SARS-CoV-2 and Pregnancy Outcomes

Published on: 27/09/2021

SARS-CoV-2 and pregnancy outcomes according to gestational age at time of infection

Badr et al, Emerging Infectious Diseases, Oct 2021

Researchers from four University Hospitals around Europe have conducted a retrospective study – looking at the outcomes of what actually happened – of 10,925 women, which was all the women in their four hospitals who were pregnant at 10 weeks gestation (with one baby) and whose pregnancy had a known outcome between 1st February and 30th November 2020.

393 of the 10,925 women (3.60%) were found to have been infected with Covid. The results showed significant increases in composite adverse obstetric outcomes and composite adverse neonatal outcomes for women infected with Covid.

The following conditions were included as adverse obstetric outcomes:

  • Pre-term delivery (before 37 weeks)
  • Pre-eclampsia, eclampsia, or HELLP syndrome
  • Unscheduled caesarean section
  • DVT/PE
  • Pregnancy loss before 24 weeks
  • Stillbirth after 24 weeks
  • Maternal death

The following conditions were included as adverse neonatal outcomes:

  • Low birthweight (less than 2500g)
  • Neonatal intensive care unit (NICU) admission
  • APGAR score of <7 at 5 minutes
  • Respiratory distress
  • Neonatal death


In the group of pregnant women infected with Covid-19, adverse obstetric outcomes occurred in 22.75% of women versus 19.25% of uninfected women. Adverse neonatal outcomes occurred in 17.86% of infected women versus 14.28% of uninfected women.

The study also examined the impact on the rate of individual conditions when a woman contracted Covid, and found an increase in many of these adverse obstetric and neonatal outcomes:

Pre-eclampsia, eclampsia, HELLP syndrome – 2.44% vs 1.89%

Pre-term (<37 weeks) birth – 12.22% vs 8.90%

Caesarean section – 26.63% vs 24.68%

Unplanned caesarean section – 13.87% vs 12.27%

Postpartum hemorrhage – 12.57% vs 9.23%

DVT or PE – 0.53% vs 0.06%

Fetal distress – 10.85% vs 8.74%

NICU admission – 13.09% vs 7.76%

APGAR of <7 at 5 minutes – 4.01% vs 2.58%

The data showed a significantly greater adverse impact from contracting Covid in the second or third trimester.

“In conclusion, SARS-CoV-2 infection in pregnant women during the late second and third trimesters increases the risk for adverse obstetric and neonatal outcomes. However, there is no evidence that infection before 20 week’s gestation increases these risks, except for risk of pre-eclampsia. These findings have implications for public health policy and suggest that vaccination programs should target women either before pregnancy or early in pregnancy to ensure adequate protection when they will be most vulnerable.”

Heidi Eldridge, CEO of MAMA Academy, said:

“This study provides further evidence of the increased risk for women and their babies associated with contracting Covid-19 during pregnancy, and therefore supports the existing evidence base advocating the benefits of vaccination either before or early in pregnancy.

 The evidence already shows that the vaccines being offered to pregnant women and birthing people are not associated with any increased risk during pregnancy. We already know from the evidence that being vaccinated reduces your chances of contracting Covid-19, and reduces the severity of it if you do contract it. Importantly, this study emphasises that the optimal time to get vaccinated during pregnancy is as early as possible rather than to delay until after a certain gestation. This study demonstrates that contracting Covid-19 in the latter stages of pregnancy is associated with a significant increase in complications.

The choice of whether or not to get vaccinated in pregnancy is a very personal one. At MAMA Academy, as the UK’s safer pregnancy charity, we encourage anyone to discuss their concerns and any questions they may have with their midwife, GP or obstetrician, who will support them to reach the right informed decision for them.”

The full study can be found here.