Effects of prenatal exposure to maternal COVID-19 and perinatal care on neonatal outcome: results from the INTERCOVID Multinational Cohort Study

Francesca Giuliani, Daniel Oros, Robert B. Gunier, Sonia Deantoni, Stephen Rauch, Roberto Casale, Ricardo Nieto, Enrico Bertino, Albertina Rego, Camilla Menis, Michael G. Gravett, Massimo Candiani, Philippe Deruelle, Perla K. García-May, Mohak Mhatre, Mustapha Ado Usman, Sherief Abd-Elsalam, Saturday Etuk, Raffaele Napolitano, Becky LiuFederico Prefumo, Valeria Savasi, Marynéa Silva Do Vale, Eric Baafi, Shabina Ariff, Nerea Maiz, Muhammad Baffah Aminu, Jorge Arturo Cardona-Perez, Rachel Craik, Gabriela Tavchioska, Babagana Bako, Caroline Benski, Fatimah Hassan-Hanga, Mónica Savorani, Loïc Sentilhes, Maria Carola Capelli, Ken Takahashi, Carmen Vecchiarelli, Satoru Ikenoue, Ramachandran Thiruvengadam, Constanza P. Soto Conti, Irene Cetin, Vincent Bizor Nachinab, Ernawati Ernawati, Eduardo A. Duro, Alexey Kholin, Jagjit Singh Teji, Sarah Rae Easter, Laurent J. Salomon, Adejumoke Idowu Ayede, Rosa Maria Cerbo, Josephine Agyeman-Duah, Paola Roggero, Brenda Eskenazi, Ana Langer, Zulfiqar A. Bhutta, Stephen H. Kennedy, Aris T. Papageorghiou, Jose Villar

Research output: Contribution to journalArticlepeer-review

37 Citations (Scopus)


Background: The effect of COVID-19 in pregnancy on maternal outcomes and its association with preeclampsia and gestational diabetes mellitus have been reported; however, a detailed understanding of the effects of maternal positivity, delivery mode, and perinatal practices on fetal and neonatal outcomes is urgently needed. Objective: To evaluate the impact of COVID-19 on fetal and neonatal outcomes and the role of mode of delivery, breastfeeding, and early neonatal care practices on the risk of mother-to-child transmission. Study Design: In this cohort study that took place from March 2020 to March 2021, involving 43 institutions in 18 countries, 2 unmatched, consecutive, unexposed women were concomitantly enrolled immediately after each infected woman was identified, at any stage of pregnancy or delivery, and at the same level of care to minimize bias. Women and neonates were followed up until hospital discharge. COVID-19 in pregnancy was determined by laboratory confirmation and/or radiological pulmonary findings or ≥2 predefined COVID-19 symptoms. The outcome measures were indices of neonatal and perinatal morbidity and mortality, neonatal positivity and its correlation with mode of delivery, breastfeeding, and hospital neonatal care practices. Results: A total of 586 neonates born to women with COVID-19 diagnosis and 1535 neonates born to women without COVID-19 diagnosis were enrolled. Women with COVID-19 diagnosis had a higher rate of cesarean delivery (52.8% vs 38.5% for those without COVID-19 diagnosis, P<.01) and pregnancy-related complications, such as hypertensive disorders of pregnancy and fetal distress (all with P<.001), than women without COVID-19 diagnosis. Maternal diagnosis of COVID-19 carried an increased rate of preterm birth (P≤.001) and lower neonatal weight (P≤.001), length, and head circumference at birth. In mothers with COVID-19 diagnosis, the length of in utero exposure was significantly correlated to the risk of the neonate testing positive (odds ratio, 4.5; 95% confidence interval, 2.2–9.4 for length of in utero exposure >14 days). Among neonates born to mothers with COVID-19 diagnosis, birth via cesarean delivery was a risk factor for testing positive for COVID-19 (odds ratio, 2.4; 95% confidence interval, 1.2–4.7), even when severity of maternal conditions was considered and after multivariable logistic analysis. In the subgroup of neonates born to women with COVID-19 diagnosis, the outcomes worsened when the neonate also tested positive, with higher rates of neonatal intensive care unit admission, fever, gastrointestinal and respiratory symptoms, and death, even after adjusting for prematurity. Breastfeeding by mothers with COVID-19 diagnosis and hospital neonatal care practices, including immediate skin-to-skin contact and rooming-in, were not associated with an increased risk of newborn positivity. Conclusion: In this multinational cohort study, COVID-19 in pregnancy was associated with increased maternal and neonatal complications. Cesarean delivery was significantly associated with newborn COVID-19 diagnosis. Vaginal delivery should be considered the safest mode of delivery if obstetrical and health conditions allow it. Mother-to-child skin-to-skin contact, rooming-in, and direct breastfeeding were not risk factors for newborn COVID-19 diagnosis, thus well-established best practices can be continued among women with COVID-19 diagnosis.

Original languageEnglish
Pages (from-to)488.e1-488.e17
JournalAmerican Journal of Obstetrics and Gynecology
Issue number3
Publication statusPublished - Sept 2022


  • COVID-19
  • SARS-CoV-2
  • SARS-CoV-2 exposure
  • birthweight
  • breastfeeding
  • cesarean delivery
  • cohort
  • feeding problems
  • hospital stay
  • infections
  • intrauterine growth restriction
  • morbidity
  • mortality
  • multicenter study
  • neonatal intensive care unit admission
  • neonatal outcomes
  • neonate
  • neurologic outcome
  • newborn
  • perinatal practices
  • preeclampsia
  • pregnancy
  • preterm birth
  • respiratory support
  • respiratory symptoms
  • risk ratio
  • rooming-in
  • skin-to-skin
  • small for gestational age


Dive into the research topics of 'Effects of prenatal exposure to maternal COVID-19 and perinatal care on neonatal outcome: results from the INTERCOVID Multinational Cohort Study'. Together they form a unique fingerprint.

Cite this