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Tytuł:
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SARS-CoV-2 and pregnancy outcomes under universal and non-universal testing in Sweden: register-based nationwide cohort study.
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Autorzy:
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Stephansson O; The Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.; Department of Women's Health, Karolinska University Hospital, Stockholm, Sweden.
Pasternak B; The Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.; Statens Serum Institut, Copenhagen, Denmark.
Ahlberg M; The Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.; Department of Women's Health, Karolinska University Hospital, Stockholm, Sweden.
Hervius Askling H; Division of Infectious Diseases, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.; Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.
Aronsson B; The Public Health Agency of Sweden, Solna, Sweden.
Appelqvist E; The Public Health Agency of Sweden, Solna, Sweden.
Jonsson J; The Public Health Agency of Sweden, Solna, Sweden.
Sengpiel V; Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden.; Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Söderling J; The Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.
Norman M; Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.; Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden.
Ludvigsson JF; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.; Department of Paediatrics, Örebro University Hospital, Örebro, Sweden.
Neovius M; The Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.
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Źródło:
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BJOG : an international journal of obstetrics and gynaecology [BJOG] 2022 Jan; Vol. 129 (2), pp. 282-290. Date of Electronic Publication: 2021 Nov 18.
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Typ publikacji:
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Journal Article; Research Support, Non-U.S. Gov't
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Język:
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English
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Imprint Name(s):
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Publication: : Oxford : Wiley-Blackwell
Original Publication: Oxford [England] : Blackwell Science, [2000]-
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MeSH Terms:
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COVID-19*/diagnosis
COVID-19*/epidemiology
COVID-19*/therapy
COVID-19 Testing*/methods
COVID-19 Testing*/statistics & numerical data
Pregnancy Complications, Infectious*/diagnosis
Pregnancy Complications, Infectious*/epidemiology
Pregnancy Complications, Infectious*/therapy
Intensive Care Units, Neonatal/*statistics & numerical data
Pregnancy Outcome/*epidemiology
SARS-CoV-2/*isolation & purification
Apgar Score ; Cohort Studies ; Female ; Humans ; Infant, Newborn ; Pregnancy ; Premature Birth/epidemiology ; Prenatal Care/methods ; Prenatal Care/standards ; Risk Assessment/methods ; Risk Assessment/statistics & numerical data ; Stillbirth/epidemiology ; Sweden/epidemiology
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References:
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Am J Obstet Gynecol. 2020 Jul;223(1):111.e1-111.e14. (PMID: 32335053)
Lancet Glob Health. 2021 Jun;9(6):e759-e772. (PMID: 33811827)
JAMA. 2021 Mar 16;325(11):1099-1100. (PMID: 33555287)
JAMA Intern Med. 2021 May 1;181(5):714-717. (PMID: 33449067)
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Acta Obstet Gynecol Scand. 2018 Apr;97(4):466-476. (PMID: 29172245)
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J Matern Fetal Neonatal Med. 2022 Jul;35(14):2648-2654. (PMID: 32689846)
Obstet Gynecol. 2021 Apr 1;137(4):585-596. (PMID: 33706357)
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Eur J Epidemiol. 2009;24(11):659-67. (PMID: 19504049)
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Am J Reprod Immunol. 2020 Nov;84(5):e13332. (PMID: 32865300)
BMJ. 2020 Sep 1;370:m3320. (PMID: 32873575)
JAMA. 2020 Nov 3;324(17):1782-1785. (PMID: 32965467)
BJOG. 2020 Nov;127(12):1548-1556. (PMID: 32633022)
BJOG. 2022 Jan;129(2):282-290. (PMID: 34706148)
Aust N Z J Obstet Gynaecol. 2020 Oct;60(5):640-659. (PMID: 32779193)
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Grant Information:
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2020-937944 The Swedish Society of Medicine; 105545 United Kingdom WT_ Wellcome Trust; ALF 2020-0443 Region Stockholm and Karolinska Institutet; Childhood Foundation of the Swedish Order of Freemasons; 105545 United Kingdom WT_ Wellcome Trust
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Contributed Indexing:
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Keywords: Apgar; coronavirus disease 2019; neonatal care; preterm birth; severe acute respiratory syndrome coronavirus 2; stillbirth; universal
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Entry Date(s):
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Date Created: 20211027 Date Completed: 20220103 Latest Revision: 20221005
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Update Code:
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20240105
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PubMed Central ID:
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PMC8652549
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DOI:
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10.1111/1471-0528.16990
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PMID:
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34706148
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Objective: To assess associations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and pregnancy outcomes considering testing policy and test-positivity-to-delivery interval.
Design: Nationwide cohort study.
Setting: Sweden.
Population: From the Pregnancy-Register we identified 88 593 singleton births, 11 March 2020-31 January 2021, linked to data on SARS-CoV-2-positivity from the Public Health Agency, and information on neonatal care admission from the Neonatal Quality Register. Adjusted odds ratios (aORs) were estimated stratified by testing-policy and test-positivity-to-delivery interval.
Main Outcome Measures: Five-minute Apgar score, neonatal care admission, stillbirth and preterm birth.
Results: During pregnancy, SARS-CoV-2 test-positivity was 5.4% (794/14 665) under universal testing and 1.9% (1402/73 928) under non-universal testing. There were generally lower risks associated with SARS-CoV-2 under universal than non-universal testing. In women testing positive >10 days from delivery, generally no significant differences in risk were observed under either testing policy. Neonatal care admission was more common (15.3% versus 8.0%; aOR 2.24, 95% CI 1.62-3.11) in women testing positive ≤10 days before delivery under universal testing. There was no significant association with 5-minute Apgar score below 7 (1.0% versus 1.7%; aOR 0.64, 95% CI 0.24-1.72) or stillbirth (0.3% versus 0.4%; aOR 0.72, 95% CI 0.10-5.20). Compared with term births (2.1%), test-positivity was higher in medically indicated preterm birth (5.7%; aOR 2.70, 95% CI 1.60-4.58) but not significantly increased in spontaneous preterm birth (2.3%; aOR 1.12, 95% CI 0.62-2.02).
Conclusions: Testing policy and timing of test-positivity impact associations between SARS-CoV-2-positivity and pregnancy outcomes. Under non-universal testing, women with complications near delivery are more likely to be tested than women without complications, thereby inflating any association with adverse pregnancy outcomes compared with findings under universal testing.
Tweetable Abstract: Testing policy and time from SARS-CoV-2 infection to delivery influence the association with pregnancy outcomes.
(© 2021 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.)
