Pregnancy and neonatal outcomes of COVID-19: The PAN-COVID study

Objective To assess perinatal outcomes for pregnancies affected by suspected or confirmed SARS-CoV-2 infection. Methods Prospective, web-based registry. Pregnant women were invited to participate if they had suspected or confirmed SARS-CoV-2 infection between 1st January 2020 and 31st March 2021 to assess the impact of infection on maternal and perinatal outcomes including miscarriage, stillbirth, fetal growth restriction, pre-term birth and transmission to the infant. Results Between April 2020 and March 2021, the study recruited 8239 participants who had suspected or confirmed SARs-CoV-2 infection episodes in pregnancy between January 2020 and March 2021. Maternal death affected 14/8197 (0.2%) participants, 176/8187 (2.2%) of participants required ventilatory support. Pre-eclampsia affected 389/8189 (4.8%) participants, eclampsia was reported in 40/ 8024 (0.5%) of all participants. Stillbirth affected 35/8187 (0.4 %) participants. In participants delivering within 2 weeks of delivery 21/2686 (0.8 %) were affected by stillbirth compared with 8/4596 (0.2 %) delivering ≥ 2 weeks after infection (95 % CI 0.3–1.0). SGA affected 744/7696 (9.3 %) of livebirths, FGR affected 360/8175 (4.4 %) of all pregnancies. Pre-term birth occurred in 922/8066 (11.5%), the majority of these were indicated pre-term births, 220/7987 (2.8%) participants experienced spontaneous pre-term births. Early neonatal deaths affected 11/8050 livebirths. Of all neonates, 80/7993 (1.0%) tested positive for SARS-CoV-2. Conclusions Infection was associated with indicated pre-term birth, most commonly for fetal compromise. The overall proportions of women affected by SGA and FGR were not higher than expected, however there was the proportion affected by stillbirth in participants delivering within 2 weeks of infection was significantly higher than those delivering ≥ 2 weeks after infection. We suggest that clinicians’ threshold for delivery should be low if there are concerns with fetal movements or fetal heart rate monitoring in the time around infection

Prediction of small for gestational age neonates: Screening by maternal serum biochemical markers at 19-24 weeks

ObjectiveTo investigate the potential value of maternal serum concentrations of placental growth factor (PlGF), soluble fms-like tyrosine kinase-1 (sFlt-1), pregnancy associated plasma protein-A (PAPP-A), free β-human chorionic gonadotropin (β-hCG) and α-fetoprotein (AFP) at 19-24 weeks’ gestation, in combination with maternal maternal factors and fetal biometry for prediction of delivery of small for gestational age (SGA) neonates in the absence of preeclampsia (PE) and examine the potential value of such assessment in deciding whether the third-trimester scan should be at 32 and / or 36 weeks’ gestation.MethodsScreening study in 9,715 singleton pregnancies, including 481 (5.0%) that delivered SGA neonates with birth weight <5th percentile (SGA <5th) in the absence of PE. Multivariable logistic regression analysis was used to determine if screening by a combination of maternal factors, fetal head circumference (HC), abdominal circumference (AC) and femur length (FL) and log10 multiple of the median (MoM) values of PLGF, sFlt-1, PAPP-A, free ß-hCG or AFP had significant contribution in predicting SGA neonates. A model was developed in selecting the gestational age for third-trimester assessment, at 32 and / or 36 weeks, based on the results of screening at 19-24 weeks.ResultsIn the SGA <5th group delivering at <37 weeks, compared to the normal group, the mean log10 MoM value of PlGF was lower, AFP was higher and sFlt-1, PAPP-A and free β-hCG were not significantly different. The detection rate (DR) of combined screening by maternal factors, fetal biometry and serum PlGF and AFP at 19-24 weeks, was 100%, 76% and 38% for SGA <5th delivering at <32, 32-36 and at >37 weeks’ gestation, respectively, at false positive rate (FPR) of 10%. In a hypothetical model, it was estimated that if the desired objective of prenatal screening is to predict about 80% of the cases of SGA <5th, it would be necessary at the 19-24 weeks assessment to select 11% of the population to be reassessed at 32 weeks, 46% to be reassessed at 36 weeks and 54% that do not require a third-trimester scan.ConclusionPrenatal prediction of a high proportion of SGA neonates necessitates the undertaking of screening in the third-trimester of pregnancy, in addition to assessment in the second-trimester, and the timing of such screening, at 32 and / or 36 weeks, should be contingent on the results of the assessment at 19-24 weeks