Diguisto C, Ancel PY, Seco A, Baunot N, Caze C, Crenn-Hébert C, Dupont C, Garabedian C, Lebeaux C, Le Ray C, Letouzey M, Lorthe E, Marrer E, Rouger V, Vayssière C, Vauloup Fellous C, Bonnet MP, Deneux-Tharaux C.
Paediatr Perinat Epidemiol. 2025 May 21. doi: 10.1111/ppe.70028. Online ahead of print.
PMID: 40396221
Abstract
Background: Population-based data are needed to reliably assess the impact of SARS-CoV-2 infection during pregnancy.
Objectives: To estimate the population-based incidence of SARS-CoV-2 infection and its severe forms in the obstetric population, identify risk factors of severe SARS-CoV-2 infection (severe COVID-19) and describe delivery, maternal and neonatal outcomes by disease severity, using a definition of severity based on organ dysfunction.
Methods: A prospective population-based study conducted over the three first pandemic waves between March 2020 and April 2021 in 281 maternity hospitals in six French regions included all women with SARS-CoV-2 infection during pregnancy or within 7 days post-partum, whether symptomatic or not, hospitalised or not. Severe COVID-19 forms were defined a priori using clinical, biological and management criteria of organ dysfunction. We calculated infection and severe infection rates and studied associations between sociodemographic, medical and pregnancy characteristics and severe COVID-19 by univariate and multivariate modified Poisson regression modelling.
Results: From a population of 385,214 deliveries in the participating regions, 6015 women with SARS-CoV-2 infection were identified, including 337 severe cases. The rates of severe COVID-19 were 1.1, 0.9 and 3.6 per 1000 deliveries during the first, second and third pandemic waves, respectively, and the proportions of severe COVID-19 were 8.6%, 3.4% and 9.3%, respectively. On multivariate analysis, the risk of severe COVID-19 was associated with younger and older age, migrant status, living with > 4 people, overweight or obesity, chronic hypertension or diabetes and infection ≥ 22 weeks of gestation rather than earlier in pregnancy. Neonatal morbidity occurred mostly with severe maternal infection.
Conclusion: Using an organ-based definition of severity and population-based data, rates of severe COVID-19 appeared lower than in previous studies. A permanent perinatal surveillance system is needed to assess efficiently and rapidly the impact of future pandemics.
Keywords: COVID‐19; SARS‐CoV‐2; maternal morbidity; neonatal morbidity; pregnancy; risk factors.
