SARS-CoV-2 infection in pregnancy in Denmark-characteristics and outcomes after confirmed infection in pregnancy: A nationwide, prospective, population-based cohort study

Anna J M Aabakke; Lone Krebs; Tanja G Petersen; Frank S Kjeldsen; Giulia Corn; Karen Wøjdemann; Mette H Ibsen; F Jonsdottir; Elisabeth Rønneberg; Charlotte S Andersen; Iben Sundtoft; Tine Clausen; Julie Milbak; Lars Burmester; Birgitte Lindved; Annette Thorsen-Meyer; Mohammed R Khalil; Birgitte Henriksen; Lisbeth Jønsson; Lise L T Andersen; Kamilla K Karlsen; Monica L Pedersen; Åse Klemmensen; Marianne Vestgaard; Dorthe Thisted; Manrinder K Tatla; Line S Andersen; Anne-Line Brülle; Arense Gulbech; Charlotte B Andersson; Richard Farlie; Lea Hansen; Lone Hvidman; Anne N Sørensen; Sidsel L Rathcke; Katrine H Rubin; Lone K Petersen; Jan S Jørgensen; Lonny Stokholm; Mette Bliddal

doi:10.1111/aogs.14252

SARS-CoV-2 infection in pregnancy in Denmark-characteristics and outcomes after confirmed infection in pregnancy: A nationwide, prospective, population-based cohort study

Anna J M Aabakke, Lone Krebs, Tanja G Petersen, Frank S Kjeldsen, Giulia Corn, Karen Wøjdemann, Mette H Ibsen, F Jonsdottir, Elisabeth Rønneberg, Charlotte S Andersen, Iben Sundtoft, Tine Clausen, Julie Milbak, Lars Burmester, Birgitte Lindved, Annette Thorsen-Meyer, Mohammed R Khalil, Birgitte Henriksen, Lisbeth Jønsson, Lise L T AndersenKamilla K Karlsen, Monica L Pedersen, Åse Klemmensen, Marianne Vestgaard, Dorthe Thisted, Manrinder K Tatla, Line S Andersen, Anne-Line Brülle, Arense Gulbech, Charlotte B Andersson, Richard Farlie, Lea Hansen, Lone Hvidman, Anne N Sørensen, Sidsel L Rathcke, Katrine H Rubin, Lone K Petersen, Jan S Jørgensen, Lonny Stokholm, Mette Bliddal

23 Citations (Scopus)

Abstract

INTRODUCTION: Assessing the risk factors for and consequences of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during pregnancy is essential to guide clinical care. Previous studies on SARS-CoV-2 infection in pregnancy have been among hospitalized patients, which may have exaggerated risk estimates of severe outcomes because all cases of SARS-CoV-2 infection in the pregnant population were not included. The objectives of this study were to identify risk factors for and outcomes after SARS-CoV-2 infection in pregnancy independent of severity of infection in a universally tested population, and to identify risk factors for and outcomes after severe infection requiring hospital admission.

MATERIAL AND METHODS: This was a prospective population-based cohort study in Denmark using data from the Danish National Patient Register and Danish Microbiology Database and prospectively registered data from medical records. We included all pregnancies between March 1 and October 31, 2020 and compared women with a positive SARS-CoV-2 test during pregnancy to non-infected pregnant women. Cases of SARS-CoV-2 infection in pregnancy were both identified prospectively and through register linkage to ensure that all cases were identified and that cases were pregnant during infection. Main outcome measures were pregnancy, delivery, maternal, and neonatal outcomes. Severe infection was defined as hospital admission due to coronavirus disease 2019 (COVID-19) symptoms.

