Journal of Preventive Medicine and Public Health

The Korean Society for Preventive Medicine (대한예방의학회)
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Adverse Birth Outcomes Among Pregnant Women With and Without COVID-19: A Comparative Study From Bangladesh

  • Received : 2021.08.06
  • Accepted : 2021.09.20
  • Published : 2021.11.30
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Abstract

Objectives: Pregnant women are especially vulnerable to respiratory infections such as coronavirus disease 2019 (COVID-19), but insufficient research has investigated pregnancy and its outcomes in women with COVID-19. This cross-sectional study compared birth outcomes related to COVID-19 between Bangladeshi pregnant women with and without COVID-19. Methods: The study was conducted at 3 tertiary referral hospitals in Dhaka, Bangladesh, from March to August 2020. Pregnant women admitted for delivery at these hospitals with laboratory results (reverse-transcription polymerase chain reaction) were analyzed. Using convenience sampling, we included 70 COVID-19-positive and 140 COVID-19-negative pregnant women. Trained and experienced midwives conducted the interviews. Data were analyzed using the t-test, the chi-square test, and univariate and multivariable linear and logistic regression. Results: Pregnant women with COVID-19 were more likely to give birth to a preterm baby (adjusted odds ratio [aOR], 2.15; 95% confidence interval [CI], 1.06 to 4.37) and undergo a cesarean section (aOR, 3.27; 95% CI, 1.51 to 7.07). There were no significant differences in birth weight, premature rupture of membranes, and the Apgar score at 1 minute or 5 minutes post-delivery between women with and without COVID-19. All the newborn babies who were born to COVID-19-positive women were COVID-19-negative. Conclusions: Our study suggests that pregnant women with COVID-19 were more likely to give birth to a preterm baby and undergo a cesarean section. For this reason, physicians should be particularly cautious to minimize adverse birth outcomes among pregnant women with COVID-19 and their newborn babies.

Keywords

Acknowledgement

We would like to express our heartfelt appreciation and gratitude to the hospital authorities for their kind support and assistance during the research process. We are thankful to the patients for their patience and cooperation. We are also thankful to the midwives for their fantastic efforts in data collection, and to OGSB & North South University (NSU) for their cooperation.

