SARS-CoV-2 and pregnancy outcomes under universal and non-universal testing in Sweden: register-based nationwide cohort study.
Apgar Score
COVID-19
/ diagnosis
COVID-19 Testing
/ methods
Cohort Studies
Female
Humans
Infant, Newborn
Intensive Care Units, Neonatal
/ statistics & numerical data
Pregnancy
Pregnancy Complications, Infectious
/ diagnosis
Pregnancy Outcome
/ epidemiology
Premature Birth
/ epidemiology
Prenatal Care
/ methods
Risk Assessment
/ methods
SARS-CoV-2
/ isolation & purification
Stillbirth
/ epidemiology
Sweden
/ epidemiology
Apgar
coronavirus disease 2019
neonatal care
preterm birth
severe acute respiratory syndrome coronavirus 2
stillbirth
universal
Journal
BJOG : an international journal of obstetrics and gynaecology
ISSN: 1471-0528
Titre abrégé: BJOG
Pays: England
ID NLM: 100935741
Informations de publication
Date de publication:
01 2022
01 2022
Historique:
revised:
13
10
2021
received:
09
07
2021
accepted:
23
10
2021
pubmed:
28
10
2021
medline:
4
1
2022
entrez:
27
10
2021
Statut:
ppublish
Résumé
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. Nationwide cohort study. Sweden. 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. Five-minute Apgar score, neonatal care admission, stillbirth and preterm birth. 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). 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. Testing policy and time from SARS-CoV-2 infection to delivery influence the association with pregnancy outcomes.
Identifiants
pubmed: 34706148
doi: 10.1111/1471-0528.16990
pmc: PMC8652549
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
282-290Subventions
Organisme : The Swedish Society of Medicine
ID : 2020-937944
Organisme : Wellcome Trust
ID : 105545
Pays : United Kingdom
Organisme : Region Stockholm and Karolinska Institutet
ID : ALF 2020-0443
Organisme : Childhood Foundation of the Swedish Order of Freemasons
Organisme : Wellcome Trust
ID : 105545
Pays : United Kingdom
Informations de copyright
© 2021 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.
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