RESULTS: Among 82 682 pregnancies, 418 women had SARS-CoV-2 infection during pregnancy, corresponding to an incidence of 5.1 per 1000 pregnancies, 23 (5.5%) of which required hospital admission due to COVID-19. Risk factors for infection were asthma (odds ratio [OR] 2.19, 95% CI 1.41-3.41) and being foreign born (OR 2.12, 95% CI 1.70-2.64). Risk factors for hospital admission due to COVID-19 included obesity (OR 2.74, 95% CI 1.00-7.51), smoking (OR 4.69, 95% CI 1.58-13.90), infection after gestational age (GA) 22 weeks (GA 22-27 weeks: OR 3.77, 95% CI 1.16-12.29; GA 28-36 weeks: OR 4.76, 95% CI 1.60-14.12), and having asthma (OR 4.53, 95% CI 1.39-14.79). We found no difference in any obstetrical or neonatal outcomes.

CONCLUSIONS: Only 1 in 20 women with SARS-CoV-2 infection during pregnancy required admission to hospital due to COVID-19. Risk factors for admission comprised obesity, smoking, asthma, and infection after GA 22 weeks. Severe adverse outcomes of SARS-CoV-2 infection in pregnancy were rare.

Original language	English
Article number	14252
Journal	Acta Obstetricia et Gynecologica Scandinavica
Volume	100
Issue number	11
Pages (from-to)	2097-2110
Number of pages	14
ISSN	0001-6349
DOIs	https://doi.org/10.1111/aogs.14252
Publication status	Published - Nov 2021

Keywords

cohort studies
coronavirus disease 2019
obstetric delivery
pregnancy complications
pregnancy outcome
prospective studies
severe acute respiratory syndrome coronavirus 2
Humans
Risk Factors
Hospitalization
COVID-19/diagnosis
Pregnancy
Young Adult
Pregnancy Complications, Infectious/epidemiology
Denmark
Adult
Female
Infant, Newborn
Pregnancy Outcome
Cohort Studies

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Aabakke, A. J. M., Krebs, L., Petersen, T. G., Kjeldsen, F. S., Corn, G., Wøjdemann, K., Ibsen, M. H., Jonsdottir, F., Rønneberg, E., Andersen, C. S., Sundtoft, I., Clausen, T., Milbak, J., Burmester, L., Lindved, B., Thorsen-Meyer, A., Khalil, M. R., Henriksen, B., Jønsson, L., ... Bliddal, M. (2021). SARS-CoV-2 infection in pregnancy in Denmark-characteristics and outcomes after confirmed infection in pregnancy: A nationwide, prospective, population-based cohort study. Acta Obstetricia et Gynecologica Scandinavica, 100(11), 2097-2110. Article 14252. https://doi.org/10.1111/aogs.14252

SARS-CoV-2 infection in pregnancy in Denmark-characteristics and outcomes after confirmed infection in pregnancy: A nationwide, prospective, population-based cohort study. / Aabakke, Anna J M; Krebs, Lone; Petersen, Tanja G et al.
In: Acta Obstetricia et Gynecologica Scandinavica, Vol. 100, No. 11, 14252, 11.2021, p. 2097-2110.

Research output: Contribution to journal › Journal article › Research › peer-review

Aabakke, AJM, Krebs, L, Petersen, TG, Kjeldsen, FS, Corn, G, Wøjdemann, K, Ibsen, MH, Jonsdottir, F, Rønneberg, E, Andersen, CS, Sundtoft, I, Clausen, T , Milbak, J, Burmester, L, Lindved, B, Thorsen-Meyer, A, Khalil, MR, Henriksen, B, Jønsson, L, Andersen, LLT, Karlsen, KK, Pedersen, ML, Klemmensen, Å, Vestgaard, M, Thisted, D, Tatla, MK, Andersen, LS, Brülle, A-L, Gulbech, A, Andersson, CB, Farlie, R, Hansen, L, Hvidman, L, Sørensen, AN, Rathcke, SL, Rubin, KH, Petersen, LK, Jørgensen, JS, Stokholm, L & Bliddal, M 2021, 'SARS-CoV-2 infection in pregnancy in Denmark-characteristics and outcomes after confirmed infection in pregnancy: A nationwide, prospective, population-based cohort study', Acta Obstetricia et Gynecologica Scandinavica, vol. 100, no. 11, 14252, pp. 2097-2110. https://doi.org/10.1111/aogs.14252

