INFECÇÃO POR SARS-COV-2 EM GESTANTES ATENDIDAS EM MATERNIDADE DE ALTO RISCO NO BRASIL

Abstract

Introduction: The rapid spread of severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) infection, the possible development of serious illness, and the possibility of severe obstetric outcomes highlight the importance of addressing SARS-CoV-2 infection in obstetric management. Objectives: To evaluate the obstetric and neonatal outcomes of pregnant women with acute infection or exposed to SARS-CoV-2 during pregnancy, admitted for delivery or abortion care in a high-risk maternity hospital in Brazil. Methods: A cross-sectional study of pregnant women assisted in a high-risk maternity hospital in 2020 in Brazil. All patients admitted for delivery or miscarriage care were tested for severe acute respiratory syndrome coronavirus-2(SARS-CoV-2) using polymerase chain reaction (PCR), immunoglobulin (I)gM, and IgG by immunochromatography. Clinical aspects and obstetric outcomes were analyzed. Newborns of positive mothers were followed up to the sixth month of life through telephone contact. Results: A total of 265 pregnant women were included in the study. Regarding positivity for SARS-CoV-2, the following were found: 12 (4.6%) patients were PCR positive at admission screening, 26 patients (9.8%) were PCR positive during pregnancy, at least 3 weeks before admission, and 71 patients (27.2%) were IgM and/or IgG positive on admission for delivery. Included patients were further classified according to infection activity: patients with positive RT-PCR on admission (regardless of the serology result) and patients with negative IgG and positive IgM serology at admission were considered infected, and patients with a history of of previous positive RT-PCR during pregnancy or with negative RT-PCR and positive IgG on admission (regardless of the IgM result) were considered exposed. Considering this classification, 18 patients (6.8%) were considered infected at hospital admission and 68 (25.7%) were exposed to the virus during pregnancy. Thirty patients (35%) with a positive test had asymptomatic infection for SARS-CoV-2 during pregnancy, while only 6 patients required hospitalization due to respiratory symptoms: 2 (2.3%) with a moderate condition and 4 (4.6% ) with a severe condition that required admission to the Intensive Care Unit (ICU). The relationship between obesity and SARS-CoV-2 infection was statistically significant for any positive test (p=0.038) and the presence of antibodies (p=0.040). SARS-CoV-2- positive patients had greater contact with known positive patients (p=0.001). Newborns of SARS-CoV-2 positive mothers had a greater need for phototherapy after delivery (p=0.05). None of the 17 newborns of infected mothers showed symptoms after birth, 8 were tested and 3 were positive (37.5%) within 72 hours after delivery. Seventy-two percent of the newborns from positive mothers were exclusively breastfed at medical discharge and 61% maintained it until the sixth month of life. Patients with acute infection at delivery had a higher rate of preterm delivery (p=0.02), of and neonatal death (p=0.02) when compared with exposed and negative patients. Conclusion: Data on the impact of SARS-CoV-2 infection on pregnant women and their newborns are still limited, especially in the long term. However, it is notable that pregnant women with documented infection have greater morbidity and obstetric complications than negative patients.