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BMC Pregnancy and Childbirth

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Open Access 01-12-2024 | SARS-CoV-2 | Research

SARS-CoV-2 infection during pregnancy and the risk of adverse maternal outcomes in the Republic of Georgia: a national birth registry-based cohort study

Authors: Natia Skhvitaridze, Amiran Gamkrelidze, Tinatin Manjavidze, Tormod Brenn, Charlotta Rylander

Published in: BMC Pregnancy and Childbirth | Issue 1/2024

Abstract

Background

Georgia experienced an increase in maternal deaths (MD) during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, which warrants further investigation. This study aimed to assess associations between timing of SARS-CoV-2 infection during pregnancy and MD, post-delivery intensive care unit (ICU) admission, and caesarean section (CS) delivery.

Methods

We performed a national birth registry-based cohort study of pregnant women who had completed 22 weeks of gestation and delivered between February 28, 2020, and August 31, 2022. The data were linked to coronavirus disease 2019 (COVID-19) testing, vital, and immunization registries. Pregnant women were classified into three groups: confirmed SARS-CoV-2 infection from conception through 31 days before delivery; confirmed infection within 30 days before or at delivery; and women negative for SARS-CoV-2 infection or without any test results (reference group). Multivariable logistic regression was used to calculate the adjusted odds ratios (aORs) and 95% confidence intervals (CIs).

Results

Among 111,493 pregnant women, 16,751 had confirmed infection during pregnancy, and 7,332 were fully vaccinated against COVID-19 before delivery. Compared to the reference group, those with confirmed infection within 30 days before or at delivery experienced increased odds of MD (aOR: 43.11, 95% CI, 21.99–84.55), post-delivery ICU admission (aOR: 5.20, 95% CI, 4.05–6.67), and CS delivery (aOR: 1.11, 95% CI, 1.03–1.20).

Conclusions

Pregnant women in Georgia with confirmed SARS-CoV-2 infection within 30 days before or at delivery experienced a considerably higher risk of MD and post-delivery ICU admission and a slightly higher risk for CS delivery. Additionally, the results highlighted that most pregnant women were not vaccinated against COVID-19. These findings should alert stakeholders that adherence to public health preventive measures needs to be improved.

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Zaigham M, Andersson O. Maternal and perinatal outcomes with COVID-19: a systematic review of 108 pregnancies. Acta Obstet Gynecol Scand. 2020;99:823–9.CrossRefPubMed

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;2:100049.CrossRefPubMedPubMedCentral

Royal College of Obstetricians Gynecologists. Coronavirus infection in pregnancy: Information for healthcare professionals 2020.

Centers for Disease Control and Prevention. COVID-19 during pregnancy. National Center for Immunization and Respiratory diseases. editor. What We Have Learned: CDC; 2020.

Castro EM. How is COVID-19 affecting pregnant women? Instituto de Salud Global Barcelona, ISGlobal2021.

Metz TD, Clifton RG, Hughes BL, Sandoval GJ, Grobman WA, Saade GR, et al. Association of SARS-CoV-2 infection with serious maternal morbidity and mortality from obstetric complications. JAMA. 2022. https://doi.org/10.1001/jama.2022.1190.CrossRefPubMedPubMedCentral

McClymont E, Albert AY, Alton GD, Boucoiran I, Castillo E, Fell DB, et al. Association of SARS-CoV-2 infection during pregnancy with maternal and perinatal outcomes. JAMA). 2022. https://doi.org/10.1001/jama.2022.5906.CrossRefPubMed

Smith ER, Oakley E, Grandner GW, Ferguson K, Farooq F, Afshar Y, et al. Adverse maternal, fetal, and newborn outcomes among pregnant women with SARS-CoV-2 infection: an individual participant data meta-analysis. BMJ Glob Health. 2023. https://doi.org/10.1136/bmjgh-2022-009495.CrossRefPubMedPubMedCentral

Mullins E, Perry A, Banerjee J, Townson J, Grozeva D, Milton R, et al. Pregnancy and neonatal outcomes of COVID-19: the PAN-COVID study. Eur J Obstet Gynecol Reprod Biol. 2022. https://doi.org/10.1016/j.ejogrb.2022.07.010.CrossRefPubMedPubMedCentral

10.

National Center for Disease Control and Public Health of Georgia. COVID-19 Report of the National Center for Disease Control and Public Health 2020–2021, the 8th revision. 2022.

11.

National Center for Disease Control and Public Health of Georgia. COVID-19 Statistics in Georgia 2022. Accessed 15 Oct, 2022.

12.

Ministry of Internally Displaced Persons from the Occupied Territories. Health and Social Affairs. National Strategy of Supporting Maternal and Child Health in Georgia 2017–2030. Tbilisi; 2017.

