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- W4310373608 abstract "A SARS-CoV-2 infection during pregnancy increases the risk for preterm birth (PTB).1Mullins E. Hudak M.L. Banerjee J. 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: 573-581Crossref PubMed Scopus (154) Google Scholar Recently, it has been shown that the gestational age at infection, but not the severity of the infection, has a significant impact on PTB rate.2Piekos S.N. Roper R.T. Hwang Y.M. et al.The effect of maternal SARS-CoV-2 infection timing on birth outcomes: a retrospective multicentre cohort study.Lancet Digit Health. 2022; 4: e95-e104Abstract Full Text Full Text PDF PubMed Scopus (35) Google Scholar This study aimed to analyze the association of the timing of symptomatic SARS-CoV-2 infection during pregnancy with PTB and stillbirth risk. From April 3, 2020 to August 24, 2021, the data of 2650 women with a confirmed SARS-CoV-2 infection during pregnancy from 113 hospitals in Germany and Austria (covering about 30% of all deliveries in Germany) were collected in the prospective register COVID-19 Related Obstetrics and Neonatal Outcome Study (CRONOS). The exclusion criteria were defined as follows: (1) asymptomatic infection, (2) SARS-CoV-2 infection after 37+0 weeks of gestation, (3) miscarriage before 20+0 weeks, and (4) incomplete data in terms of infection or delivery date, live birth, maternal age, admission for SARS-CoV-2 symptoms or for obstetrical reasons or a history of stillbirth or PTB in previous pregnancies. The timing of exposure was dichotomized into early (first or second trimester) and late (third trimester) infections. The primary endpoints were PTB (classified as early PTB ≤32 weeks’ gestation or late PTB >32 weeks’ gestation) and stillbirth. Association was assessed using log-binominal regression models for calculating adjusted relative risk (aRR) and 95% confidence intervals (95% CI). Secondary endpoints were defined as delivery within 4 weeks after SARS-CoV-2 infection and occurrence of other pregnancy complications. For categorical variables, chi-Square or Fisher exact tests (n<5) were used. All statistical analyses were performed using SPSS (version 27) for Windows (IBM Corp, Armond, NY). A total of 1149 patients were eligible for the final analysis. Of those, 1128 (98.2%) had a live birth and of those, 201 (17.8%) were preterm (Supplemental Figure). A total of 21 (1.8%) stillbirths occurred (Supplemental Table). More than half of the analyzed women acquired the infection in the third trimester and 45.5% acquired it earlier in pregnancy. Of the 1084 women with known immunization status, no one was vaccinated at the time of infection. Early symptomatic SARS-CoV-2 infection increased the risk for early PTB (aRR, 2.07; 95% CI, 1.10–3.91) and stillbirth (aRR, 2.76; 95% CI, 1.15–6.64) when compared with a late infection (Table). The risk for PTB was higher within 4 weeks after infection (RR, 4.89; 95% CI, 3.86–6.19). Threatened PTB (RR, 1.80; 95% CI,1.07–3.01) and gestational cholestasis (RR, 3.18; 95% CI, 1.19–8.44) occurred more often in late infections.TableMultivariate log-binominal model analysis of the risk for stillbirth and early and late preterm birth according to the time point of SARS-CoV-2 infections (early vs late infection)ParameterStillbirth (all patients)Early PTB (only live births)Late PTB (only live births)RR95% CIP valueRR95% CIP valueRR95% CIP valueMaternal age (per year increase)0.980.91–1.06.6181.050.99–1.12.0961.010.99–1.04.266History of miscarriage or preterm delivery4.971.38–17.98.014aIndicates significant P values.1.220.19–7.98.8371.761.06–2.91.027aIndicates significant P values.In-patient care for SARS-COV-2 infection16.623.34–82.54.001aIndicates significant P values.12.975.37–31.33<.001aIndicates significant P values.3.992.77–5.77<.001aIndicates significant P values.In-patient care for other obstetrical complications25.495.82–111.60<.001aIndicates significant P values.7.633.09–18.83<.001aIndicates significant P values.5.273.78–7.36<.001aIndicates significant P values.Early (1st and 2nd trimester) vs late (3rd trimester) infection2.761.15–6.64.023aIndicates significant P values.2.071.10–3.91.025aIndicates significant P values.0.600.44–0.81.001aIndicates significant P values.RR adjusted for maternal age, SARS-CoV-2 infection needing in-patients’ treatment, obstetrical reasons urging in-patients’ treatment and history of miscarriage or preterm delivery.CI, confidence interval; PTB, preterm birth; RR, risk ratio.Iannaccone. Preterm birth risk after symptomatic SARS-CoV-2 in pregnancy. Am J Obstet Gynecol 2023.a Indicates significant P values. Open table in a new tab RR adjusted for maternal age, SARS-CoV-2 infection needing in-patients’ treatment, obstetrical reasons urging in-patients’ treatment and history of miscarriage or preterm delivery. CI, confidence interval; PTB, preterm birth; RR, risk ratio. Iannaccone. Preterm birth risk after symptomatic SARS-CoV-2 in pregnancy. Am J Obstet Gynecol 2023. A total of 17.8% of the women with symptomatic infections delivered preterm—more than double the rate when compared with the general German preterm birth rate of nearly 9%.3Berger R. Rath W. Abele H. Garnier Y. Kuon R.J. Maul H. Reducing the risk of preterm birth by ambulatory risk factor management.Dtsch Arztebl Int. 2019; 116: 858-864PubMed Google Scholar Hospitalization for any reason was associated with PTB and stillbirth. However, although hospitalization for obstetrical complications mirrors a high-risk pregnancy possibly leading to PTB independently of COVID-19,4Falavina L.P. Oliveira R.R. Melo E.C. Varela P.L.R. Mathias T.A.F. Hospitalization during pregnancy according to childbirth financial coverage: a population-based study.Rev Esc Enferm USP. 2018; 52e03317PubMed Google Scholar hospitalization because of SARS-CoV-2 infection could be regarded as a surrogate marker for the severity of COVID-19. The impact of the hospitalization rate for SARS-CoV-2 on the risk for PTB and stillbirth suggests that the severity of infection is also contradictory to previous reports.2Piekos S.N. Roper R.T. Hwang Y.M. et al.The effect of maternal SARS-CoV-2 infection timing on birth outcomes: a retrospective multicentre cohort study.Lancet Digit Health. 2022; 4: e95-e104Abstract Full Text Full Text PDF PubMed Scopus (35) Google Scholar" @default.
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- W4310373608 title "Is the risk of still and preterm birth affected by the timing of symptomatic SARS-CoV-2 infection during pregnancy? Data from the COVID-19 Related Obstetrics and Neonatal Outcome Study Network, Germany" @default.
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