Maternal and perinatal outcomes of SARS-COV-2 Infection in Vaccinated Compared with Unvaccinated Pregnant Patients

Abstract

The objective of this study is to evaluate maternal and fetal outcomes of Covid-19 in vaccinated compared with unvaccinated pregnant patients. The study included 244 pregnant patients with COVID-19 infection confirmed by a positive SARS-CoV-2 polymerized chain reaction (PCR) test. Two hundred-four patients were not unvaccinated, and 40 patients were vaccinated. The clinical, biochemical, radiological results and maternofetal outcomes of the pregnant patients were recorded. All the data were evaluated statistically. The pregnant patients included in the study had a mean age of 31.4 in the vaccinated group, and 28.3 years in the unvaccinated group. Comorbidities were determined in 25% of the patients, and the most common symptom was fever in 65.5% of cases. Sore throat, loss of taste sensation, and loss of smell sensation were detected significantly more in the unvaccinated group (p<0.01). Most of the patients were in third-trimester pregnancy in both groups. No patient in the vaccinated group needed intensive care due to covid. A significant difference was found between the two groups in terms of neonatal intensive care requirements. This study determined that intensive care requirement is increased for both mother and newborn, covid symptoms could be prolonged and hospital stay is longer in the unvaccinated group. Considering these data, the covid-19 vaccine should be offered to all pregnant women.

Keywords

• COVID-19
• vaccine
• pregnancy
• cesarean
• intensive care

References

1. 1. Yu N., Li W., Kang Q., Xiong Z.,Wang S. Clinical features and obstetric and neonatal outcomes of pregnant patients with COVID-19 in Wuhan, China: a retrospective, single-centre, descriptive study. Lancet Infect Dis. 2020;20: 559–64
2. 2. Wu Z, McGoogan JM. Characteristics of and important lessons from the Coronavirus disease 2019 (COVID‐19) outbreak in China: Summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020; 323:1239.
3. 3. Chen, Huijun et al. "Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records." Lancet, vol. 395,10226 (2020): 809-815.
4. 4. Buekens P, Alger J, Bréart G, Cafferata ML, Harville E, Tomasso G. A call for action for COVID-19 surveillance and research during pregnancy. Lancet Glob Health. 2020 Jul;8(7): e877-e878.
5. 5. Morgan JA, Biggio JR Jr, Martin JK et. al; Maternal Outcomes After Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection in Vaccinated Compared with Unvaccinated Pregnant Patients. Obstet Gynecol. 2022 Jan 1;139(1):107-109.
6. 6. Shimabukuro TT, Kim SY, Myers TR et. al; CDC v-safe COVID-19 Pregnancy Registry Team. Preliminary Findings of mRNA Covid-19 Vaccine Safety in Pregnant Persons. N Engl J Med. 2021 Jun 17;384(24):2273-2282.
7. 7. Dubey P, Reddy SY, Manuel S, Dwivedi AK. Maternal and neonatal characteristics and outcomes among COVID-19 infected women: An updated systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2020 Sep; 252: 490-501.
8. 8. Monteleone PA, Nakano M, Lazar V, Gomes AP, de H Martin, Bonetti TC. A review of initial data on pregnancy during the COVID-19 outbreak: implications for assisted reproductive treatments. JBRA Assist Reprod. 2020 May 1;24(2):219-225.

