Study finds COVID-19 during pregnancy is associated with preterm birth


According to a large study led by researchers at the University of California, San Francisco, pregnant women who contract COVID-19 face an increased risk of having a very preterm birth, as well as any preterm birth.

The study’s findings were published in ‘The Lancet Regional Health – Americas’.

The risk of very preterm birth, defined as birth before 32 weeks of gestation, was 60% higher in pregnant women who were infected with COVID-19, while the risk of giving birth before 37 weeks (all preterm births) was 40% higher in those who were infected.

Preterm birth risk increased 160 percent in those with hypertension, diabetes, and/or obesity in addition to COVID-19.

“Preterm birth is associated with a variety of adverse outcomes for pregnant women and infants, and extremely preterm births are associated with the highest risk of infant complications,” said lead and corresponding author Deborah Karasek, PhD, an assistant professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences at UCSF and a researcher with the California Preterm Birth Initiative.

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“Our findings emphasise the critical importance of preventing COVID-19 infection in pregnant women in order to avoid preterm birth, including vaccination,” Karasek said.

“Because pregnant women may have concerns about vaccines and the health of their baby, it is critical to have an open dialogue that values those concerns, describes safety evidence, and communicates the risks associated with COVID-19 infection during pregnancy,” Karasek explained.

On July 30, the American College of Obstetricians and Gynecologists (ACOG) updated its recommendations, strongly recommending that all pregnant women receive the COVID-19 vaccine.

Pregnant women are a high-risk group for COVID-19 infection, but less than a quarter have received at least one dose of vaccine, according to the US Centers for Disease Control and Prevention (CDC).

The UCSF study was the first of its kind to conduct a large-scale analysis of COVID-19 risks by preterm birth subtype, as well as by race, ethnic origin, and insurance status.

The study’s findings reflected both existing disparities in preterm birth rates between Black, Indigenous, and other people of colour (BIPOC) and whites, as well as the pandemic’s known disproportionate burden on communities of colour.

Latinx, American Indian/Alaska Native, Native Hawaiian/Pacific Islander, and those on public insurance all had significantly higher COVID-19 rates during pregnancy.

For example, while Latinx people accounted for 47% of pregnant women overall in the study, they accounted for 72% of those with COVID-19 diagnoses.

“Given that the burden of COVID-19 is greater in these populations, as is the burden of preterm birth,” Karasek explained.

“With the increase in infections and the Delta variant, we must prioritise pregnant women, particularly Black and Brown populations, through supportive policies that reduce exposure and stress and increase access to care,” Karasek added.

The researchers analysed all live births recorded on California Vital Statistics birth certificates between July 2020 and January 2021.

Nearly 9,000, or 3.7 percent, of the 240,157 recorded births indicated a COVID-19 diagnosis during pregnancy. Preterm birth occurred at a rate of 11.8 percent among pregnant women with a COVID-19 diagnosis, compared to 8.7 percent among those without a COVID-19 diagnosis.

Overall, 47.2 percent of respondents identified as Latinx, 26.8 percent as white, 4.9 percent as black, 13.2 percent as Asian, 0.03 percent as American Indian/Alaskan Native, 0.4 percent as Hawaiian/Pacific Islander, and 7.3 percent as other, unknown, or a combination of two or more races.

40% of women in the study had public insurance at the time of delivery, and 15.9% had hypertension, diabetes, obesity, or a combination of these conditions.

Comorbidities increased the risk of preterm birth when combined with COVID-19 infection. Individuals with hypertension, diabetes, and/or obesity who also had a COVID-19 diagnosis had a 160 percent increased risk of very preterm birth and a 100% increased risk of preterm birth, respectively, compared to those without comorbidities or COVID-19.

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“Researchers discovered that preterm birth rates did not differ according to whether births were spontaneous or medically indicated, suggesting that multiple pathways exist between COVID-19 diagnosis and preterm birth,” Karasek concluded.

The study’s limitations include the inability to determine when individuals contracted COVID-19 during pregnancy or the severity of the infections.

These are critical details for understanding how COVID-19 affects preterm birth risk, and Karasek noted that they are currently being studied at UCSF and other institutions.


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