Maternal and neonatal outcomes associated with mild COVID-19 infection in an obstetric cohort in Brazil.

RESUMO

INTRODUÇÃO: Previous coronavirus epidemics were associated with increased maternal morbidity, mortality, and adverse obstetric outcomes. Reports for SARS-Cov-2 indicated that the obstetric population is at increased risk for severe illness, although there is still limited data on obstetric outcomes due to mild COVID-19 during pregnancy.

OBJETIVOS: To determine the association between COVID-19 infection during the pregnancy and maternal and neonatal outcomes, Long COVID symptoms, and postpartum depression.

MÉTODOS: We performed a prospective cohort study among pregnant women with COVID-19 and a control group in a referral center in Northeast Brazil, recruited between March 18, 2020, and July 31, 2021. All data (clinical, laboratory, ultrasound) from both groups and newborns were prospectively collected from medical records. Patients that reported persistent symptoms in the post COVID period were monitored in the follow-up consultations about the duration of symptoms. Postnatal depressive symptoms were assessed at the first postpartum consultation using the Edinburgh Postnatal Depression Scale. Chi-Square test or Fisher’s exact test was used to estimate the association between categorical variables and Student’s t-test or Mann-Whitney U test was used for continuous variables as appropriate. Statistical significance was considered with a p <0.05. This study was approved by the local ethics committee.

RESULTADOS: Eighty-eight pregnant patients with confirmed Covid-19 were enrolled in the study between 5 to 40 gestational weeks when infected, and 88 pregnant women without Covid-19. All participants were unvaccinated when recruited. The majority (95%) had a mild illness. The most common post-Covid-19 symptoms were hyposmia (81.8%), headache (81.8%), and asthenia (80,6%). In 77% of the patients, at least one symptom persisted, and the median duration of Long COVID symptoms was 60 days (IQR=120). One-third (27/88) of the patients received a prescription for “Covid kits” that included off-label prescriptions. Pregnant women with a COVID-19 diagnosis were at higher risk for obstetrical ultrasound abnormalities - mainly fetal growth restriction- (relative risk [RR] 12.72; 95% CI, 1.71- 94.27), premature birth (RR 3.07; 95% CI, 1.17- 8.05) and postnatal depression (RR 1.84; 95% CI, 1.03- 3.28). Rates of cesarean delivery, Apgar scores at 1 and 5 minutes, average birth weight, length at birth, and head circumference were similar in the two groups.

CONCLUSÃO: Our results alert clinicians to the consequences of Covid-19 during pregnancy, even in mild cases, given the increased risk of ultrasound abnormalities, premature birth, Long Covid symptoms, and postpartum depression. National guidelines on preventive measures and treatments should be based on scientific evidence, including attention to the impact on health and family needs during and after the COVID-19 pandemic.

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PALAVRA-CHAVE: COVID-19; Infectious Disease Transmission, Vertical; Coronavirus Infections; Pregnancy Complications, Infectious; Pregnancy outcome; Perinatal outcome; long COVID; Postpartum depression