TY - JOUR
T1 - Risk for stillbirth among pregnant individuals with SARS-CoV-2 infection varied by gestational age
AU - of the National COVID Cohort Collaborative Consortium
AU - Lyu, Tianchu
AU - Liang, Chen
AU - Liu, Jihong
AU - Hung, Peiyin
AU - Zhang, Jiajia
AU - Campbell, Berry
AU - Ghumman, Nadia
AU - Olatosi, Bankole
AU - Hikmet, Neset
AU - Zhang, Manting
AU - Yi, Honggang
AU - Li, Xiaoming
AU - Wilcox, Adam B.
AU - Lee, Adam M.
AU - Graves, Alexis
AU - Anzalone, Alfred (Jerrod)
AU - Manna, Amin
AU - Saha, Amit
AU - Olex, Amy
AU - Zhou, Andrea
AU - Williams, Andrew E.
AU - Southerland, Andrew
AU - Girvin, Andrew T.
AU - Walden, Anita
AU - Sharathkumar, Anjali A.
AU - Amor, Benjamin
AU - Bates, Benjamin
AU - Hendricks, Brian
AU - Patel, Brijesh
AU - Alexander, Caleb
AU - Bramante, Carolyn
AU - Ward-Caviness, Cavin
AU - Madlock-Brown, Charisse
AU - Suver, Christine
AU - Chute, Christopher
AU - Dillon, Christopher
AU - Wu, Chunlei
AU - Schmitt, Clare
AU - Takemoto, Cliff
AU - Housman, Dan
AU - Gabriel, Davera
AU - Eichmann, David A.
AU - Mazzotti, Diego
AU - Brown, Don
AU - Boudreau, Eilis
AU - Hill, Elaine
AU - Zampino, Elizabeth
AU - Marti, Emily Carlson
AU - Pfaff, Emily R.
AU - French, Evan
AU - Koraishy, Farrukh M.
AU - Mariona, Federico
AU - Prior, Fred
AU - Sokos, George
AU - Martin, Greg
AU - Lehmann, Harold
AU - Spratt, Heidi
AU - Mehta, Hemalkumar
AU - Liu, Hongfang
AU - Sidky, Hythem
AU - Hayanga, J. W.Awori
AU - Pincavitch, Jami
AU - Clark, Jaylyn
AU - Harper, Jeremy Richard
AU - Islam, Jessica
AU - Ge, Jin
AU - Gagnier, Joel
AU - Saltz, Joel H.
AU - Saltz, Joel
AU - Loomba, Johanna
AU - Buse, John
AU - Mathew, Jomol
AU - Rutter, Joni L.
AU - McMurry, Julie A.
AU - Guinney, Justin
AU - Starren, Justin
AU - Crowley, Karen
AU - Bradwell, Katie Rebecca
AU - Walters, Kellie M.
AU - Wilkins, Ken
AU - Gersing, Kenneth R.
AU - Cato, Kenrick Dwain
AU - Murray, Kimberly
AU - Kostka, Kristin
AU - Northington, Lavance
AU - Pyles, Lee Allan
AU - Misquitta, Leonie
AU - Cottrell, Lesley
AU - Portilla, Lili
AU - Deacy, Mariam
AU - Bissell, Mark M.
AU - Clark, Marshall
AU - Emmett, Mary
AU - Saltz, Mary Morrison
AU - Palchuk, Matvey B.
AU - Haendel, Melissa A.
AU - Adams, Meredith
AU - Temple-O'Connor, Meredith
AU - Kurilla, Michael G.
AU - Morris, Michele
AU - Qureshi, Nabeel
AU - Safdar, Nasia
AU - Garbarini, Nicole
AU - Sharafeldin, Noha
AU - Sadan, Ofer
AU - Francis, Patricia A.
AU - Burgoon, Penny Wung
AU - Robinson, Peter
AU - Payne, Philip R.O.
AU - Fuentes, Rafael
AU - Jawa, Randeep
AU - Erwin-Cohen, Rebecca
AU - Patel, Rena
AU - Moffitt, Richard A.
AU - Zhu, Richard L.
AU - Kamaleswaran, Rishi
AU - Hurley, Robert
AU - Miller, Robert T.
AU - Pyarajan, Saiju
AU - Michael, Sam G.
AU - Bozzette, Samuel
AU - Mallipattu, Sandeep
AU - Vedula, Satyanarayana
AU - Chapman, Scott
AU - O'Neil, Shawn T.
AU - Setoguchi, Soko
AU - Hong, Stephanie S.
AU - Johnson, Steve
AU - Bennett, Tellen D.
AU - Callahan, Tiffany
AU - Topaloglu, Umit
AU - Sheikh, Usman
AU - Gordon, Valery
AU - Subbian, Vignesh
AU - Kibbe, Warren A.
