TY - JOUR
T1 - Pregnancy and neonatal outcomes of COVID-19
T2 - coreporting of common outcomes from PAN-COVID and AAP-SONPM registries
AU - PAN-COVID investigators and the National Perinatal COVID-19 Registry Study Group
AU - Mullins, E.
AU - Hudak, M. L.
AU - Banerjee, J.
AU - Getzlaff, T.
AU - Townson, J.
AU - Barnette, K.
AU - Playle, R.
AU - Perry, A.
AU - Bourne, T.
AU - Lees, C. C.
AU - Nallapeta, Soum
AU - Mills, Emma
AU - Peers, Beth
AU - Stables, Sarah
AU - Iliodromiti, Stamatina
AU - Armstrong, Maggie
AU - Owen, Hilary
AU - Mccooty, Shanteela
AU - Asghar, Anila
AU - Mutema, Eric
AU - Tanton, Emma
AU - Syson, Jen
AU - Thornton, Danielle
AU - Goddard, Julie
AU - Goddard, Julie
AU - Romero, Elena
AU - Bray, Maryanne
AU - Bourke, Miriam
AU - Trepte, Lauren
AU - Cresswell, Janet
AU - Balling, Trevor
AU - Atkinson, Vicki
AU - Ajay, Bini
AU - Margarit, Lavinia
AU - Toure, Samirah
AU - Windsor, Laurie
AU - Wixted, Donna
AU - Zill-E-Huma, Rabia
AU - Vasu, Vimal
AU - Woodward, Zoe
AU - Hammond, Beverley
AU - Hassan, Wassim
AU - Gada, Ruta
AU - Mason, Nicky
AU - Midwif, Consultant
AU - Emmet, Louise
AU - Chapman, Lianne
AU - Coxon, Sarah
AU - Moller-Christensen, Christine
AU - Verma, Amit
N1 - Funding Information:
The PAN‐COVID study used a purpose‐built Elsevier Macro database and collected outcome data from pregnant women with confirmed or suspected SARS‐CoV‐2 infection, who delivered from 1 January 2020 onwards, and their neonates. The PAN‐COVID study was sponsored by Imperial College London, London, UK and funded by the United Kingdom Research Institute and the National Institute for Health Research. The protocol for the PAN‐COVID study is detailed elsewhere , and we describe briefly the methodology below. The study had 177 participating centers in the UK and 10 countries around the world. The main objective of the PAN‐COVID study was to establish a UK and international disease registry for women with confirmed or suspected SARS‐CoV‐2 infection in pregnancy. Women with suspected SARS‐CoV‐2 infection were included because capacity for SARS‐CoV‐2 polymerase chain reaction testing in the UK was limited to hospital‐admitted patients until April 2020 and we expected the majority of women with infection not to have received testing before this time. SARS‐CoV‐2 infection was considered suspected when an untested pregnant woman reported symptoms that her healthcare professionals thought were likely due to SARS‐CoV‐2. As such, until 30 May 2020, the PAN‐COVID study collected data on women with COVID‐19‐defining symptoms but no confirmatory test, on women who had a positive test and on women with COVID‐19 symptoms and a confirmatory test. From 1 July 2020, symptom data on all participants were collected. 11
Funding Information:
The PAN‐COVID registry is funded by the United Kingdom Research Institute (UKRI) and NIHR through COVID‐19 Rapid Response Call 2, grant reference: MC_PC 19066. The AAP‐SONPM Registry is funded by the University of Florida College of Medicine, Division of Neonatology.
Funding Information:
Participating centers and investigators are listed in Appendices S1 and S2. PAN‐COVID was funded by the UK National Institute for Health Research (NIHR) and supported by UK Clinical Research Network (CRN) and the Urgent Public Health committee. We are grateful to Dr Nigel Simpson for his advice throughout the study. E.M. was funded by a NIHR academic clinical lecturer award. C.C.L. is supported by the UK NIHR Biomedical Research Centre (BRC) based at Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust and Imperial College London, London, UK. The AAP‐SONPM was funded by the University of Florida College of Medicine, Division of Neonatology, Jacksonville, FL, USA and by the in‐kind contributions of participating centers. We thank Karina Aashamar, study management and administration, Women's Health Research Centre, Imperial College London. Infrastructure support for this research was provided by the NIHR Imperial BRC. We are grateful for the support provided by NIHR CRN in England and for the work of Abiola Ojuade and Regimantas Pestininkas at North West London CRN. We thank the PAN‐COVID data team at the Centre for Trials Research, Cardiff University: Rebecca Milton, Nigel Kirby, Matthew Robinson‐Burt, Christopher Lloyd and Kim Munnery. We are grateful to Prof. Helen Ward, Imperial College London, for her comments on this manuscript.
