Risk factors for and pregnancy outcomes after SARS‐CoV‐2 in pregnancy according to disease severity: A nationwide cohort study with validation of the SARS‐CoV‐2 diagnosis
Abstract Introduction We identified risk factors and outcomes associated with SARS‐CoV‐2 infection in pregnancy in a universally tested population according to disease severity and validated information on SARS‐CoV‐2 during pregnancy in national health registers in Denmark. Material and methods Coho...
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2023-03-01
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| Series: | Acta Obstetricia et Gynecologica Scandinavica |
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| Online Access: | https://doi.org/10.1111/aogs.14512 |
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| author | Anna J. M. Aabakke Tanja G. Petersen Karen Wøjdemann Mette H. Ibsen Fjola Jonsdottir Elisabeth Rønneberg Charlotte S. Andersen Anne Hammer Tine D. Clausen Julie Milbak Lars Burmester Rikke Zethner Birgitte Lindved Annette Thorsen‐Meyer Mohammed R. Khalil Birgitte Henriksen Lisbeth Jønsson Lise L. T. Andersen Kamilla K. Karlsen Monica L. Pedersen Gitte Hedermann Marianne Vestgaard Dorthe Thisted Agnethe N. Fallesen Josephine N. Johansson Ditte C. Møller Greta Dubietyte Charlotte B. Andersson Richard Farlie Ane‐Kersti Skaarup Knudsen Lea Hansen Lone Hvidman Anne N. Sørensen Sidsel L. Rathcke Katrine H. Rubin Lone K. Petersen Jan S. Jørgensen Lone Krebs Mette Bliddal |
| author_facet | Anna J. M. Aabakke Tanja G. Petersen Karen Wøjdemann Mette H. Ibsen Fjola Jonsdottir Elisabeth Rønneberg Charlotte S. Andersen Anne Hammer Tine D. Clausen Julie Milbak Lars Burmester Rikke Zethner Birgitte Lindved Annette Thorsen‐Meyer Mohammed R. Khalil Birgitte Henriksen Lisbeth Jønsson Lise L. T. Andersen Kamilla K. Karlsen Monica L. Pedersen Gitte Hedermann Marianne Vestgaard Dorthe Thisted Agnethe N. Fallesen Josephine N. Johansson Ditte C. Møller Greta Dubietyte Charlotte B. Andersson Richard Farlie Ane‐Kersti Skaarup Knudsen Lea Hansen Lone Hvidman Anne N. Sørensen Sidsel L. Rathcke Katrine H. Rubin Lone K. Petersen Jan S. Jørgensen Lone Krebs Mette Bliddal |
| author_sort | Anna J. M. Aabakke |
| collection | DOAJ |
| description | Abstract Introduction We identified risk factors and outcomes associated with SARS‐CoV‐2 infection in pregnancy in a universally tested population according to disease severity and validated information on SARS‐CoV‐2 during pregnancy in national health registers in Denmark. Material and methods Cohort study using data from national registers and medical records including all pregnancies between March 1, 2020 and February 28, 2021. We compared women with a validated positive SARS‐CoV‐2 test during pregnancy with non‐infected pregnant women. Risk factors and pregnancy outcomes were assessed by Poisson and Cox regression models and stratified according to disease severity defined by hospital admission status and admission reason (COVID‐19 symptoms or other). Using medical record data on actual period of pregnancy, we calculated predictive values of the SARS‐CoV‐2 diagnosis in pregnancy in the registers. Results SARS‐CoV‐2 infection was detected in 1819 (1.6%) of 111 185 pregnancies. Asthma was associated with infection (relative risk [RR] 1.63, 95% confidence interval [CI] 1.28–2.07). Risk factors for severe COVID‐19 disease requiring hospital admission were high body mass index (median ratio 1.06, 95% CI 1.04–1.09), asthma (RR 7.47, 95% CI 3.51–15.90) and gestational age at the time of infection (gestational age 28–36 vs < 22: RR 3.53, 95% CI 1.75–7.10). SARS‐CoV‐2‐infected women more frequently had hypertensive disorders in pregnancy (adjusted hazard ratio [aHR] 1.31, 95% CI 1.04–1.64), early pregnancy loss (aHR 1.37, 95% CI 1.00–1.88), preterm delivery before gestational age 28 (aHR 2.31, 95% CI 1.01–5.26), iatrogenically preterm delivery before gestational age 37 (aHR 1.49, 95% CI 1.01–2.19) and small‐for‐gestational age children (aHR 1.28, 95% CI 1.05–1.54). The associations were stronger among women admitted to hospital for any reason. The validity of the SARS‐CoV‐2 diagnosis in relation to pregnancy in the registers compared with medical records showed a negative predictive value of 99.9 (95% CI 99.9–100.0) and a positive predictive value of 82.1 (95% CI 80.4–83.7). Conclusions Women infected with SARS‐CoV‐2 during pregnancy were at increased risk of hypertensive disorders in pregnancy, early pregnancy loss, preterm delivery and having children small for gestational age. The validity of Danish national registers was acceptable for identification of SARS‐CoV‐2 infection during pregnancy. |
| format | Article |
| id | doaj-art-6adf29050da6413ea26e7e4cc48bfff6 |
| institution | OA Journals |
| issn | 0001-6349 1600-0412 |
| language | English |
| publishDate | 2023-03-01 |
| publisher | Wiley |
| record_format | Article |
| series | Acta Obstetricia et Gynecologica Scandinavica |
| spelling | doaj-art-6adf29050da6413ea26e7e4cc48bfff62025-08-20T02:36:42ZengWileyActa Obstetricia et Gynecologica Scandinavica0001-63491600-04122023-03-01102328229310.1111/aogs.14512Risk factors for and pregnancy outcomes after SARS‐CoV‐2 in pregnancy according to disease severity: A nationwide cohort study with validation of the SARS‐CoV‐2 diagnosisAnna J. M. Aabakke0Tanja G. Petersen1Karen Wøjdemann2Mette H. Ibsen3Fjola Jonsdottir4Elisabeth Rønneberg5Charlotte S. Andersen6Anne Hammer7Tine D. Clausen8Julie Milbak9Lars Burmester10Rikke Zethner11Birgitte Lindved12Annette Thorsen‐Meyer13Mohammed R. Khalil14Birgitte Henriksen15Lisbeth Jønsson16Lise L. T. Andersen17Kamilla K. Karlsen18Monica L. Pedersen19Gitte Hedermann20Marianne Vestgaard21Dorthe Thisted22Agnethe N. Fallesen23Josephine N. Johansson24Ditte C. Møller25Greta Dubietyte26Charlotte B. Andersson27Richard Farlie28Ane‐Kersti Skaarup Knudsen29Lea Hansen30Lone Hvidman31Anne N. Sørensen32Sidsel L. Rathcke33Katrine H. Rubin34Lone K. Petersen35Jan S. Jørgensen36Lone Krebs37Mette Bliddal38Department of Obstetrics and Gynecology Copenhagen University Hospital—Holbæk Holbæk DenmarkOPEN, Odense University Hospital Odense DenmarkDepartment of Obstetrics and Gynecology Copenhagen University Hospital—Bornholm Rønne DenmarkDepartment Obstetrics and Gynecology Hospital of South West Jutland Esbjerg DenmarkDepartment of Obstetrics and Gynecology Copenhagen University Hospital—Herlev and Gentofte Herlev DenmarkDepartment of Obstetrics and Gynecology Copenhagen University Hospital—Herlev and Gentofte Herlev DenmarkDepartment of Obstetrics and Gynecology Gødstrup Hospital Herning DenmarkDepartment of Obstetrics and Gynecology Gødstrup Hospital Herning DenmarkDepartment of Obstetrics and Gynecology Copenhagen University Hospital—North Zealand Hillerød DenmarkDepartment of Obstetrics and Gynecology Copenhagen University Hospital—North Zealand Hillerød DenmarkDepartment of Obstetrics and Gynecology The North Denmark Regional Hospital Hjørring Hjørring DenmarkDepartment of Obstetrics and Gynecology Copenhagen University Hospital—Holbæk Holbæk DenmarkDepartment of Obstetrics and Gynecology Horsens Regional