References

  1. Qiao J. What are the risks of COVID-19 infection in pregnant women? Lancet 2020;395(10226):760-762. https://doi.org/10.1016/s0140-6736(20)30365-2
  2. Sun M, Xu G, Yang Y, Tao Y, Pian-Smith M, Madhavan V, et al. Evidence of mother-to-newborn infection with COVID-19. Br J Anaesth 2020;125(2):e245-e247. https://doi.org/10.1016/j.bja.2020.04.066
  3. Ainul S, Hossain M, Bhuiyan M, Hossain SM, Rob U, Bajracharya A. Trends in maternal health services in Bangladesh before, during and after COVID-19 lockdowns: evidence from national routine service data; 2020 [cited 2021 Aug 5]. Available from: https://knowledgecommons.popcouncil.org/cgi/viewcontent.cgi?article=2299&context=departments_sbsr-rh.
  4. Mor G, Cardenas I. The immune system in pregnancy: a unique complexity. Am J Reprod Immunol 2010;63(6):425-433. https://doi.org/10.1111/j.1600-0897.2010.00836.x
  5. Liu H, Wang LL, Zhao SJ, Kwak-Kim J, Mor G, Liao AH. Why are pregnant women susceptible to COVID-19? An immunological viewpoint. J Reprod Immunol 2020;139:103122. https://doi.org/10.1016/j.jri.2020.103122
  6. Marim F, Karadogan D, Eyuboglu TS, Emiralioglu N, Gurkan CG, Toreyin ZN, et al. Lessons learned so far from the pandemic: a review on pregnants and neonates with COVID-19. Eurasian J Med 2020;52(2):202-210. https://doi.org/10.5152/eurasianjmed.2020.20118
  7. Fenizia C, Biasin M, Cetin I, Vergani P, Mileto D, Spinillo A, et al. Analysis of SARS-CoV-2 vertical transmission during pregnancy. Nat Commun 2020;11(1):5128. https://doi.org/10.1038/s41467-020-18933-4
  8. Wong SF, Chow KM, Leung TN, Ng WF, Ng TK, Shek CC, et al. Pregnancy and perinatal outcomes of women with severe acute respiratory syndrome. Am J Obstet Gynecol 2004;191(1):292-297. https://doi.org/10.1016/j.ajog.2003.11.019
  9. Yang R, Mei H, Zheng T, Fu Q, Zhang Y, Buka S, et al. Pregnant women with COVID-19 and risk of adverse birth outcomes and maternal-fetal vertical transmission: a population-based cohort study in Wuhan, China. BMC Med 2020;18(1):330. https://doi.org/10.1186/s12916-020-01798-1
  10. Ronnje L, Lansberg JK, Vikhareva O, Hansson SR, Herbst A, Zaigham M. Complicated COVID-19 in pregnancy: a case report with severe liver and coagulation dysfunction promptly improved by delivery. BMC Pregnancy Childbirth 2020;20(1):511. https://doi.org/10.1186/s12884-020-03172-8
  11. Smith V, Seo D, Warty R, Payne O, Salih M, Chin KL, et al. Maternal and neonatal outcomes associated with COVID-19 infection: a systematic review. PLoS One 2020;15(6):e0234187. https://doi.org/10.1371/journal.pone.0234187
  12. Mustafa FN, Yasmin N, Islam M, Mehzabin S, Siddique S, Alam S. Pregnancy outcome in covid-19 positive women in a covid dedicated hospital. J Dhaka Med Coll 2020;29(2):153-157.
  13. Kontou PI, Braliou GG, Dimou NL, Nikolopoulos G, Bagos PG. Antibody tests in detecting SARS-CoV-2 infection: a meta-analysis. Diagnostics (Basel) 2020;10(5):319. https://doi.org/10.3390/diagnostics10050319
  14. Chen Y, Peng H, Wang L, Zhao Y, Zeng L, Gao H, et al. Infants born to mothers with a new coronavirus (COVID-19). Front Pediatr 2020;8:104. https://doi.org/10.3389/fped.2020.00104
  15. Zaigham M, Andersson O. Maternal and perinatal outcomes with COVID-19: a systematic review of 108 pregnancies. Acta Obstet Gynecol Scand 2020;99(7):823-829. https://doi.org/10.1111/aogs.13867
  16. Sayeed SJ, Rahman MM, Kabir AH, Moniruzzaman M, Mahmud R, Yusuf MA, et al. Clinical, laboratory characteristics and pregnancy outcome of COVID-19 patients admitted in the largest COVID dedicated hospital of Bangladesh. Am J Intern Med 2021;9(1):11-16.
  17. Karabon P. Rare events or non-convergence with a binary outcome? The power of Firth regression in PROC LOGISTIC; 2020 [cited 2021 Aug 4]. Available from: https://www.sas.com/content/dam/SAS/support/en/sas-global-forum-proceedings/2020/4654-2020.pdf.
  18. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020;395(10229):1054-1062. https://doi.org/10.1016/s0140-6736(20)30566-3
  19. Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med 2020;180(7):934-943. https://doi.org/10.1001/jamainternmed.2020.0994