Funding Information:
Participating centers and investigators are listed in Appendices S1 and S2. PAN-COVID was funded by the UK National Institute for Health Research (NIHR) and supported by UK Clinical Research Network (CRN) and the Urgent Public Health committee. We are grateful to Dr Nigel Simpson for his advice throughout the study. E.M. was funded by a NIHR academic clinical lecturer award. C.C.L. is supported by the UK NIHR Biomedical Research Centre (BRC) based at Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust and Imperial College London, London, UK. The AAP-SONPM was funded by the University of Florida College of Medicine, Division of Neonatology, Jacksonville, FL, USA and by the in-kind contributions of participating centers. We thank Karina Aashamar, study management and administration, Women's Health Research Centre, Imperial College London. Infrastructure support for this research was provided by the NIHR Imperial BRC. We are grateful for the support provided by NIHR CRN in England and for the work of Abiola Ojuade and Regimantas Pestininkas at North West London CRN. We thank the PAN-COVID data team at the Centre for Trials Research, Cardiff University: Rebecca Milton, Nigel Kirby, Matthew Robinson-Burt, Christopher Lloyd and Kim Munnery. We are grateful to Prof. Helen Ward, Imperial College London, for her comments on this manuscript. The PAN-COVID registry is funded by the United Kingdom Research Institute (UKRI) and NIHR through COVID-19 Rapid Response Call 2, grant reference: MC_PC 19066. The AAP-SONPM Registry is funded by the University of Florida College of Medicine, Division of Neonatology.
Publisher Copyright:
Copyright © 2021 ISUOG. Published by John Wiley & Sons Ltd.
PY - 2021/4
Y1 - 2021/4
N2 - Objective: Few large cohort studies have reported data on maternal, fetal, perinatal and neonatal outcomes associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in pregnancy. We report the outcome of infected pregnancies from a collaboration formed early during the pandemic between the investigators of two registries, the UK and Global Pregnancy and Neonatal outcomes in COVID-19 (PAN-COVID) study and the American Academy of Pediatrics (AAP) Section on Neonatal–Perinatal Medicine (SONPM) National Perinatal COVID-19 Registry. Methods: This was an analysis of data from the PAN-COVID registry (1 January to 25 July 2020), which includes pregnancies with suspected or confirmed maternal SARS-CoV-2 infection at any stage in pregnancy, and the AAP-SONPM National Perinatal COVID-19 registry (4 April to 8 August 2020), which includes pregnancies with positive maternal testing for SARS-CoV-2 from 14 days before delivery to 3 days after delivery. The registries collected data on maternal, fetal, perinatal and neonatal outcomes. The PAN-COVID results are presented overall for pregnancies with suspected or confirmed SARS-CoV-2 infection and separately in those with confirmed infection. Results: We report on 4005 pregnant women with suspected or confirmed SARS-CoV-2 infection (1606 from PAN-COVID and 2399 from AAP-SONPM). For obstetric outcomes, in PAN-COVID overall and in those with confirmed infection in PAN-COVID and AAP-SONPM, respectively, maternal death occurred in 0.5%, 0.5% and 0.2% of cases, early neonatal death in 0.2%, 0.3% and 0.3% of cases and stillbirth in 0.5%, 0.6% and 0.4% of cases. Delivery was preterm (< 37 weeks' gestation) in 12.0% of all women in PAN-COVID, in 16.1% of those women with confirmed infection in PAN-COVID and in 15.7% of women in AAP-SONPM. Extreme preterm delivery (< 27 weeks' gestation) occurred in 0.5% of cases in PAN-COVID and 0.3% in AAP-SONPM. Neonatal SARS-CoV-2 infection was reported in 0.9% of all deliveries in PAN-COVID overall, in 2.0% in those with confirmed infection in PAN-COVID and in 1.8% in AAP-SONPM; the proportions of neonates tested were 9.5%, 20.7% and 87.2%, respectively. The rates of a small-for-gestational-age (SGA) neonate were 8.2% in PAN-COVID overall, 9.7% in those with confirmed infection and 9.6% in AAP-SONPM. Mean gestational-age-adjusted birth-weight Z-scores were −0.03 in PAN-COVID and −0.18 in AAP-SONPM. Conclusions: The findings from the UK and USA registries of pregnancies with SARS-CoV-2 infection were remarkably concordant. Preterm delivery affected a higher proportion of women than expected based on historical and contemporaneous national data. The proportions of pregnancies affected by stillbirth, a SGA infant or early neonatal death were comparable to those in historical and contemporaneous UK and USA data. Although maternal death was uncommon, the rate was higher than expected based on UK and USA population data, which is likely explained by underascertainment of women affected by milder or asymptomatic infection in pregnancy in the PAN-COVID study, although not in the AAP-SONPM study. The data presented support strong guidance for enhanced precautions to prevent SARS-CoV-2 infection in pregnancy, particularly in the context of increased risks of preterm delivery and maternal mortality, and for priority vaccination of pregnant women and women planning pregnancy.
