Is SARS ‐ CoV ‐2 Infection ( COVID ‐19) Associated With Congenital Anomalies? A Population Study of Congenital Anomaly Surveillance Data and Maternal SARS ‐ CoV ‐2 Infection in Wales

OBJECTIVES: Explore the relationship between maternal SARS-CoV-2 infection and congenital anomalies in Wales. STUDY DESIGN: Mixed observational epidemiological cross-sectional and cohort. METHODS: Congenital anomaly prevalence data were provided by the Congenital Anomaly Register and Information Service. Two comparisons were made using these data: firstly, congenital anomaly subgroup prevalence prior to and during the pandemic at population level, and in a cohort of women with laboratory-confirmed maternal SARS-CoV-2 infection compared with the population trend. RESULTS: Prevalence of congenital anomalies in Wales was lower during the pandemic (mean 365 per 10,000 in 2020-22 vs. 454 per 10,000 in 2009-19) showing stable trends. However, the mean for abdominal wall defects increased from 9.8 per 10,000 births between 2009 and 2019 to 13.9 per 10,000 births in 2020-2022, largely attributed to an increase in omphalocele. A cohort of 486 confirmed maternal SARS-CoV-2 infections led to 181 births affected by congenital anomalies, and the trimester of infection did not impact the adjusted odds of this occurring. Circulatory anomalies were most frequently reported, consistent with pre-pandemic population-level data. Urinary and cardiac anomalies were more prevalent in this cohort group than at population level. CONCLUSIONS: There was no clear evidence at population-level of an association between congenital anomalies and maternal SARS-CoV-2 infection in Wales. However, a potential association with specific congenital anomalies cannot be excluded. Increased omphalocele is consistent with a Europe-wide trend that pre-dated COVID-19. National surveillance registries should remain vigilant.