Infection with SARS-CoV-2 during pregnancy and perinatal death or neonatal intensive care admission: population-based cohort study

Introduction There is a need for understanding the newborn outcomes among SARS-CoV-2 infected mothers during pregnancy. Objective To assess the associations between SARS-CoV-2 infection during pregnancy and perinatal death (PD) and admission to the neonatal intensive care unit (NICU). Methods This population-based cohort study used health data from the Georgian Birth Registry combined with the vital registration system, LabCov (COVID registry) and immunisation electronic module between 26 February 2020 and 31 August 2022. Results In total, 111 490 women gave birth to 113 398 newborns who were included in this study. The participants were classified into three groups based on SARS-CoV-2 infection status during pregnancy: no infection during pregnancy (reference), infection from conception through 14 days before delivery, and infection 14 days before or at delivery. Of women, 15% (16 713) were SARS-CoV-2 positive during pregnancy, and of these, 10.3% (1,564) tested positive within 2 weeks of delivery. The latter group had the highest PD and NICU admission rates. Compared with non-infected women, those with SARS-CoV-2 infection ≤14 days prior to or at delivery had 2.34 (95% CI 1.74 to 3.16) times higher odds of PD; women with SARS-CoV-2 >14 days prior to or at delivery had 36% (adjusted OR 0.64, 95% CI 0.53 to 0.77) lower odds of PD. Likewise, NICU admission was 3.06 (95% CI 2.73 to 3.44) times higher among women with SARS-CoV-2 ≤14 days prior to or at delivery and 8% (95% CI 0.87 to 0.97) lower among women with SARS-CoV-2 >14 days prior to or at delivery compared with women with no documented infection. Conclusions Maternal SARS-CoV-2 infection detected within 14 days before or at delivery was associated with higher odds of PD and NICU admission, while infection occurring earlier in pregnancy (>14 days before delivery) was not associated with increased odds of these outcomes.