CIs. We fit models for the overall COVID-19 sample, and separately for those with mild or severe disease, and by trimester of infection. Additionally, we investigated potential bias induced by missing non-tested pregnancies.Results The overall sample comprised 17 340 singleton pregnancies, of which 30% tested positive. We found that those with mild COVID-19 had an RR of 0.89 (95% CI 0.80 to 0.99) for PTB and those with severe COVID-19 had an RR of 1.53 (95% CI 1.07 to 2.19) for LGA. COVID-19 in the first trimester was associated with fetal death, RR=2.36 (95% CI 1.04, 5.36). Results also demonstrate that missing non-tested pregnancies might induce bias in the associations.Conclusions In the overall sample, there was no evidence of an association between COVID-19 and adverse perinatal outcomes. However, the findings suggest that severe COVID-19 may increase the risk of some perinatal outcomes, with the first trimester potentially being a high-risk period.https://bmjopen.bmj.com/content/14/4/e075928.full |
| spellingShingle | Rakesh Ghosh Juan Pablo Gutierrez Stefano M Bertozzi Arturo Juárez-Flores Iván de Jesús Ascencio-Montiel SARS-CoV-2 infection by trimester of pregnancy and adverse perinatal outcomes: a Mexican retrospective cohort study BMJ Open |
| title | SARS-CoV-2 infection by trimester of pregnancy and adverse perinatal outcomes: a Mexican retrospective cohort study |
| title_full | SARS-CoV-2 infection by trimester of pregnancy and adverse perinatal outcomes: a Mexican retrospective cohort study |
| title_fullStr | SARS-CoV-2 infection by trimester of pregnancy and adverse perinatal outcomes: a Mexican retrospective cohort study |
| title_full_unstemmed | SARS-CoV-2 infection by trimester of pregnancy and adverse perinatal outcomes: a Mexican retrospective cohort study |
| title_short | SARS-CoV-2 infection by trimester of pregnancy and adverse perinatal outcomes: a Mexican retrospective cohort study |
| title_sort | sars cov 2 infection by trimester of pregnancy and adverse perinatal outcomes a mexican retrospective cohort study |
| url | https://bmjopen.bmj.com/content/14/4/e075928.full |
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