AB - Objective: Few large cohort studies have reported data on maternal, fetal, perinatal and neonatal outcomes associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in pregnancy. We report the outcome of infected pregnancies from a collaboration formed early during the pandemic between the investigators of two registries, the UK and Global Pregnancy and Neonatal outcomes in COVID-19 (PAN-COVID) study and the American Academy of Pediatrics (AAP) Section on Neonatal–Perinatal Medicine (SONPM) National Perinatal COVID-19 Registry. Methods: This was an analysis of data from the PAN-COVID registry (1 January to 25 July 2020), which includes pregnancies with suspected or confirmed maternal SARS-CoV-2 infection at any stage in pregnancy, and the AAP-SONPM National Perinatal COVID-19 registry (4 April to 8 August 2020), which includes pregnancies with positive maternal testing for SARS-CoV-2 from 14 days before delivery to 3 days after delivery. The registries collected data on maternal, fetal, perinatal and neonatal outcomes. The PAN-COVID results are presented overall for pregnancies with suspected or confirmed SARS-CoV-2 infection and separately in those with confirmed infection. Results: We report on 4005 pregnant women with suspected or confirmed SARS-CoV-2 infection (1606 from PAN-COVID and 2399 from AAP-SONPM). For obstetric outcomes, in PAN-COVID overall and in those with confirmed infection in PAN-COVID and AAP-SONPM, respectively, maternal death occurred in 0.5%, 0.5% and 0.2% of cases, early neonatal death in 0.2%, 0.3% and 0.3% of cases and stillbirth in 0.5%, 0.6% and 0.4% of cases. Delivery was preterm (< 37 weeks' gestation) in 12.0% of all women in PAN-COVID, in 16.1% of those women with confirmed infection in PAN-COVID and in 15.7% of women in AAP-SONPM. Extreme preterm delivery (< 27 weeks' gestation) occurred in 0.5% of cases in PAN-COVID and 0.3% in AAP-SONPM. Neonatal SARS-CoV-2 infection was reported in 0.9% of all deliveries in PAN-COVID overall, in 2.0% in those with confirmed infection in PAN-COVID and in 1.8% in AAP-SONPM; the proportions of neonates tested were 9.5%, 20.7% and 87.2%, respectively. The rates of a small-for-gestational-age (SGA) neonate were 8.2% in PAN-COVID overall, 9.7% in those with confirmed infection and 9.6% in AAP-SONPM. Mean gestational-age-adjusted birth-weight Z-scores were −0.03 in PAN-COVID and −0.18 in AAP-SONPM. Conclusions: The findings from the UK and USA registries of pregnancies with SARS-CoV-2 infection were remarkably concordant. Preterm delivery affected a higher proportion of women than expected based on historical and contemporaneous national data. The proportions of pregnancies affected by stillbirth, a SGA infant or early neonatal death were comparable to those in historical and contemporaneous UK and USA data. Although maternal death was uncommon, the rate was higher than expected based on UK and USA population data, which is likely explained by underascertainment of women affected by milder or asymptomatic infection in pregnancy in the PAN-COVID study, although not in the AAP-SONPM study. The data presented support strong guidance for enhanced precautions to prevent SARS-CoV-2 infection in pregnancy, particularly in the context of increased risks of preterm delivery and maternal mortality, and for priority vaccination of pregnant women and women planning pregnancy.
KW - SARS-CoV-2
KW - coronavirus
KW - fetal growth restriction
KW - outcome
KW - perinatal
KW - preterm delivery
KW - stillbirth
UR - http://www.scopus.com/inward/record.url?scp=85103801599&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85103801599&partnerID=8YFLogxK
U2 - 10.1002/uog.23619
DO - 10.1002/uog.23619
M3 - Article
C2 - 33620113
AN - SCOPUS:85103801599
VL - 57
SP - 573
EP - 581
JO - Ultrasound in Obstetrics and Gynecology
JF - Ultrasound in Obstetrics and Gynecology
SN - 0960-7692
IS - 4
ER -