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Am J Perinatol 2022; 39(S 01): S42-S48
DOI: 10.1055/s-0042-1757274
Original Article

Active Intrapartum SARS-CoV-2 Infection and Pregnancy Outcomes

Marta C. Nunes
1   South African Medical Research Council, Vaccines, and Infectious Diseases Analytics (VIDA) Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
2   Department of Science and Technology/National Research Foundation, South African Research Chair Initiative in Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
,
Stephanie Jones
1   South African Medical Research Council, Vaccines, and Infectious Diseases Analytics (VIDA) Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
2   Department of Science and Technology/National Research Foundation, South African Research Chair Initiative in Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
,
Renate Strehlau
3   Nkanyezi Research Unit Sub-Division of VIDA, Department of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
,
Vuyelwa Baba
4   Department of Obstetrics and Gynecology, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
,
Zanele Ditse
1   South African Medical Research Council, Vaccines, and Infectious Diseases Analytics (VIDA) Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
2   Department of Science and Technology/National Research Foundation, South African Research Chair Initiative in Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
,
Kelly da Silva
1   South African Medical Research Council, Vaccines, and Infectious Diseases Analytics (VIDA) Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
2   Department of Science and Technology/National Research Foundation, South African Research Chair Initiative in Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
,
Lané Bothma
1   South African Medical Research Council, Vaccines, and Infectious Diseases Analytics (VIDA) Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
,
Natali Serafin
1   South African Medical Research Council, Vaccines, and Infectious Diseases Analytics (VIDA) Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
2   Department of Science and Technology/National Research Foundation, South African Research Chair Initiative in Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
,
Vicky L. Baillie
1   South African Medical Research Council, Vaccines, and Infectious Diseases Analytics (VIDA) Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
2   Department of Science and Technology/National Research Foundation, South African Research Chair Initiative in Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
,
Gaurav Kwatra
1   South African Medical Research Council, Vaccines, and Infectious Diseases Analytics (VIDA) Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
2   Department of Science and Technology/National Research Foundation, South African Research Chair Initiative in Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
,
Megan Burke
3   Nkanyezi Research Unit Sub-Division of VIDA, Department of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
,
Amy Wise
5   Department of Obstetrics and Gynecology, Rahima Moosa Mother and Child Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
,
Mary Adam
4   Department of Obstetrics and Gynecology, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
,
Philiswa Mlandu
4   Department of Obstetrics and Gynecology, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
,
Mpolokeng Melamu
4   Department of Obstetrics and Gynecology, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
,
Juliette Phelp
4   Department of Obstetrics and Gynecology, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
,
Wendy Fraser
6   Lancet Laboratories, Johannesburg, Gauteng, South Africa
,
Colleen Wright
6   Lancet Laboratories, Johannesburg, Gauteng, South Africa
7   Division of Anatomical Pathology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
,
Elizabeth Zell
8   Stat-Epi Associates, Inc., Ponte Vedra Beach, Florida
,
Yasmin Adam
4   Department of Obstetrics and Gynecology, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
,
Shabir A. Madhi
1   South African Medical Research Council, Vaccines, and Infectious Diseases Analytics (VIDA) Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
2   Department of Science and Technology/National Research Foundation, South African Research Chair Initiative in Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
9   African Leadership in Vaccinology Expertise, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
› Author Affiliations Funding The Bill & Melinda Gates Foundation (grant number: INV-017282). There was also partial support from the Department of Science and Technology and National Research Foundation: South African Research Chair Initiative in Vaccine Preventable Diseases.
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Abstract

Objective Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection during pregnancy has been associated with poor pregnancy outcomes. There is, however, not much information on the impact of the timing of SARS-CoV-2 infection on pregnancy outcomes, and studies from low-middle income settings are also scarce.

Study Design We conducted a cross-sectional study from April to December 2020, in South Africa, to assess the association of SARS-CoV-2 infection on a nasal swab at the time of labor with fetal death, preterm birth, low birth weight, or pregnancy-induced complications. When possible, maternal blood, cord blood, and placenta were collected. SARS-CoV-2 infection was investigated by a nucleic acid amplification test (NAAT).

Results Overall, 3,117 women were tested for SARS-CoV-2 on a nasal swab, including 1,562 (50%) healthy women with uncomplicated term delivery. A positive NAAT was detected among 132 (4%) women. Adverse birth outcomes or pregnancy-related complications were not associated with SARS-CoV-2 infection at the time of labor. Among SARS-CoV-2-infected women, an NAAT-positive result was also obtained from 6 out of 98 (6%) maternal blood samples, 8 out of 93 (9%) cord-blood samples, 14 out of 54 (26%) placentas, and 3 out of 22 (14%) nasopharyngeal swabs from newborns collected within 72 hours of birth. Histological assessment of placental tissue revealed that women with SARS-CoV-2 nasal infection had a higher odds (3.82, 95% confidence interval: 1.20, 12.19) of chronic chorioamnionitis compared with those without SARS-CoV-2 infection.

Conclusion Our study demonstrates that intrapartum, SARS-CoV-2 infection was not associated with evaluated poor outcomes. In utero fetal and placental infections and possible vertical and/or horizontal viral transfer to the newborn were detected among women with nasal SARS-CoV-2 infection.

Key Points

  • Intrapartum SARS-CoV-2 infection was not associated with evaluated poor outcomes.