9. 9. Turan O, Hakim A, Dashraath P, Jeslyn WJL, Wright A, Abdul-Kadir R. Clinical characteristics, prognostic factors, and maternal and neonatal outcomes of SARS-CoV-2 infection among hospitalized pregnant women: A systematic review. Int J Gynaecol Obstet. 2020 Oct;151(1):7-16.
10. 10. Huntley BJF, Huntley ES, Di Mascio D, Chen T, Berghella V, Chauhan SP. Rates of Maternal and Perinatal Mortality and Vertical Transmission in Pregnancies Complicated by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-Co-V-2) Infection: A Systematic Review. Obstet Gynecol. 2020 Aug;136(2):303-312.
11. 11. Wang X, Tan L, Wang X, Liu W, Lu Y, Cheng L, Sun Z. Comparison of nasopharyngeal and oropharyngeal swabs for SARS-CoV-2 detection in 353 patients received tests with both specimens simultaneously. Int J Infect Dis. 2020 May;94:107-109.
12. 12. Schwartz DA. An Analysis of 38 Pregnant Women With COVID-19, Their Newborn Infants, and Maternal-Fetal Transmission of SARS-CoV-2: Maternal Coronavirus Infections and Pregnancy Outcomes. Arch Pathol Lab Med. 2020 Jul 1;144(7):799-805.
13. 13. Di Mascio D, Khalil A, Saccone G, Rizzo G, Buca D, Liberati et al.Outcome of coronavirus spectrum infections (SARS, MERS, COVID-19) during pregnancy: a systematic review and meta-analysis. Am J Obstet Gynecol MFM. 2020 May;2(2):100107. doi: 10.1016/j.ajogmf.2020.100107. Epub 2020 Mar 25. PMID: 32292902; PMCID: PMC7104131.
14. 14. Della Gatta AN, Rizzo R, Pilu G, Simonazzi G. Coronavirus disease 2019 during pregnancy: a systematic review of reported cases. Am J Obstet Gynecol. 2020 Jul;223(1):36-41. doi: 10.1016/j.ajog.2020.04.013. Epub 2020 Apr 18. PMID: 32311350; PMCID: PMC7165087.
15. 15. Marchand G, Patil AS, Masoud AT, Ware K, King A, Ruther S, et al. : Systematic review and meta-analysis of COVID-19 maternal and neonatal clinical features and pregnancy outcomes up to June 3, 2021. AJOG Glob Rep. 2022 Feb;2(1):100049. doi: 10.1016/j.xagr.2021.100049. Epub 2022 Jan 3. PMID: 35005663; PMCID: PMC8720679.
16. 16. Stock SJ, Carruthers J, Calvert C, Denny C, Donaghy J, Goulding A, et al. SARS-CoV-2 infection and COVID-19 vaccination rates in pregnant women in Scotland. Nat Med. 2022 Mar;28(3):504-512.
17. 17. Goldshtein I, Nevo D, Steinberg DM, Rotem RS, Gorfine M, Chodick G, Segal Y. Association Between BNT162b2 Vaccination and Incidence of SARS-CoV-2 Infection in Pregnant Women. JAMA. 2021 Aug 24;326(8):728-735.
18. 18. Jafari M, Pormohammad A, Sheikh Neshin SA, Ghorbani S, Bose D, Alimohammadi S, Basirjafari S, Mohammadi M, Rasmussen-Ivey C, Razizadeh MH, Nouri-Vaskeh M, Zarei M. Clinical characteristics and outcomes of pregnant women with COVID-19 and comparison with control patients: A systematic review and meta-analysis. Rev Med Virol. 2021 Sep;31(5):1-16. doi: 10.1002/rmv.2208. Epub 2021 Jan 2. PMID: 33387448; PMCID: PMC7883245.
19. 19. Blakeway, Helena et al. "COVID-19 vaccination during pregnancy: coverage and safety." American journal of obstetrics and gynecology vol. 226,2 (2022): 236.e1-236.e14. doi:10.1016/j.ajog.2021.08.007
20. 20. Aktaş HA., Aboalhasan Y., Aygün T., Başol G., Kale A. Covid-19 ve Gebelik. South. Clin. Ist. Euras. 2020;31(Suppl):69-73
21. 21. Burke RM, Killerby ME, Newton S, Ashworth CE, Berns AL, Brennan S, et al.; Case Investigation Form Working Group. Symptom Profiles of a Convenience Sample of Patients with COVID-19 – United States, January-April 2020. MMWR Morb Mortal Wkly Rep. 2020 Jul 17;69(28):904-908
22. 22. Pierce-Williams RAM, Burd J, Felder L, Khoury R, Bernstein PS, Avila K, et a. Clinical course of severe and critical coronavirus disease 2019 in hospitalized pregnancies: a United States cohort study. Am J Obstet Gynecol MFM. 2020 Aug;2(3):100134.
23. 23. WAPM (World Association of Perinatal Medicine) Working Group on COVID-19. Maternal and perinatal outcomes of pregnant women with SARS-CoV-2 infection. Ultrasound Obstet Gynecol. 2021 Feb;57(2):232-241. doi: 10.1002/uog.23107. Epub 2021 Jan 21. Erratum in: Ultrasound Obstet Gynecol. 2021 Sep;58(3):496.
24. 24. Alzamora MC, Paredes T, Caceres D, Webb CM, Valdez LM, La Rosa M. Severe COVID‐19 during pregnancy and possible vertical transmission. Am J Perinatol. 2020;37:861–865.