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    Maternal and perinatal outcomes in high compared to low risk pregnancies complicated by severe acute respiratory syndrome coronavirus 2 infection (phase 2): the World Association of Perinatal Medicine working group on coronavirus disease 2019
    (Elsevier, 2021) D'Antonio, Francesco; Şen, Cihat; Di Mascio, Daniele; Galindo, Alberto; Villalain, Cecilia; Herraiz, Ignacio; Gündüz, Reyhan; Ağaçayak, Elif
    BACKGROUND: It has still to be ascertained whether severe acute respiratory syndrome coronavirus 2 infection in pregnancy is associated with worse maternal and fetal outcomes compared to low risk gestations. OBJECTIVE: This study aimed to evaluate maternal and perinatal outcomes in high- and low-risk pregnancies complicated by severe acute respiratory syndrome coronavirus 2 infection. STUDY DESIGN: This was a multinational retrospective cohort study involving women with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection from 76 centers from 25 countries in Europe, the United States, South America, Asia, and Australia from April 4, 2020, to October 28, 2020. The primary outcome was a composite measure of maternal mortality and morbidity, including admission to the intensive care unit, use of mechanical ventilation, or death. The secondary outcome was a composite measure of adverse perinatal outcome, including miscarriage, fetal loss, neonatal and perinatal death, and admission to the neonatal intensive care unit. All outcomes were assessed in high- and low-risk pregnancies. Pregnancies were considered high risk in case of either preexisting chronic medical conditions in pregnancy or obstetrical disorders occurring in pregnancy. The Fisher exact test and logistic regression analysis were used to analyze the data. RESULTS: A total of 887 singleton pregnancies who tested positive for severe acute respiratory syndrome coronavirus 2 infection using reverse transcription-polymerase chain reaction of nasal and pharyngeal swab specimens were included in the study. The risk of composite adverse maternal outcomes was higher in high-risk pregnancies than in low-risk pregnancies (odds ratio, 1.52; 95% confidence interval, 1.03-2.24; P=.035). In addition, women carrying high-risk pregnancies were at higher risk of hospital admission (odds ratio, 1.48; 95% confidence interval, 1.07-2.04; P=.002), presence of severe respiratory symptoms (odds ratio, 2.13; 95% confidence interval, 0.41-3.21; P=.001), admission to the intensive care unit (odds ratio, 2.63; 95% confidence interval, 1.42-4.88), and invasive mechanical ventilation (odds ratio, 2.65; 95% confidence interval, 1.19-5.94; P=.002). When exploring perinatal outcomes, high-risk pregnancies were at high risk of adverse perinatal outcomes (odds ratio, 1.78; 95% confidence interval, 0.15-2.72; P=.009). However, such association was mainly because of the higher incidence of miscarriage in high-risk pregnancies compared with that in low-risk pregnancies (5.3% vs 1.6%, P=.008); furthermore, there was no difference in other explored outcomes between the 2 study groups. At logistic regression analysis, maternal age (odds ratio, 1.12; 95% confidence interval, 1.02-1.22; P=.023) and high-risk pregnancy (odds ratio, 4.21; 95% confidence interval, 3.90-5.11; P<.001) were independently associated with adverse maternal outcomes. CONCLUSION: High-risk pregnancies complicated by severe acute respiratory syndrome coronavirus 2 infection were at higher risk of adverse maternal outcomes than low-risk pregnancies complicated by severe acute respiratory syndrome coronavirus 2 infection.
