Association between maternal SARS-CoV-2 infection & clinical outcomes in infants: A multicentric retrospective cohort study in India

Background & objectives The effects of COVID-19 on neonatal and perinatal outcomes and infant development in low- and middle-income countries have not been well studied. Our study aimed to explore the effect of maternal COVID-19 infection on pregnancy, neonatal outcomes, and development of infants. Methods We conducted a retrospective cohort study on women exposed to and not exposed to COVID-19 during pregnancy and their infants (exposed and comparison cohort, respectively). Data were collected through hospital records and interview of mothers. Outcomes included stillbirth, preterm birth, low birth weight, admission to special newborn care unit (SNCU) and attainment of age-appropriate developmental milestones till one year of age. We conducted propensity score matching analysis to address any selection bias. Results Exposure to SARS-CoV-2 was associated with a higher risk of stillbirths [adjusted odds ratio (aOR) 2.63; 95% confidence interval (CI) 1.39, 4.96] and admission to SNCU (aOR 2.57; 95% CI 1.85, 3.58) after adjusting for pregnancy and birth-related covariates. Risk of illness among babies born to COVID-positive mothers was higher [relative risk (RR) 4.23; 95% CI 3.14, 5.69; P<0.001]. Age of attainment of developmental milestones were similar between both cohorts. Interpretation & conclusions Women who contracted COVID-19 in pregnancy were at higher risk of stillbirths, and their babies were more likely to be admitted to the SNCU as compared to their COVID-negative counterparts. There were no clinically meaningful differences between babies of both cohorts in the age at which developmental milestones were attained.