AU - Hernandez, Wenndy
AU - Beasley, Will
AU - Cooper, Will
AU - Hillegass, William
AU - Zhang, Xiaohan Tanner
N1 - Publisher Copyright:
© 2023 Elsevier Inc.
PY - 2023/9
Y1 - 2023/9
N2 - Background: Despite previous research findings on higher risks of stillbirth among pregnant individuals with SARS-CoV-2 infection, it is unclear whether the gestational timing of viral infection modulates this risk. Objective: This study aimed to examine the association between timing of SARS-CoV-2 infection during pregnancy and risk of stillbirth. Study Design: This retrospective cohort study used multilevel logistic regression analyses of nationwide electronic health records in the United States. Data were from 75 healthcare systems and institutes across 50 states. A total of 191,403 pregnancies of 190,738 individuals of reproductive age (15–49 years) who had childbirth between March 1, 2020 and May 31, 2021 were identified and included. The main outcome was stillbirth at ≥20 weeks of gestation. Exposures were the timing of SARS-CoV-2 infection: early pregnancy (<20 weeks), midpregnancy (21–27 weeks), the third trimester (28–43 weeks), any time before delivery, and never infected (reference). Results: We identified 2342 (1.3%) pregnancies with COVID-19 in early pregnancy, 2075 (1.2%) in midpregnancy, and 12,697 (6.9%) in the third trimester. After adjusting for maternal and clinical characteristics, increased odds of stillbirth were observed among pregnant individuals with SARS-CoV-2 infection only in early pregnancy (odds ratio, 1.75, 95% confidence interval, 1.25–2.46) and midpregnancy (odds ratio, 2.09; 95% confidence interval, 1.49–2.93), as opposed to pregnant individuals who were never infected. Older age, Black race, hypertension, acute respiratory distress syndrome or acute respiratory failure, and placental abruption were found to be consistently associated with stillbirth across different trimesters. Conclusion: Increased risk of stillbirth was associated with COVID-19 only when pregnant individuals were infected during early and midpregnancy, and not at any time before the delivery or during the third trimester, suggesting the potential vulnerability of the fetus to SARS-CoV-2 infection in early pregnancy. Our findings underscore the importance of proactive COVID-19 prevention and timely medical intervention for individuals infected with SARS-CoV-2 during early and midpregnancy.
AB - Background: Despite previous research findings on higher risks of stillbirth among pregnant individuals with SARS-CoV-2 infection, it is unclear whether the gestational timing of viral infection modulates this risk. Objective: This study aimed to examine the association between timing of SARS-CoV-2 infection during pregnancy and risk of stillbirth. Study Design: This retrospective cohort study used multilevel logistic regression analyses of nationwide electronic health records in the United States. Data were from 75 healthcare systems and institutes across 50 states. A total of 191,403 pregnancies of 190,738 individuals of reproductive age (15–49 years) who had childbirth between March 1, 2020 and May 31, 2021 were identified and included. The main outcome was stillbirth at ≥20 weeks of gestation. Exposures were the timing of SARS-CoV-2 infection: early pregnancy (<20 weeks), midpregnancy (21–27 weeks), the third trimester (28–43 weeks), any time before delivery, and never infected (reference). Results: We identified 2342 (1.3%) pregnancies with COVID-19 in early pregnancy, 2075 (1.2%) in midpregnancy, and 12,697 (6.9%) in the third trimester. After adjusting for maternal and clinical characteristics, increased odds of stillbirth were observed among pregnant individuals with SARS-CoV-2 infection only in early pregnancy (odds ratio, 1.75, 95% confidence interval, 1.25–2.46) and midpregnancy (odds ratio, 2.09; 95% confidence interval, 1.49–2.93), as opposed to pregnant individuals who were never infected. Older age, Black race, hypertension, acute respiratory distress syndrome or acute respiratory failure, and placental abruption were found to be consistently associated with stillbirth across different trimesters. Conclusion: Increased risk of stillbirth was associated with COVID-19 only when pregnant individuals were infected during early and midpregnancy, and not at any time before the delivery or during the third trimester, suggesting the potential vulnerability of the fetus to SARS-CoV-2 infection in early pregnancy. Our findings underscore the importance of proactive COVID-19 prevention and timely medical intervention for individuals infected with SARS-CoV-2 during early and midpregnancy.
KW - COVID-19
KW - electronic health records
KW - gynecology
KW - obstetrics
KW - pregnancy
KW - stillbirth
UR - http://www.scopus.com/inward/record.url?scp=85151298171&partnerID=8YFLogxK
U2 - 10.1016/j.ajog.2023.02.022
DO - 10.1016/j.ajog.2023.02.022
M3 - Article
C2 - 36858096
AN - SCOPUS:85151298171
SN - 0002-9378
VL - 229
SP - 288.e1-288.e13
JO - American journal of obstetrics and gynecology
JF - American journal of obstetrics and gynecology
IS - 3
ER -