  20. World Health Organization. Coronavirus disease (COVID-19): pregnancy and childbirth; 2021 [cited 2021 Sep 9]. Available from: https://www.who.int/news-room/questions-and-answers/item/coronavirus-disease-covid-19-pregnancy-andchildbirth.
  21. Zambrano LD, Ellington S, Strid P, Galang RR, Oduyebo T, Tong VT, et al. Update: characteristics of symptomatic women of reproductive age with laboratory-confirmed SARS-CoV-2 infection by pregnancy status - United States, January 22-October 3, 2020. MMWR Morb Mortal Wkly Rep 2020;69(44):1641-1647. https://doi.org/10.15585/mmwr.mm6944e3
  22. Blagosklonny MV. From causes of aging to death from COVID-19. Aging (Albany NY) 2020;12(11):10004-10021. https://doi.org/10.18632/aging.103493
  23. Women in late stages of pregnancy at higher COVID-19 risk. Japan Times; 2021 Aug 22 [cited 2021 Sep 9]. Available from: https://www.japantimes.co.jp/news/2021/08/22/national/pregnant-women-coronavirus/.
  24. Weng YH, Yang CY, Chiu YW. Risk assessment of adverse birth outcomes in relation to maternal age. PLoS One 2014;9(12):e114843. https://doi.org/10.1371/journal.pone.0114843
  25. Parazzini F, Bortolus R, Mauri PA, Favilli A, Gerli S, Ferrazzi E. Delivery in pregnant women infected with SARS-CoV-2: a fast review. Int J Gynaecol Obstet 2020;150(1):41-46. https://doi.org/10.1002/ijgo.13166
  26. Chen L, Li Q, Zheng D, Jiang H, Wei Y, Zou L, et al. Clinical characteristics of pregnant women with Covid-19 in Wuhan, China. N Engl J Med 2020;382(25):e100. https://doi.org/10.1056/NEJMc2009226
  27. Gupta P, Kumar S, Sharma SS. SARS-CoV-2 prevalence and maternal-perinatal outcomes among pregnant women admitted for delivery: experience from COVID-19-dedicated maternity hospital in Jammu, Jammu and Kashmir (India). J Med Virol 2021;93(9):5505-5514. https://doi.org/10.1002/jmv.27074
  28. Vizheh M, Muhidin S, Aghajani F, Maleki Z, Bagheri F, Hosamirudsari H, et al. Characteristics and outcomes of COVID-19 pneumonia in pregnancy compared with infected nonpregnant women. Int J Gynaecol Obstet 2021;153(3):462-468. https://doi.org/10.1002/ijgo.13697
  29. Knight M, Bunch K, Vousden N, Morris E, Simpson N, Gale C, et al. 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.
  30. Mullins E, Evans D, Viner RM, O'Brien P, Morris E. Coronavirus in pregnancy and delivery: rapid review. Ultrasound Obstet Gynecol 2020;55(5):586-592. https://doi.org/10.1002/uog.22014
  31. Schwartz DA, Graham AL. Potential maternal and infant outcomes from (Wuhan) coronavirus 2019-nCoV infecting pregnant women: lessons from SARS, MERS, and other human coronavirus infections. Viruses 2020;12(2):194. https://doi.org/10.3390/v12020194
  32. Chen L, Deng H, Cui H, Fang J, Zuo Z, Deng J, et al. Inflammatory responses and inflammation-associated diseases in organs. Oncotarget 2017;9(6):7204-7218. https://doi.org/10.18632/oncotarget.23208
  33. Hantoushzadeh S, Anvari Aliabad R, Norooznezhad AH. Antibiotics, inflammation, and preterm labor: a missed conclusion. J Inflamm Res 2020;13:245-254. https://doi.org/10.2147/JIR.S248382
  34. Garcia LF. Immune response, inflammation, and the clinical spectrum of COVID-19. Front Immunol 2020;11:1441. https://doi.org/10.3389/fimmu.2020.01441
  35. Melo GC, Araujo KC. COVID-19 infection in pregnant women, preterm delivery, birth weight, and vertical transmission: a systematic review and meta-analysis. Cad Saude Publica 2020;36(7):e00087320. https://doi.org/10.1590/0102-311x00087320
  36. Zhang L, Jiang Y, Wei M, Cheng BH, Zhou XC, Li J, et al. Analysis of the pregnancy outcomes in pregnant women with COVID-19 in Hubei Province. Zhonghua Fu Chan Ke Za Zhi 2020;55(3):166-171 (Chinese).
  37. Mullins E, Hudak ML, Banerjee J, Getzlaff T, Townson J, Barnette K, et al. Pregnancy and neonatal outcomes of COVID-19: coreporting of common outcomes from PAN-COVID and AAP-SONPM registries. Ultrasound Obstet Gynecol 2021;57(4):573-581. https://doi.org/10.1002/uog.23619
  38. Moreno SC, To J, Chun H, Ngai IM. Vertical transmission of COVID-19 to the neonate. Infect Dis Obstet Gynecol 2020;2020:8460672.
  39. Suidan RS, Apuzzio JJ, Williams SF. Obesity, comorbidities, and the cesarean delivery rate. Am J Perinatol 2012;29(8):623-628. https://doi.org/10.1055/s-0032-1311987