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    Maternal and perinatal outcomes of pregnant women with SARS-CoV-2 infection
    (Wiley, 2021) Saccone, Gabriele; Sen, Cihat; Di Mascio, Daniele; Galindo, Alberto; Grunebaum, Amos; Yoshimatsu, Jun; Stanojevic, Milan; Kurjak, Asim; Chervenak, Frank; Rodriguez Suarez, Maria Jose; Maria Gambacorti-Passerini, Zita; Anaya Baz, Maria de los Angeles; Aguilar Galan, Esther Vanessa; Cunarro Lopez, Yolanda; De Leon Luis, Juan Antonio; Cueto Hernandez, Ignacio; Herraiz, Ignacio; Villalain, Cecilia; Venturella, Roberta; Rizzo, Giuseppe; Mappa, Ilenia; Gerosolima, Giovanni; Hellmeyer, Lars; Koenigbauer, Josefine; Ameli, Giada; Frusca, Tiziana; Volpe, Nicola; Luca Schera, Giovanni Battista; Fieni, Stefania; Esposito, Eutalia; Simonazzi, Giuliana; Di Donna, Gaetana; Youssef, Aly; Della Gatta, Anna Nunzia; Di Donna, Mariano Catello; Chiantera, Vito; Buono, Natalina; Sozzi, Giulio; Greco, Pantaleo; Morano, Danila; Bianchi, Beatrice; Marino, Maria Giulia Lombana; Laraud, Federica; Ramone, Arianna; Cagnacci, Angelo; Barra, Fabio; Gustavino, Claudio; Ferrero, Simone; Ghezzi, Fabio; Cromi, Antonella; Lagana, Antonio Simone; Longo, Valentina Laurita; Stollagli, Francesca; Sirico, Angelo; Lanzone, Antonio; Driul, Lorenza; Cecchini, Fabiana; Xodo, Serena; Rodriguez, Brian; Mercado-Olivares, Felipe; Elkafrawi, Deena; Sisti, Giovanni; Esposito, Rosanna; Coviello, Antonio; Cerbone, Marco; Morlando, Maddalena; Schiattarella, Antonio; Colacurci, Nicola; De Franciscis, Pasquale; Cataneo, Ilaria; Lenzi, Marinella; Sandri, Fabrizio; Buscemi, Riccardo; Gattei, Giorgia; della Sala, Francesca; Valori, Eleonora; Rovellotti, Maria Cristina; Done, Elisa; Faron, Gilles; Gucciardo, Leonardo; Esposito, Valentina; Vena, Flaminia; Giancotti, Antonella; Brunelli, Roberto; Muzii, Ludovico; Nappi, Luigi; Sorrentino, Felice; Liberati, Marco; Buca, Danilo; Leombroni, Martina; Di Sebastiano, Francesca; Franchi, Massimo; Ianniciello, Quintino Cesare; Garzon, Simone; Petriglia, Giuliano; Borrello, Leonardo; Nieto-Calvache, Albaro Jose; Burgos-Luna, Juan Manuel; Kadji, Caroline; Carlin, Andrew; Bevilacqua, Elisa; Moucho, Marina; Pinto, Pedro Viana; Figueiredo, Rita; Morales Rosello, Jose; Loscalzo, Gabriela; Martinez-Varea, Alicia; Diago, Vincente; Jimenez Lopez, Jesus S.; Aykanat, Yeliz; Cosma, Stefano; Carosso, Andrea; Benedetto, Chiara; Bermejo, Amanda; May Feuerschuette, Otto Henrique; Uyaniklar, Ozlem; Ocakouglu, Sakine Rahimli; Atak, Zeliha; Gündüz, Reyhan; Haberal, Esra Tustas; Froessler, Bernd; Parange, Anupam; Palm, Peter; Samardjiski, Igor; Taccaliti, Chiara; Okuyan, Erhan; Daskalakis, George; Moreira de Sa, Renato Augusto; Pittaro, Alejandro; Gonzalez-Duran, Maria Luisa; Concheiro Guisan, Ana; Genc, Serife Ozlem; Zlatohlavkova, Blanka; Luengo Piqueras, Anna; Esteban Oliva, Dolores; Cil, Aylin Pelin; Api, Olus; Antsaklis, Panos; Ples, Liana; Kyvernitakis, Ioannis; Maul, Holger; Malan, Marcel; Lila, Albert; Granese, Roberta; Ercoli, Alfredo; Zoccali, Giuseppe; Villasco, Andrea; Biglia, Nicoletta; Madalina, Ciuhodaru; Costa, Elena; Daelemans, Caroline; Pintiaux, Axelle; Cueto, Elisa; Hadar, Eran; Dollinger, Sarah; Brzezinski-Sinai, Noa