Clinical spectrum and impact on pregnancy outcomes of SARS-CoV-2 infection during pregnancy: an international series based on prevalence studies
What is the impact of COVID-19 in mothers and fetuses? We do not have an answer to this question.
- Despite most pregnancies with COVID-19 have a mild disease, there are reports of cases with severe or even fatal presentations, which create alarm among women, doctors and the society.
- Likewise, pregnant women are highly vulnerable to the "collateral damage" of COVID-19, i.e. the long term social, wellbeing and economic consequences.
- Because they are young, and apparently "more protected" from COVID-19, there has been a lack of attention on pregnancy.
- This has led to lack of reliable scientific data, generating stress on women and preventing evidence-based information to inform the society, make recommendations and guide policies.
- Therefore, there is an urgent need to have solid data on how COVID19 affects pregnancy and their child.
- International collaboration is critical need to accelerate generation of knowledge.
What are our main questions
How is COVID-19 presenting in pregnant women?
Is it worse in pregnancy like influenza? Could we predict which women are at increased risk?
What is the impact on pregnancy outcomes?
Does it increase the risk of miscarriage, prematurity or fetal death?
- How is the pandemics affecting mental well-being in pregnant women and their children?
- Do lifestyle, socio-economic and air pollution play a role in COVID-19 in pregnancy?
- Will the children of the "Covid generation" develop well?
To provide answers to these critical questions we have designed AN AMBITIOUS RESEARCH PROGRAMME with several lines and studies to create different cohorts.
This is an ambitious initiative. We will put together prevalence studies from countries globally. We have already partners in Europe, Americas and Africa, and are working to make it more global. We expect to put together a series of 10,000 to 15,000 pregnancies.
This study will have less detail than local studies like COVID19: clinical presentation during pregnancy and impact on pregnancy outcomes. A population-based study, but it will give us much more power to detect small differences and describe the rare forms of COVID-19, to know what happens in patients with chronic hypertension or diabetes.
More importantly, we will be able to study very severe forms of COVID-19. We hope to identify determinants and predictors of severe COVID-19 in pregnancy and create algorithms of risk, allowing early treatment which seems to be critical to avoid severe complications.
We expect to complete this study and have the results by September.
- To describe the prevalence of SARS-CoV-2 infection in pregnant women in different countries and regions of the world.
- To describe the clinical spectrum and the impact on perinatal outcomes at different moments of gestation.
- To evaluate geographical or health system factors associated with the clinical presentation and the rate of severe complications.
Data and samples
This is a multicentre collaborative study including case series from different centers. Series are composed of all pregnant women consecutively attending for routine care. Women at any gestational age are of interest.
We obtain structured clinical information about the pregnancy, symptoms of COVID-19, clinical history, perinatal and maternal outcomes. SARS-CoV-2 can be defined by either:
- Real-time reverse transcription-polymerase chain reaction (RT-PCR) test from nasopharyngeal (NP) swabs or saliva samples.
- Serology measurement of antibodies (IgG, IgM or IgM/IgA).
A network of excellence
- Sant Joan De Déu Children's Hospital (SJD), Spain: Francesca Crovetto, Maria Dolores Gómez Roig, Elisenda Bonet-Carne.
- Hospital Clinic Barcelona (HCB), Spain: Fàtima Crispi, Francesc Figueras.
- Hospital Sant Pau Barcelona, Spain: Elisa Llurba, Mónica Cruz Lemini.
- Hospital Italiano de Buenos Aires, Argentina: Lucas Otanño
- Hospital Universitario de Chile, Chile: Mauro Parra Cordero
- ESE Clinica Maternidad Rafael Calvo, Colombia: Jezid Miranda
- Żelazna Medical Center, Poland: Anna Kajdy
- Institute of Clinical Sciences Lund, Sweden: Stefan Hansson
- CHUV Centre hospitalier universitaire vaudois, Switzerland: David Baud, Alice Panchaud Monnat.
The network is still increasing. Information will be updated soon.
While this is a collection of prevalence studies registries of cases are very important.
We support the international registry set up in Switzerland (COVI-Preg, Profs. D Baud and A Panchaud) and encourage you to register their COVID-19 cases in pregnancy. Link: www.covi-preg.ch
In some collaborating centers, children will be followed during 1-2 years to evaluate the neurodevelopment of the "Covid-19 generation".