  • In utero fetal and placental infections were detected among women with nasal SARS-CoV-2 infection.

  • Women with SARS-CoV-2 nasal infection had a higher odds of chronic chorioamnionitis.

Keywords

pregnancy - intrapartum - SARS-CoV-2 infection - placenta - cord blood

Supplementary Material



Publication History

Received: 13 June 2022

Accepted: 04 August 2022

Article published online:
28 October 2022

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  • References

  • 1 Allotey J, Stallings E, Bonet M. et al; for PregCOV-19 Living Systematic Review Consortium. Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis. BMJ 2020; 370: m3320
    Google Scholar
  • 2 Lassi ZS, Ana A, Das JK. et al. A systematic review and meta-analysis of data on pregnant women with confirmed COVID-19: clinical presentation, and pregnancy and perinatal outcomes based on COVID-19 severity. J Glob Health 2021; 11: 05018
    CrossrefPubMedGoogle Scholar
  • 3 Villar J, Ariff S, Gunier RB. et al. Maternal and neonatal morbidity and mortality among pregnant women with and without COVID-19 Infection: the INTERCOVID multinational cohort study. JAMA Pediatr 2021; 175 (08) 817-826
    Google Scholar
  • 4 Knight M, Bunch K, Vousden N. et al; UK Obstetric Surveillance System SARS-CoV-2 Infection in Pregnancy Collaborative Group. Characteristics and outcomes of pregnant women admitted to hospital with confirmed SARS-CoV-2 infection in UK: national population based cohort study. BMJ 2020; 369: m2107
    CrossrefPubMedGoogle Scholar
  • 5 Adhikari EH, Moreno W, Zofkie AC. et al. Pregnancy outcomes among women with and without severe acute respiratory syndrome coronavirus 2 infection. JAMA Netw Open 2020; 3 (11) e2029256
    CrossrefPubMedGoogle Scholar
  • 6 Angelidou A, Sullivan K, Melvin PR. et al. Association of maternal perinatal SARS-CoV-2 infection with neonatal outcomes during the COVID-19 pandemic in Massachusetts. JAMA Netw Open 2021; 4 (04) e217523
    CrossrefPubMedGoogle Scholar
  • 7 Woodworth KR, Olsen EO, Neelam V. et al; CDC COVID-19 Response Pregnancy and Infant Linked Outcomes Team, COVID-19 Pregnancy and Infant Linked Outcomes Team (PILOT). Birth and infant outcomes following laboratory-confirmed SARS-CoV-2 infection in pregnancy—SET-NET, 16 jurisdictions, March 29-October 14, 2020. MMWR Morb Mortal Wkly Rep 2020; 69 (44) 1635-1640
    CrossrefPubMedGoogle Scholar
  • 8 Ciapponi A, Bardach A, Comandé D. et al. COVID-19 and pregnancy: an umbrella review of clinical presentation, vertical transmission, and maternal and perinatal outcomes. PLoS One 2021; 16 (06) e0253974
    CrossrefPubMedGoogle Scholar
  • 9 Basu JK, Chauke L, Magoro T. Cert Maternal and Fetal Medicine. Clinical features and outcomes of COVID-19 infection among pregnant women in South Africa. Int J MCH AIDS 2021; 10 (02) 1-9
    PubMedGoogle Scholar
  • 10 Hcini N, Maamri F, Picone O. et al. Maternal, fetal and neonatal outcomes of large series of SARS-CoV-2 positive pregnancies in peripartum period: a single-center prospective comparative study. Eur J Obstet Gynecol Reprod Biol 2021; 257: 11-18
    CrossrefPubMedGoogle Scholar
  • 11 Lu X, Wang L, Sakthivel SK. et al. US CDC real-time reverse transcription PCR panel for detection of severe acute respiratory syndrome coronavirus 2. Emerg Infect Dis 2020; 26 (08) 1654-1665
    CrossrefPubMedGoogle Scholar
  • 12 Madhi SA, Izu A, Kwatra G. et al. Association of Group B streptococcus serum serotype-specific anti-capsular IgG concentration and risk reduction for invasive Group B streptococcus disease in South African infants: an observational birth-cohort, matched case-control study. Clin Infect Dis 2021; 73 (05) e1170-e1180
    CrossrefPubMedGoogle Scholar
  • 13 Khong TY, Mooney EE, Ariel I. et al. Sampling and definitions of placental lesions: Amsterdam placental workshop group consensus statement. Arch Pathol Lab Med 2016; 140 (07) 698-713
    CrossrefPubMedGoogle Scholar
  • 14 Shah PS, Diambomba Y, Acharya G, Morris SK, Bitnun A. Classification system and case definition for SARS-CoV-2 infection in pregnant women, fetuses, and neonates. Acta Obstet Gynecol Scand 2020; 99 (05) 565-568
    CrossrefPubMedGoogle Scholar
  • 15 Crovetto F, Crispi F, Llurba E, Figueras F, Gómez-Roig MD, Gratacós E. Seroprevalence and presentation of SARS-CoV-2 in pregnancy. Lancet 2020; 396 (10250): 530-531
    CrossrefPubMedGoogle Scholar
  • 16 Nunes MC, Madhi SA. COVID-19 vaccines in pregnancy. Trends Mol Med 2022; 28 (08) 662-680
    CrossrefPubMedGoogle Scholar