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title = "SARS-CoV-2 infection in pregnancy in Denmark-characteristics and outcomes after confirmed infection in pregnancy: A nationwide, prospective, population-based cohort study",

abstract = "INTRODUCTION: Assessing the risk factors for and consequences of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during pregnancy is essential to guide clinical care. Previous studies on SARS-CoV-2 infection in pregnancy have been among hospitalized patients, which may have exaggerated risk estimates of severe outcomes because all cases of SARS-CoV-2 infection in the pregnant population were not included. The objectives of this study were to identify risk factors for and outcomes after SARS-CoV-2 infection in pregnancy independent of severity of infection in a universally tested population, and to identify risk factors for and outcomes after severe infection requiring hospital admission.MATERIAL AND METHODS: This was a prospective population-based cohort study in Denmark using data from the Danish National Patient Register and Danish Microbiology Database and prospectively registered data from medical records. We included all pregnancies between March 1 and October 31, 2020 and compared women with a positive SARS-CoV-2 test during pregnancy to non-infected pregnant women. Cases of SARS-CoV-2 infection in pregnancy were both identified prospectively and through register linkage to ensure that all cases were identified and that cases were pregnant during infection. Main outcome measures were pregnancy, delivery, maternal, and neonatal outcomes. Severe infection was defined as hospital admission due to coronavirus disease 2019 (COVID-19) symptoms.RESULTS: Among 82 682 pregnancies, 418 women had SARS-CoV-2 infection during pregnancy, corresponding to an incidence of 5.1 per 1000 pregnancies, 23 (5.5%) of which required hospital admission due to COVID-19. Risk factors for infection were asthma (odds ratio [OR] 2.19, 95% CI 1.41-3.41) and being foreign born (OR 2.12, 95% CI 1.70-2.64). Risk factors for hospital admission due to COVID-19 included obesity (OR 2.74, 95% CI 1.00-7.51), smoking (OR 4.69, 95% CI 1.58-13.90), infection after gestational age (GA) 22 weeks (GA 22-27 weeks: OR 3.77, 95% CI 1.16-12.29; GA 28-36 weeks: OR 4.76, 95% CI 1.60-14.12), and having asthma (OR 4.53, 95% CI 1.39-14.79). We found no difference in any obstetrical or neonatal outcomes.CONCLUSIONS: Only 1 in 20 women with SARS-CoV-2 infection during pregnancy required admission to hospital due to COVID-19. Risk factors for admission comprised obesity, smoking, asthma, and infection after GA 22 weeks. Severe adverse outcomes of SARS-CoV-2 infection in pregnancy were rare.",

keywords = "cohort studies, coronavirus disease 2019, obstetric delivery, pregnancy complications, pregnancy outcome, prospective studies, severe acute respiratory syndrome coronavirus 2, Humans, Risk Factors, Hospitalization, COVID-19/diagnosis, Pregnancy, Young Adult, Pregnancy Complications, Infectious/epidemiology, Denmark, Adult, Female, Infant, Newborn, Pregnancy Outcome, Cohort Studies",

author = "Aabakke, {Anna J M} and Lone Krebs and Petersen, {Tanja G} and Kjeldsen, {Frank S} and Giulia Corn and Karen W{\o}jdemann and Ibsen, {Mette H} and F Jonsdottir and Elisabeth R{\o}nneberg and Andersen, {Charlotte S} and Iben Sundtoft and Tine Clausen and Julie Milbak and Lars Burmester and Birgitte Lindved and Annette Thorsen-Meyer and Khalil, {Mohammed R} and Birgitte Henriksen and Lisbeth J{\o}nsson and Andersen, {Lise L T} and Karlsen, {Kamilla K} and Pedersen, {Monica L} and {\AA}se Klemmensen and Marianne Vestgaard and Dorthe Thisted and Tatla, {Manrinder K} and Andersen, {Line S} and Anne-Line Br{\"u}lle and Arense Gulbech and Andersson, {Charlotte B} and Richard Farlie and Lea Hansen and Lone Hvidman and S{\o}rensen, {Anne N} and Rathcke, {Sidsel L} and Rubin, {Katrine H} and Petersen, {Lone K} and J{\o}rgensen, {Jan S} and Lonny Stokholm and Mette Bliddal",

