Newborns of women with Covid-19 during pregnancy are at risk of adverse outcomes, suggests a study published in the September 2022 issue of the American Journal of Obstetrics and Gynecology.¹ Infants born via cesarean deliveries were more likely to test positive for the infection.

The INTERCOVID Multinational Cohort Study, conducted between March 2020 to March 2021, examined the association between Covid-19 during pregnancy and neonatal outcomes among 569 women (either pregnant or at delivery) with Covid-19. The study included 586 newborns of women with Covid-19 and 1535 newborns of women who did not have the infection. The safety of perinatal care practices with regard to mother-to-child transmission, including breastfeeding, in mothers with a COVID-19 diagnosis was also investigated. For every infected pregnant woman, two women of similar gestational age or at the same level of care but without Covid-19 were enrolled.

Cesarean section rates were higher among women with Covid-19 compared to those without Covid-19; 52.8% vs 38.5%, respectively. They were also at a significantly greater risk of pregnancy-related complications such as fetal distress and hypertensive disorders of pregnancy. The odds of preterm births were also increased among pregnant women with Covid-19. Their newborns had lower birth weight, including lower length and head circumference. The longer the mother had the infection, greater was the likelihood of the newborn testing positive for the infection with odds ratio of 4.5. The risk of infection was doubled among infants born via cesarean section with OR of 2.4.

Covid-positive neonates were more likely to be admitted to neonatal ICUs and have fever and symptoms related to the respiratory and GI systems. Mortality rates were also higher among these newborns. However, breastfeeding and practices such as immediate skin-to-skin contact and rooming-in were not associated with increased risk of transmission to the newborns.

This international study has shown that women with Covid-19 during pregnancy are more likely to have pregnancy-related complications, both maternal and neonatal. Cesarean births were particularly at risk; hence, vaginal delivery should be preferred, provided there are no obstetrical and health exigencies. Women with Covid-19 can continue to breastfeed.

Reference

1. Francesca Giuliani, et al. Effects of prenatal exposure to maternal COVID-19 and perinatal care on neonatal outcome: results from the INTERCOVID Multinational Cohort Study. Am J Obstet Gynecol. 2022 Sep;227(3):488.e1-488.e17. doi: 10.1016/j.ajog.2022.04.019.