Comparing the Risk of Maternal Complications and Adverse Infant Outcomes Among Pregnancies With and Without COVID ‐19 in the Sentinel System

BACKGROUND: SARS-CoV-2 infection during pregnancy may increase the risk of adverse pregnancy outcomes, but knowledge about the timing of COVID-19 infection during pregnancy on these outcomes is limited. OBJECTIVES: We implemented the CONSIGN protocol to examine the impact of COVID-19 on pregnancy-related complications and adverse infant outcomes. STUDY DESIGN: We identified eligible females with live-birth deliveries who had a COVID-19 diagnosis or a positive-confirmed test for SARS-CoV-2. Pregnancies with COVID-19 were propensity score (PS) matched 1:1 to pregnancies without COVID-19 during the 6 months prior to or during pregnancy. RESULTS: From 2020 to 2023, we identified 69 901 pregnancies with COVID-19 and 1:1 matched pregnancies without COVID-19. Most pregnancies with COVID-19 were diagnosed in the third trimester (49%, 33 979/69 901) and < 5% (1860/69 901) were classified as severe. Pregnancies with severe COVID-19 in the first trimester had a higher rate of preterm delivery, and pregnancies with severe COVID-19 in the second trimester had a higher rate of cesarean section compared to those without COVID-19. No increased risk of adverse infant outcomes was observed among 22 865 linked mother-infant pairs with COVID-19 although a slightly increased risk of low birth weight was noted among pregnancies exposed to severe COVID-19 in the third trimester. CONCLUSION: Among nearly 70 000 live-birth pregnancies with COVID-19, severe COVID-19 was associated with cesarean section and preterm delivery. No association with adverse infant outcomes was noted. Our study enabled assessment of the timing and severity of COVID-19 on adverse pregnancy outcomes, although changing treatment and prevention recommendations might impact trends of these outcomes.