PC1056: Impact of sars-cov-2 Infection at Delivery on Maternal and Neonatal Outcomes

Background: Pregnant women are at considerable risk for SARS-CoV-2 infection with adverse maternal and neonatal outcomes. Mother-to-child-transmission can occur, in-utero, perinatally or postnatally with significant complications in the newborn. Little is known on impact of SARS-CoV-2 on newborn infants. Our county had the highest Covid PCR positive rates in the country. Our objectives were to describe maternal and neonatal outcomes among those with SARS-CoV-2 infection from 2 inner city urban hospitals since beginning of the pandemic and compare outcomes of PCR positive infants to PCR negative infants.

Methods: This was a retrospective review of data from two centers with level III NICUs from April 2020 through March 2022 in Los Angeles, CA. The study included pregnant women who were screened (n= 5478) at or within 15 days of delivery and were PCR positive. Additionally, women with active covid symptoms at delivery were also included even if they had positive PCR test more than 15 days ago. Data of these women and their infants were reviewed from medical records. USC IRB approval was obtained to review the data. Statistical analysis was done using IBM SPSS software version 28.

Results: Out of 5478 women delivered, 350 (6.4%) mothers were SARs-CoV-2 positive at delivery (Figure 1). Majority of SARS-CoV-2 PCR positive patients were Hispanic 319 (91.1%) and asymptomatic 316 (90.2%). Thirty-four (9.8%) were symptomatic for 0-7 days prior to delivery. Three mothers (0.9%) required hospitalization for COVID-19 with ventilatory support. Majority (68.4%) delivered vaginally.
SARS-CoV-2 exposed infants were predominantly singletons births (1 twin) with a mean gestational age of 38.3 weeks; 48 (13.7%) were preterm. Mean birthweight was 3155 grams and 32 infants (9.1%) were low birthweight. Thirty-nine (11.1%) infants needed resuscitation with positive pressure ventilation and 4 (1.1%) infants required intubation. Most of the infants (344) had PCR tests at 24 hours and 48 hours if still hospitalized. Nine (2.6%) were PCR positive: 7 at 24 hours and 2 at 48 hours. (Table 1) Two infants (22%) were treated with remdesevir, dexamethasone and enoxaparin. All SARS-CoV-2 PCR positive infants survived and discharged home.

Conclusion: SARS-CoV-2 infection was present at delivery in more than 6 % of women and 2.8 % of their infants. Although a majority of women were asymptomatic at the time of delivery, there was significant morbidity among newborns including prematurity, low birth weight and respiratory distress even in PCR negative newborns. Two PCR positive infants were symptomatic requiring mechanical ventilation and antiviral medication. These data emphasize the need for screening all pregnant women for SARS-CoV-2 at delivery, and close monitoring of mother-infant dyad if infected. Vaccination of pregnant women should be encouraged.