학술논문
Late miscarriage and stillbirth in asymptomatic and symptomatic hospitalised pregnant women in Belgium during the first and second waves of COVID-19: a prospective nationwide population-based study
Document Type
Clinical report
Author
Vercoutere, An; Zina, Mbiton Joel; Benoit, Karolien; Costa, Elena; Derisbourg, Sara; Boulvain, Michel; Roelens, Kristien; Vandenberghe, Griet; Daelemans, Caroline; Ackermans, J.; Anton, D.; Bafort, M.; Batter, A.; Belhomme, Julie; Beliard, A.; Bollen, B.; Boon, V.; Bosteels, Jan; Bracke, V.; Ceysens, Gilles; Chaban, F.; Chantraine, Frédéric; Christiaensen, E.; Clabout, L.; Cryns, P.; Dallequin, M.-C.; De Keersmaecker, Bart; De Keyser, J.; De Knif, A.; Scheir, Petra; De Loose, Jeff; De Vits, A.; De Vos, Toenga; Debecker, B.; Delforge, C.; Deloor, J.; Depauw, V.; Depierreux, A.; Devolder, K.; Claes, L.; Dirx, S.; Eerdekens, C.; Emonts, Patrick; Goenen, E.; Grandjean, P.; Hollemaert, S.; Houben, Sylvie; Jankelevitch, E.; Janssen, G.; Quintelier, J.; Kacem, Yasmine; Klay, C.; Laurent, A.; Legrève, J.-F.; Lestrade, A.; Lietaer, C.; Loccufier, A.; Logghe, Hilde; Loumaye, F.; Mariman, V.; Minten, N.; Mortier, D.; Mulders, K.; Palgen, G.; Pezin, Thomas; Polisiou, K.; Riera, Catherine; Romain, M.; Rombaut, Benoit; Ruymbeke, M.; Scharpé, K.; Schockaert, C.; Segers, A.; Serkei, Elvira; Steenhaut, Patricia; Steylemans, An; Thaler, B.; Van Dalen, W.; Van De Poel, E.; Van Deynse, E.; Van Dijck, R.; Van Holsbeke, Caroline; Van Hoorick, L.; Van Olmen, G.; Vanballaer, P.; Vancalsteren, Kristel; Vandeginste, S.; Vandepitte, S.; Verbeken, K.; Vereecke, A.; Verheecke, M.; Watkins-Masters, L.; Wijckmans, V.; Wuyts, K.
Source
BMC Pregnancy and Childbirth. May 16, 2023, Vol. 23 Issue 1
Subject
Language
English
Abstract
Author(s): An Vercoutere[sup.1] , Mbiton Joel Zina[sup.2] , Karolien Benoit[sup.3] , Elena Costa[sup.1] , Sara Derisbourg[sup.1] , Michel Boulvain[sup.1] , Kristien Roelens[sup.3,4,5] , Griet Vandenberghe[sup.3,4] , Caroline Daelemans[sup.3,6] , J. [...]
Background Stillbirth has been recognized as a possible complication of a SARS-CoV-2 infection during pregnancy, probably due to destructive placental lesions (SARS-CoV-2 placentitis). The aim of this work is to analyse stillbirth and late miscarriage cases in unvaccinated pregnant women infected with SARS-CoV-2 during the first two waves (wild-type period) in Belgium. Methods Stillbirths and late miscarriages in our prospective observational nationwide registry of SARS-CoV-2 infected pregnant women (n = 982) were classified by three authors using a modified WHO-UMC classification system for standardized case causality assessment. Results Our cohort included 982 hospitalised pregnant women infected with SARS-CoV-2, with 23 fetal demises (10 late miscarriages from 12 to 22 weeks of gestational age and 13 stillbirths). The stillbirth rate was 9.50/00 for singleton pregnancies and 83.30/00 for multiple pregnancies, which seems higher than for the background population (respectively 5.60/00 and 13.80/00). The agreement between assessors about the causal relationship with SARS-Cov-2 infection was fair (global weighted kappa value of 0.66). Among these demises, 17.4% (4/23) were "certainly" attributable to SARS-CoV-2 infection, 13.0% (3/23) "probably" and 30.4% (7/23) "possibly". Better agreement in the rating was noticed when pathological examination of the placenta and identification of the virus were available, underlining the importance of a thorough investigation in case of intra-uterine fetal demise. Conclusions SARS-CoV-2 causality assessment of late miscarriage and stillbirth cases in our Belgian nationwide case series has shown that half of the fetal losses could be attributable to SARS-CoV-2. We must consider in future epidemic emergencies to rigorously investigate cases of intra-uterine fetal demise and to store placental tissue and other material for future analyses. Keywords: COVID-19, SARS-CoV-2, Stillbirth, Late miscarriage, Classification, Placentitis
Background Stillbirth has been recognized as a possible complication of a SARS-CoV-2 infection during pregnancy, probably due to destructive placental lesions (SARS-CoV-2 placentitis). The aim of this work is to analyse stillbirth and late miscarriage cases in unvaccinated pregnant women infected with SARS-CoV-2 during the first two waves (wild-type period) in Belgium. Methods Stillbirths and late miscarriages in our prospective observational nationwide registry of SARS-CoV-2 infected pregnant women (n = 982) were classified by three authors using a modified WHO-UMC classification system for standardized case causality assessment. Results Our cohort included 982 hospitalised pregnant women infected with SARS-CoV-2, with 23 fetal demises (10 late miscarriages from 12 to 22 weeks of gestational age and 13 stillbirths). The stillbirth rate was 9.50/00 for singleton pregnancies and 83.30/00 for multiple pregnancies, which seems higher than for the background population (respectively 5.60/00 and 13.80/00). The agreement between assessors about the causal relationship with SARS-Cov-2 infection was fair (global weighted kappa value of 0.66). Among these demises, 17.4% (4/23) were "certainly" attributable to SARS-CoV-2 infection, 13.0% (3/23) "probably" and 30.4% (7/23) "possibly". Better agreement in the rating was noticed when pathological examination of the placenta and identification of the virus were available, underlining the importance of a thorough investigation in case of intra-uterine fetal demise. Conclusions SARS-CoV-2 causality assessment of late miscarriage and stillbirth cases in our Belgian nationwide case series has shown that half of the fetal losses could be attributable to SARS-CoV-2. We must consider in future epidemic emergencies to rigorously investigate cases of intra-uterine fetal demise and to store placental tissue and other material for future analyses. Keywords: COVID-19, SARS-CoV-2, Stillbirth, Late miscarriage, Classification, Placentitis