Fetal and Perinatal Outcome Following First and Second Trimester COVID-19 Infection: Evidence from a Prospective Cohort Study
2.1. Study Population
2.2. Data Collection
2.3. Follow up of SARS-CoV-2 Infected Pregnant Women
- Vertical transmission rates—all women in our cohort were offered amniocentesis for amniotic fluid RT-PCR test of SARS CoV-2 at the time of genetic amniocentesis. Those who opted for the test, were tested for amniotic fluid SARS CoV-2 RT-PCR as well as maternal serum serology for SARS CoV-2 IgG and IgM.
- Fetal imaging throughout pregnancy—women were followed with serial ultrasound investigations looking for sonographic evidence of fetal disease secondary to viral infection from the time of recruitment and every 4–6 weeks thereafter. To complete fetal brain evaluation, we offered a fetal brain magnetic resonance (MR) study at 30–32 weeks gestation.
- Delivery and newborn data were collected from medical charts or by telephone survey. Small for gestational age (SGA) was defined as birthweight <10th percentile. When possible, we collected umbilical cord blood and tested for SARS CoV-2 IgG and IgM antibodies.
2.5. Statistical Analysis
3.1. Vertical Transmission Rates
3.2. Fetal Imaging Findings Along Pregnancy
3.3. Obstetric Outcome and Neonatal Data
4.1. Main Findings
- No evidence of vertical SARS-COV-2 transmission was found upon amniotic fluid PCR testing or cord blood serology at delivery.
- No evidence of adverse fetal effects was found on serial ultrasound anatomy scans, fetal growth as well as a few cases of fetal brain MR imaging.
- No increased rates of obstetric complications were found. Deliveries occurred at term and newborns were appropriate for gestational age. Neonatal outcome was overall reassuring.
- There was no significant difference for the above outcome measures when comparing first to second trimester infections.
4.2. Strengths and Limitations
Institutional Review Board Statement
Informed Consent Statement
Conflicts of Interest
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|Variable||Overall (n = 55)||First Trimester Infection (n = 28)||Second Trimester Infection (n = 27)||p-Value|
|Age (year mean ± SD)||29.6 ± 6.2||28.9 ± 6.0||30.3 ± 6.4||0.30|
|Gravity||2 (1–5)||2 (1.2–4)||2.5 (1–5)||0.52|
|Parity||1 (0–3)||1 (0–2.7)||1 (0–3.2)||0.70|
|Singleton||51 (92.7)||24 (85.7)||27 (100)||0.04|
|BMI||23.6 ± 4.1||22.1 ± 2.1||24.9 ± 5.1||<0.01|
|19–25||23 (71.9)||15 (93.8)||8 (50.0)||<0.01|
|25–30||6 (18.8)||1 (6.3)||5 (31.3)||0.07|
|Gestational week at infection (avg)||14.2 ± 6.7||8.4 ± 3.3||20.1 ± 3.2||<0.01|
|Severity of symptoms|
|Asymptomatic||5 (9.6)||1 (3.8)||4 (15.4)||0.16|
|Mild||42 (80.8)||23 (88.5)||19 (73.1)||0.16|
|Moderate||4 (7.7)||2 (7.7)||2 (7.7)||1.00|
|Severe||1 (1.9)||0||1 (3.8)||0.31|
|Length of illness (days)||17.8 ± 13.5||15.6 ± 11.7||20.4 ± 15.2||0.28|
|Fever||16 (31.4)||7 (28.0)||9 (34.6)||0.61|
|Shortness of breath||6 (11.5)||1 (3.8)||5 (19.2)||0.08|
|Cough||14 (26.9)||5 (19.2)||9 (34.6)||0.21|
|Fatigue||27 (51.9)||15 (57.7)||12 (46.2)||0.41|
|Anorexia||3 (6.3)||2 (8.3)||1 (4.2)||0.55|
|Loss of smell/taste||29 (55.8)||17 (65.4)||12 (46.2)||0.16|
|Myalgia||14 (26.9)||6 (23.1)||8 (30.8)||0.53|
|Headache||15 (29.4)||11 (44.0)||4 (15.4)||0.02|
|Hospitalization||6 (11.1)||4 (14.8)||2 (7.4)||0.39|
|Investigation||Number of Patients||Results|
|Positive Findings||Negative Findings|
|Amniotic fluid COVID-19 PCR||22||0||22|
|Fetal Brain MRI||5||0||5|
|Fetal anomaly scans||38||8 Ɨ||30|
|Cord blood at delivery|
|Overall||First Trimester COVID (n = 7)||Second Trimester COVID (n = 22)||p-Value|
|Perinatal survival||29 (100)||7 (100)||22 (100)||1.00|
|Gestational week at delivery||38.6 ± 3.0||39.3 ± 1.6||38.3 ± 3.3||0.67|
|Preterm birth||1 (3.4)||0 (0)||1 (4.3)|
|Mode of delivery|
|Vaginal||24 (82.8)||6 (85.7)||18 (81.8)||1.00|
|Operative||2 (6.9)||1 (14.3)||1 (4.5)||0.43|
|Cesarean Section||3 (10.3)||0||3 (13.6)||0.56|
|Labor induction||6 (21.4)||0||6 (28.6)||0.29|
|Birthweight||3260 ± 411||3132 ± 449||3301 ± 400||0.69|
|1 min||9 (9–9)||9 (9–9)||9 (9–9)||1.00|
|5 min||10 (10–10)||10 (10–10)||10 (10–10)||1.00|
|PPH||1 (3.4)||0||1 (4.5)||1.00|
|Fever||3 (10.3)||1 (14.3)||2 (9.1)||1.00|
|1 (3.6)||0||1 (4.8)||1.00|
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Rosen, H.; Bart, Y.; Zlatkin, R.; Ben-Sira, L.; Ben Bashat, D.; Amit, S.; Cohen, C.; Regev-Yochay, G.; Yinon, Y. Fetal and Perinatal Outcome Following First and Second Trimester COVID-19 Infection: Evidence from a Prospective Cohort Study. J. Clin. Med. 2021, 10, 2152. https://doi.org/10.3390/jcm10102152
Rosen H, Bart Y, Zlatkin R, Ben-Sira L, Ben Bashat D, Amit S, Cohen C, Regev-Yochay G, Yinon Y. Fetal and Perinatal Outcome Following First and Second Trimester COVID-19 Infection: Evidence from a Prospective Cohort Study. Journal of Clinical Medicine. 2021; 10(10):2152. https://doi.org/10.3390/jcm10102152Chicago/Turabian Style
Rosen, Hadar, Yossi Bart, Rita Zlatkin, Liat Ben-Sira, Dafna Ben Bashat, Sharon Amit, Carmit Cohen, Gili Regev-Yochay, and Yoav Yinon. 2021. "Fetal and Perinatal Outcome Following First and Second Trimester COVID-19 Infection: Evidence from a Prospective Cohort Study" Journal of Clinical Medicine 10, no. 10: 2152. https://doi.org/10.3390/jcm10102152