13.

National Center for Disease Control. and Public Health of Georgia. Annual report, 2021. Georgia: NCDC, 2022.

14.

Skhvitaridze N, Anda EE, Brenn T, Kintraia N, Gamkrelidze A. Scoping maternal care through the lens of maternal deaths: a retrospective analysis of maternal mortality in Georgia. Sex Reprod Health; 2020.

15.

National Center for Disease Control and Public Health of Georgia. Three years report on pregnancy and newborns health surveillance electronic registry (Birth Registry). Georgia: NCDC; 2021.

16.

Ministry of Internally Displaces Persons from the Occupied Territories., Health and Social Affairs of Georgia, MoH Health Sector Capacity Building and Emergency Preparedness in terms of COVID-19 Pandemic. Action Plan 2022. Georgia, 2022.

17.

Government of Georgia. Decree of the government of Georgia N975 on the approval of the list of priority groups subject to mandatory and routine testing strategy for the SARS-CoV-2 infection and COVID-19. Decree of the Government of Georgia; 2021.

18.

Ministry of Internally Displaces Persons from the Occupied Territories, Health and Social Affairs of Georgia, National Antenatal Care Guideline., 2017. Georgia 2017. Accessed 25 Dec, 2023. https://www.moh.gov.ge/uploads/guidelines/2018/01/30/27c73e076a8aa47c01ccca4200f1e075.pdf.

19.

National Center for Disease Control and Public Health of Georgia. COVID-19 report of the National. Center for Disease Control and Public Health Georgia: NCDC; 2022.

20.

World Health Organization. International Statistical Classification of Diseases and Related Health Problems: Tenth revision (ICD-10), Stat. 2nd edition, 2004.

21.

Mancuso P, Venturelli F, Vicentini M, Perilli C, Larosa E, Bisaccia E, et al. Temporal profile and determinants of viral shedding and of viral clearance confirmation on nasopharyngeal swabs from SARS-CoV-2-positive subjects: a population-based prospective cohort study in Reggio Emilia, Italy. BMJ Open. 2020. https://doi.org/10.1136/bmjopen-2020-040380:e040380.CrossRefPubMedPubMedCentral

22.

Liu B, Jayasundara D, Pye V, Dobbins T, Dore GJ, Matthews G, et al. Whole of population-based cohort study of recovery time from COVID-19 in New South Wales Australia. Lancet Reg Health West Pac. 2021;12. https://doi.org/10.1016/j.lanwpc.2021.:100193.

23.

Zhamantayev O, Kayupova G, Nukeshtayeva K, Yerdessov N, Bolatova Z, Turmukhambetova A. COVID-19 pandemic impact on the maternal mortality in Kazakhstan and comparison with the countries in Central Asia. Int J Environ Res Public Health. 2023;20(2184). https://doi.org/10.3390/ijerph20032184.

24.

de Carvalho-Sauer RCO, Costa MDCN, Teixeira MG, do Nascimento EMR, Silva EMF, Barbosa MLA, et al. Impact of COVID-19 pandemic on time series of maternal mortality ratio in Bahia, Brazil: analysis of period 2011–2020. BMC Pregnancy Childbirth. 2021. https://doi.org/10.1186/s12884-021-03899-y.CrossRefPubMedPubMedCentral

25.

United States Government Accountability Office. Maternal health. Outcomes worsened and disparities persisted during the pandemic. USA, 2022.

26.

Papapanou M, Papaioannou M, Petta A, Routsi E, Farmaki M, Vlahos N, et al. Maternal and neonatal characteristics and outcomes of COVID-19 in pregnancy: an overview of systematic reviews. Int J Environ Res Public Health. 2021. https://doi.org/10.3390/ijerph18020596.CrossRefPubMedPubMedCentral

27.

López-Rodríguez G, Galván M, Valencia ÓG. Comorbidities associated with maternal mortality from COVID-19 in Mexico. Gac Med Mex. 2021. https://doi.org/10.24875/GMM.M21000623.CrossRefPubMed

28.

Mendez-Dominguez N, Santos-Zaldívar K, Gomez-Carro S, Datta-Banik S, Carrillo G. Maternal mortality during the COVID-19 pandemic in Mexico: a preliminary analysis during the first year. BMC Public Health 2021.

29.

Chmielewska B, Barratt I, Townsend R, Kalafat E, van der Meulen J, Gurol-Urganci I, et al. Effects of the COVID-19 pandemic on maternal and perinatal outcomes: a systematic review and meta-analysis. Lancet Glob Health. 2021. https://doi.org/10.1016/S2214-109X(21)00079-6.CrossRefPubMedPubMedCentral

30.