note = "{\textcopyright} 2021 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).",

year = "2021",

month = nov,

doi = "10.1111/aogs.14252",

language = "English",

volume = "100",

pages = "2097--2110",

journal = "Acta Obstetricia et Gynecologica Scandinavica",

issn = "0001-6349",

publisher = "Informa Healthcare",

number = "11",

}

TY - JOUR

T1 - SARS-CoV-2 infection in pregnancy in Denmark-characteristics and outcomes after confirmed infection in pregnancy

T2 - A nationwide, prospective, population-based cohort study

AU - Aabakke, Anna J M

AU - Krebs, Lone

AU - Petersen, Tanja G

AU - Kjeldsen, Frank S

AU - Corn, Giulia

AU - Wøjdemann, Karen

AU - Ibsen, Mette H

AU - Jonsdottir, F

AU - Rønneberg, Elisabeth

AU - Andersen, Charlotte S

AU - Sundtoft, Iben

AU - Clausen, Tine

AU - Milbak, Julie

AU - Burmester, Lars

AU - Lindved, Birgitte

AU - Thorsen-Meyer, Annette

AU - Khalil, Mohammed R

AU - Henriksen, Birgitte

AU - Jønsson, Lisbeth

AU - Andersen, Lise L T

AU - Karlsen, Kamilla K

AU - Pedersen, Monica L

AU - Klemmensen, Åse

AU - Vestgaard, Marianne

AU - Thisted, Dorthe

AU - Tatla, Manrinder K

AU - Andersen, Line S

AU - Brülle, Anne-Line

AU - Gulbech, Arense

AU - Andersson, Charlotte B

AU - Farlie, Richard

AU - Hansen, Lea

AU - Hvidman, Lone

AU - Sørensen, Anne N

AU - Rathcke, Sidsel L

AU - Rubin, Katrine H

AU - Petersen, Lone K

AU - Jørgensen, Jan S

AU - Stokholm, Lonny

AU - Bliddal, Mette

PY - 2021/11

Y1 - 2021/11

N2 - INTRODUCTION: Assessing the risk factors for and consequences of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during pregnancy is essential to guide clinical care. Previous studies on SARS-CoV-2 infection in pregnancy have been among hospitalized patients, which may have exaggerated risk estimates of severe outcomes because all cases of SARS-CoV-2 infection in the pregnant population were not included. The objectives of this study were to identify risk factors for and outcomes after SARS-CoV-2 infection in pregnancy independent of severity of infection in a universally tested population, and to identify risk factors for and outcomes after severe infection requiring hospital admission.MATERIAL AND METHODS: This was a prospective population-based cohort study in Denmark using data from the Danish National Patient Register and Danish Microbiology Database and prospectively registered data from medical records. We included all pregnancies between March 1 and October 31, 2020 and compared women with a positive SARS-CoV-2 test during pregnancy to non-infected pregnant women. Cases of SARS-CoV-2 infection in pregnancy were both identified prospectively and through register linkage to ensure that all cases were identified and that cases were pregnant during infection. Main outcome measures were pregnancy, delivery, maternal, and neonatal outcomes. Severe infection was defined as hospital admission due to coronavirus disease 2019 (COVID-19) symptoms.RESULTS: Among 82 682 pregnancies, 418 women had SARS-CoV-2 infection during pregnancy, corresponding to an incidence of 5.1 per 1000 pregnancies, 23 (5.5%) of which required hospital admission due to COVID-19. Risk factors for infection were asthma (odds ratio [OR] 2.19, 95% CI 1.41-3.41) and being foreign born (OR 2.12, 95% CI 1.70-2.64). Risk factors for hospital admission due to COVID-19 included obesity (OR 2.74, 95% CI 1.00-7.51), smoking (OR 4.69, 95% CI 1.58-13.90), infection after gestational age (GA) 22 weeks (GA 22-27 weeks: OR 3.77, 95% CI 1.16-12.29; GA 28-36 weeks: OR 4.76, 95% CI 1.60-14.12), and having asthma (OR 4.53, 95% CI 1.39-14.79). We found no difference in any obstetrical or neonatal outcomes.CONCLUSIONS: Only 1 in 20 women with SARS-CoV-2 infection during pregnancy required admission to hospital due to COVID-19. Risk factors for admission comprised obesity, smoking, asthma, and infection after GA 22 weeks. Severe adverse outcomes of SARS-CoV-2 infection in pregnancy were rare.