A.; Huertas, Erasmo; Arango, Pedro; Sanchez, Amadeo; Alfonso Schvartzman, Javier; Cojocaru, Liviu; Turan, Sifa; Turan, Ozhan; Di Dedda, Maria Carmela; Molpeceres, Rebeca Garrote; Zdjelar, Snezana; Premru-Srsen, Tanja; Kornhauser-Cerar, Lilijana; Druskovic, Miriam; De Robertis, Valentina; Stefanovic, Vedran; Nupponen, Irmeli; Nelskyla, Kaisa; Khodjaeva, Zulfiya; Gorina, Ksenia A.; Sukhikh, Gennady T.; Maruotti, Giuseppe Maria; Visentin, Silvia; Cosmi, Erich; Ferrari, Jacopo; Gatti, Alessandra; Luvero, Daniela; Angioli, Roberto; Puri, Ludovica; Palumbo, Marco; D'Urso, Giusella; Colaleo, Francesco; Rapisarda, Agnese Maria Chiara; Carbone, Ilma Floriana; Manzoli, Lamberto; Flacco, Maria Elena; Nazzaro, Giovanni; Locci, Mariavittoria; Guida, Maurizio; Sardo, Attilio Di Spiezio; Panici, Pierluigi Benedetti; Khalil, Asma; Berghella, Vincenzo; Bifulco, Giuseppe; Scambia, Giovanni; Zullo, Fulvio; D'Antonio, Francesco
    Objectives To evaluate the maternal and perinatal outcomes of pregnancies affected by SARS-CoV-2 infection. Methods This was a multinational retrospective cohort study including women with a singleton pregnancy and laboratory-confirmed SARS-CoV-2 infection, conducted in 72 centers in 22 different countries in Europe, the USA, South America, Asia and Australia, between 1 February 2020 and 30 April 2020. Confirmed SARS-CoV-2 infection was defined as a positive result on real-time reverse-transcription polymerase chain reaction (RT-PCR) assay of nasopharyngeal swab specimens. The primary outcome was a composite measure of maternal mortality and morbidity, including admission to the intensive care unit (ICU), use of mechanical ventilation and death. Results In total, 388 women with a singleton pregnancy tested positive for SARS-CoV-2 on RT-PCR of a nasopharyngeal swab and were included in the study. Composite adverse maternal outcome was observed in 47/388 (12.1%) women; 43 (11.1%) women were admitted to the ICU, 36 (9.3%) required mechanical ventilation and three (0.8%) died. Of the 388 women included in the study, 122 (31.4%) were still pregnant at the time of data analysis. Among the other 266 women, six (19.4% of the 31 women with first-trimester infection) had miscarriage, three (1.1%) had termination of pregnancy, six (2.3%) had stillbirth and 251 (94.4%) delivered a liveborn infant. The rate of preterm birth before 37 weeks' gestation was 26.3% (70/266). Of the 251 liveborn infants, 69/251(27.5%) were admitted to the neonatal ICU, and there were five (2.0%) neonatal deaths. The overall rate of perinatal death was 4.1% (11/266). Only one (1/251, 0.4%) infant, born to a mother who tested positive during the third trimester, was found to be positive for SARS-CoV-2 on RT-PCR. Conclusions SARS-CoV-2 infection in pregnant women is associated with a 0.8% rate of maternal mortality, but an 11.1% rate of admission to the ICU. The risk of vertical transmission seems to be negligible. (C) 2020 International Society of Ultrasound in Obstetrics and Gynecology.