Hospital Horsens DenmarkDepartment of Obstetrics and Gynecology Copenhagen University Hospital – Amager and Hvidovre Hvidovre DenmarkDepartment Obstetrics and Gynecology University Hospital of Southern Denmark – Kolding Kolding DenmarkDepartment Obstetrics and Gynecology University Hospital of Southern Denmark – Kolding Kolding DenmarkDepartment Obstetrics and Gynecology Nykøbing F. Hospital Nykøbing F DenmarkDepartment of Obstetrics and Gynecology Odense University Hospital Odense DenmarkDepartment of Obstetrics and Gynecology Odense University Hospital Odense DenmarkDepartment of Obstetrics and Gynecology Randers Regional Hospital Randers DenmarkDepartment of Obstetrics and Gynecology Copenhagen University Hospital – Rigshospitalet Copenhagen DenmarkDepartment of Obstetrics and Gynecology Copenhagen University Hospital – Rigshospitalet Copenhagen DenmarkDepartment of Obstetrics and Gynecology Copenhagen University Hospital—Holbæk Holbæk DenmarkDepartment of Obstetrics and Gynecology Copenhagen University Hospital – Næstved Slagelse DenmarkDepartment of Obstetrics and Gynecology Copenhagen University Hospital – Næstved Slagelse DenmarkDepartment of Obstetrics and Gynecology Hospital of South Jutland Aabenraa DenmarkDepartment of Obstetrics and Gynecology Hospital of South Jutland Aabenraa DenmarkDepartment of Obstetrics and Gynecology The North Denmark Regional Hospital Thisted Thisted DenmarkDepartment of Obstetrics and Gynecology Viborg Regional Hospital Viborg DenmarkDepartment of Obstetrics and Gynecology Viborg Regional Hospital Viborg DenmarkDepartment of Obstetrics and Gynecology Aarhus University Hospital Aarhus DenmarkDepartment of Obstetrics and Gynecology Aarhus University Hospital Aarhus DenmarkDepartment of Obstetrics and Gynecology Aalborg University Hospital Aalborg DenmarkDepartment of Obstetrics and Gynecology Aalborg University Hospital Aalborg DenmarkOPEN, Odense University Hospital Odense DenmarkDepartment of Obstetrics and Gynecology Odense University Hospital Odense DenmarkDepartment of Obstetrics and Gynecology Odense University Hospital Odense DenmarkDepartment of Clinical Medicine University of Copenhagen Copenhagen DenmarkOPEN, Odense University Hospital Odense DenmarkAbstract Introduction We identified risk factors and outcomes associated with SARS‐CoV‐2 infection in pregnancy in a universally tested population according to disease severity and validated information on SARS‐CoV‐2 during pregnancy in national health registers in Denmark. Material and methods Cohort study using data from national registers and medical records including all pregnancies between March 1, 2020 and February 28, 2021. We compared women with a validated positive SARS‐CoV‐2 test during pregnancy with non‐infected pregnant women. Risk factors and pregnancy outcomes were assessed by Poisson and Cox regression models and stratified according to disease severity defined by hospital admission status and admission reason (COVID‐19 symptoms or other). Using medical record data on actual period of pregnancy, we calculated predictive values of the SARS‐CoV‐2 diagnosis in pregnancy in the registers. Results SARS‐CoV‐2 infection was detected in 1819 (1.6%) of 111 185 pregnancies. Asthma was associated with infection (relative risk [RR] 1.63, 95% confidence interval [CI] 1.28–2.07). Risk factors for severe COVID‐19 disease requiring hospital admission were high body mass index (median ratio 1.06, 95% CI 1.04–1.09), asthma (RR 7.47, 95% CI 3.51–15.90) and gestational age at the time of infection (gestational age 28–36 vs < 22: RR 