AB - INTRODUCTION: Assessing the risk factors for and consequences of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during pregnancy is essential to guide clinical care. Previous studies on SARS-CoV-2 infection in pregnancy have been among hospitalized patients, which may have exaggerated risk estimates of severe outcomes because all cases of SARS-CoV-2 infection in the pregnant population were not included. The objectives of this study were to identify risk factors for and outcomes after SARS-CoV-2 infection in pregnancy independent of severity of infection in a universally tested population, and to identify risk factors for and outcomes after severe infection requiring hospital admission.MATERIAL AND METHODS: This was a prospective population-based cohort study in Denmark using data from the Danish National Patient Register and Danish Microbiology Database and prospectively registered data from medical records. We included all pregnancies between March 1 and October 31, 2020 and compared women with a positive SARS-CoV-2 test during pregnancy to non-infected pregnant women. Cases of SARS-CoV-2 infection in pregnancy were both identified prospectively and through register linkage to ensure that all cases were identified and that cases were pregnant during infection. Main outcome measures were pregnancy, delivery, maternal, and neonatal outcomes. Severe infection was defined as hospital admission due to coronavirus disease 2019 (COVID-19) symptoms.RESULTS: Among 82 682 pregnancies, 418 women had SARS-CoV-2 infection during pregnancy, corresponding to an incidence of 5.1 per 1000 pregnancies, 23 (5.5%) of which required hospital admission due to COVID-19. Risk factors for infection were asthma (odds ratio [OR] 2.19, 95% CI 1.41-3.41) and being foreign born (OR 2.12, 95% CI 1.70-2.64). Risk factors for hospital admission due to COVID-19 included obesity (OR 2.74, 95% CI 1.00-7.51), smoking (OR 4.69, 95% CI 1.58-13.90), infection after gestational age (GA) 22 weeks (GA 22-27 weeks: OR 3.77, 95% CI 1.16-12.29; GA 28-36 weeks: OR 4.76, 95% CI 1.60-14.12), and having asthma (OR 4.53, 95% CI 1.39-14.79). We found no difference in any obstetrical or neonatal outcomes.CONCLUSIONS: Only 1 in 20 women with SARS-CoV-2 infection during pregnancy required admission to hospital due to COVID-19. Risk factors for admission comprised obesity, smoking, asthma, and infection after GA 22 weeks. Severe adverse outcomes of SARS-CoV-2 infection in pregnancy were rare.

KW - cohort studies

KW - coronavirus disease 2019

KW - obstetric delivery

KW - pregnancy complications

KW - pregnancy outcome

KW - prospective studies

KW - severe acute respiratory syndrome coronavirus 2

KW - Humans

KW - Risk Factors

KW - Hospitalization

KW - COVID-19/diagnosis

KW - Pregnancy

KW - Young Adult

KW - Pregnancy Complications, Infectious/epidemiology

KW - Denmark

KW - Adult

KW - Female

KW - Infant, Newborn

KW - Pregnancy Outcome

KW - Cohort Studies

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U2 - 10.1111/aogs.14252

DO - 10.1111/aogs.14252

M3 - Journal article

C2 - 34467518

SN - 0001-6349

VL - 100

SP - 2097

EP - 2110

JO - Acta Obstetricia et Gynecologica Scandinavica

JF - Acta Obstetricia et Gynecologica Scandinavica

IS - 11

M1 - 14252

ER -

SARS-CoV-2 infection in pregnancy in Denmark-characteristics and outcomes after confirmed infection in pregnancy: A nationwide, prospective, population-based cohort study

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