Villar J, Ariff S, Gunier RB, Thiruvengadam R, Rauch S, Kholin A, et al. Maternal and neonatal morbidity and mortality among pregnant women with and without COVID-19 infection: the INTERCOVID multinational cohort study. JAMA Pediatr. 2021. https://doi.org/10.1001/jamapediatrics.2021.1050.CrossRefPubMedPubMedCentral

31.

Brioschi Dos Santos AP, Vicente CR, Cola JP, Tanaka LF, Garbin JRT, Dell’Antonio LS, et al. The impact of COVID-19 on maternal death and fetal death, a cohort study in Brazil. PLoS ONE. 2023. https://doi.org/10.1371/journal.pone.0290343.CrossRefPubMedPubMedCentral

32.

Aabakke AJM, Krebs L, Petersen TG, Kjeldsen FS, Corn G, Wøjdemann K, et al. SARS-CoV-2 infection in pregnancy in Denmark-characteristics and outcomes after confirmed infection in pregnancy: a nationwide, prospective, population-based cohort study. Acta Obstet Gynecol Scand; 2021.

33.

Engjom H, Aabakke AJM, Klungsøyr K, Svanvik T, Äyräs O, Jonasdottir E, et al. COVID-19 in pregnancy-characteristics and outcomes of pregnant women admitted to hospital because of SARS-CoV-2 infection in the nordic countries. Acta Obstet Gynecol Scand; 2021.

34.

Mullins E, Hudak ML, Banerjee J, Getzlaff T, Townson J, Barnette K, et al. Pregnancy and neonatal outcomes of COVID-19: co-reporting of common outcomes from PAN-COVID and AAP-SONPM registries. Ultrasound Obstet Gynecol. 2021. https://doi.org/10.1002/uog.23619.CrossRefPubMedPubMedCentral

35.

McDonnell S, McNamee E, Lindow SW, O’Connell MP. The impact of the Covid-19 pandemic on maternity services: A review of maternal and neonatal outcomes before, during and after the pandemic. https://doi.org/10.1016/j.ejogrb.2020.10.023 Eur J Obstet Gynecol Reprod Biol 2020.

36.

de Freitas Paganoti C, Alkmin da Costa R, Papageorghiou AT, da Silva Costa F, Quintana SM, Graziela de Godoi L, et al. COVID-19 vaccines confer protection in hospitalized pregnant and postpartum women with severe COVID-19: a retrospective cohort study. Vaccines (Basel). 2022. https://doi.org/10.3390/vaccines10050749.CrossRefPubMed

37.

World Health Organization. Questions and Answers: COVID-19 vaccines and pregnancy: WHO 2022. Accessed 20 Oct, 2022.

38.

Watanabe A, Yasuhara J, Iwagami M, Miyamoto Y, Yamada Y, Suzuki Y et al. Peripartum outcomes associated with COVID-19 vaccination during pregnancy: a systematic review and meta-analysis. JAMA Pediatr https://doi.org/10.1001/jamapediatrics.2022.3456.

39.

Fell DB, Dhinsa T, Alton GD, Török E, Dimanlig-Cruz S, Regan AK et al. Association of COVID-19 vaccination in pregnancy with adverse peripartum outcomes. JAMA https://doi.org/10.1001/jama.2022.4255.

40.

Goldshtein I, Nevo D, Steinberg DM, Rotem RS, Gorfine M, Chodick G et al. Association between BNT162b2 vaccination and incidence of SARS-CoV-2 infection in pregnant women. JAMA 2021doi: https://doi.org/10.1001/jama.2021.11035.

41.

Palmsten K, Vazquez-Benitez G, Kharbanda EO, Point. Uncertainty about estimating the risks of COVID-19 during pregnancy. Paediatr Perinat Epidemiol doi: https://doi.org/10.1111/ppe.127732022.

Title: SARS-CoV-2 infection during pregnancy and the risk of adverse maternal outcomes in the Republic of Georgia: a national birth registry-based cohort study
Authors: Natia Skhvitaridze
Amiran Gamkrelidze
Tinatin Manjavidze
Tormod Brenn
Charlotta Rylander
Publication date: 01-12-2024
Publisher: BioMed Central
Keywords: SARS-CoV-2
Sectio Caesarea
Sectio Ceasarea
Infection in Pregnancy
COVID-19
Published in: BMC Pregnancy and Childbirth / Issue 1/2024
Electronic ISSN: 1471-2393
DOI: https://doi.org/10.1186/s12884-024-06329-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

SARS-CoV-2 infection during pregnancy and the risk of adverse maternal outcomes in the Republic of Georgia: a national birth registry-based cohort study

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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