3.53, 95% CI 1.75–7.10). SARS‐CoV‐2‐infected women more frequently had hypertensive disorders in pregnancy (adjusted hazard ratio [aHR] 1.31, 95% CI 1.04–1.64), early pregnancy loss (aHR 1.37, 95% CI 1.00–1.88), preterm delivery before gestational age 28 (aHR 2.31, 95% CI 1.01–5.26), iatrogenically preterm delivery before gestational age 37 (aHR 1.49, 95% CI 1.01–2.19) and small‐for‐gestational age children (aHR 1.28, 95% CI 1.05–1.54). The associations were stronger among women admitted to hospital for any reason. The validity of the SARS‐CoV‐2 diagnosis in relation to pregnancy in the registers compared with medical records showed a negative predictive value of 99.9 (95% CI 99.9–100.0) and a positive predictive value of 82.1 (95% CI 80.4–83.7). Conclusions Women infected with SARS‐CoV‐2 during pregnancy were at increased risk of hypertensive disorders in pregnancy, early pregnancy loss, preterm delivery and having children small for gestational age. The validity of Danish national registers was acceptable for identification of SARS‐CoV‐2 infection during pregnancy.https://doi.org/10.1111/aogs.14512cohort studiesCOVID‐19obstetric deliverypregnancy complicationspregnancy outcomeprospective studies |
| spellingShingle | Anna J. M. Aabakke Tanja G. Petersen Karen Wøjdemann Mette H. Ibsen Fjola Jonsdottir Elisabeth Rønneberg Charlotte S. Andersen Anne Hammer Tine D. Clausen Julie Milbak Lars Burmester Rikke Zethner Birgitte Lindved Annette Thorsen‐Meyer Mohammed R. Khalil Birgitte Henriksen Lisbeth Jønsson Lise L. T. Andersen Kamilla K. Karlsen Monica L. Pedersen Gitte Hedermann Marianne Vestgaard Dorthe Thisted Agnethe N. Fallesen Josephine N. Johansson Ditte C. Møller Greta Dubietyte Charlotte B. Andersson Richard Farlie Ane‐Kersti Skaarup Knudsen Lea Hansen Lone Hvidman Anne N. Sørensen Sidsel L. Rathcke Katrine H. Rubin Lone K. Petersen Jan S. Jørgensen Lone Krebs Mette Bliddal Risk factors for and pregnancy outcomes after SARS‐CoV‐2 in pregnancy according to disease severity: A nationwide cohort study with validation of the SARS‐CoV‐2 diagnosis Acta Obstetricia et Gynecologica Scandinavica cohort studies COVID‐19 obstetric delivery pregnancy complications pregnancy outcome prospective studies |
| title | Risk factors for and pregnancy outcomes after SARS‐CoV‐2 in pregnancy according to disease severity: A nationwide cohort study with validation of the SARS‐CoV‐2 diagnosis |
| title_full | Risk factors for and pregnancy outcomes after SARS‐CoV‐2 in pregnancy according to disease severity: A nationwide cohort study with validation of the SARS‐CoV‐2 diagnosis |
| title_fullStr | Risk factors for and pregnancy outcomes after SARS‐CoV‐2 in pregnancy according to disease severity: A nationwide cohort study with validation of the SARS‐CoV‐2 diagnosis |
| title_full_unstemmed | Risk factors for and pregnancy outcomes after SARS‐CoV‐2 in pregnancy according to disease severity: A nationwide cohort study with validation of the SARS‐CoV‐2 diagnosis |
| title_short | Risk factors for and pregnancy outcomes after SARS‐CoV‐2 in pregnancy according to disease severity: A nationwide cohort study with validation of the SARS‐CoV‐2 diagnosis |
| title_sort | risk factors for and pregnancy outcomes after sars cov 2 in pregnancy according to disease severity a nationwide cohort study with validation of the sars cov 2 diagnosis |
| topic | cohort studies COVID‐19 obstetric delivery pregnancy complications pregnancy outcome prospective studies |
| url | https://doi.org/10.1111/aogs.14512 |
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