Investigating the association between COVID-19 exposure and fetal and maternal health before public health vaccinations: A retrospective cohort study

OBJECTIVES: Pregnant women and neonates face a higher risk of adverse outcomes from infectious diseases, such as COVID-19. COVID-19 vaccines were developed rapidly, but we do not fully understand how the disease affected pregnancies and births before these vaccines were available. This study investigated how COVID-19 impact on pregnant women and their neonates before vaccines became widely available. The aim was to investigate the association between maternal COVID-19 infection and pregnancy and neonatal outcomes. STUDY DESIGN: This retrospective cohort study included pregnant women and their neonates (n = 3472 each) in Mashhad before the COVID-19 vaccine rollout. METHODS: Participants were categorized into two groups: those who had COVID-19 and those who did not. Chi-square, t-tests, and Fisher's exact test were used to compare the groups. Linear and logistic regression analyses were used to examine the associations between COVID-19 exposure and different outcomes, both before and after adjusting for potential confounders. RESULTS: Pregnant women with COVID-19, when compared to those without, experienced less weight gain (OR = 0.91, CI 95%: 0.82-0.93) and shorter pregnancy duration (OR = 0.95, CI 95%: 0.92-0.97). COVID-19 infection in pregnant women also showed links to higher odds of cesarean (OR = 1.72, CI 95%: 1.62-1.83), gestational diabetes (OR = 1.11, CI 95%: 1.007-1.22), and unusual newborns that had congenital abnormalities (OR = 1.46, CI 95%: 1.03-2.11). CONCLUSION: The study indicates that women who had COVID-19 during pregnancy, before vaccines were available, had a higher risk of adverse maternal and neonatal outcomes. This finding can provide useful information to healthcare providers and pregnant women about how COVID-19 vaccination can reduce the severity of illness and adverse maternal and neonatal outcomes during pregnancy and the postnatal period.