Post-COVID in women after SARS-CoV-2 infection during pregnancy – a pilot study with follow-up data from the COVID-19-related Obstetric and Neonatal Outcome Study (CRONOS)

 

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Abstract

Background Pregnant women are at an increased risk of severe COVID-19 and adverse pregnancy outcomes; data on maternal long-term outcome is scarce. We analyzed long-term follow-ups on women who experienced a SARS-CoV-2 infection during pregnancy to evaluate post-COVID symptoms, particularly fatigue, and their association with quality of life (QoL).

Methods 773 women who enrolled in the CRONOS registry between April 2020 and August 2021 were contacted for follow-up from December 2022 to April 2023. Data was gathered through a web-based questionnaire. Subsequently, study coordinators matched the follow-up data with the existing CRONOS data.

Results 110/773 (14%) women provided data. 20.9% experienced only acute symptoms during their SARS-CoV-2 infection in pregnancy, while 2.7% women experienced symptoms lasting longer than 4 weeks (long COVID). Symptoms lasting longer than 12 weeks (post-COVID) were reported by 63.6% women and occurred more often after severe COVID-19. Fatigue was the most frequently reported symptom (88%), with 55% of women still experiencing it more than one year after initial infection. 76% of women rated their QoL as “good” or “very good”. Women experiencing post-COVID reported a significantly lower QoL.

Conclusion This is the first German long-term data on women after SARS-CoV-2 infection during pregnancy, showing a high rate of post-COVID, a persistence of fatigue, and the impact on QoL. Continuous monitoring of pregnant women with COVID-19 is needed to develop comprehensive management strategies.

Zusammenfassung

Hintergrund Schwangere haben ein erhöhtes Risiko für komplizierte COVID-19-Verläufe. Daten zum mütterlichen Langzeitverlauf gibt es bisher kaum. Diese Studie evaluierte das Langzeit-Follow-up von Frauen nach SARS-CoV-2-Infektion in der Schwangerschaft, mit Fokus auf Post-COVID-Symptomen, insbesondere Müdigkeit, und Auswirkungen auf die Lebensqualität.

Methoden 773 Frauen, die von April 2020 bis August 2021 im CRONOS-Register registriert waren, wurden für ein Follow-up zwischen Dezember 2022 und April 2023 kontaktiert. Daten wurden in einem webbasierten Fragebogen erhoben. Die Follow-up Daten wurden mit vorhandenen CRONOS-Daten abgeglichen.

Ergebnisse 110 (14%) der 773 Frauen stellten Daten zur Verfügung; 20,9% waren während ihrer SARS-CoV-2-Infektion akut symptomatisch, 2.7% entwickelten Long-COVID. Über 12 Wochen persistierende Symptome (Post-COVID) wurden von 63.6% berichtet und traten häufiger nach initial schwerer COVID-19-Infektion auf. Müdigkeit war das häufigste Symptom während akuter Infektion (88%), 55% litten auch nach einem Jahr noch daran. 76% der Frauen bewerteten ihre Lebensqualität „gut“ oder „sehr gut“. Frauen mit Post-COVID bewerteten diese vergleichsweise schlechter.

Zusammenfassung Dies sind die ersten nationalen Langzeit-Daten von Frauen nach SARS-CoV-2-Infektion in der Schwangerschaft, die eine hohe Rate an Post-COVID-Symptomen, insbesondere Müdigkeit, und deren Auswirkungen auf die Lebensqualität zeigen. Ein kontinuierliches Monitoring von Schwangeren mit COVID-19 ist erforderlich, um eine optimale Betreuung dieser Frauen zu gewährleisten.

Publication History

Received: 31 July 2023

Accepted after revision: 07 November 2023

Article published online:
08 February 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

• References

• 1 Pneumologie DGf. S1-Leitlinie Long/ Post-COVID. In: 2022: (S1, AWMF Registry No. 020-002, )
  PubMed
• 2 Smith ER, Oakley E, Grandner GW. et al. Clinical risk factors of adverse outcomes among women with COVID-19 in the pregnancy and postpartum period: a sequential, prospective meta-analysis. Am J Obstet Gynecol 2023; 228: 161-177 DOI: 10.1016/j.ajog.2022.08.038.
  CrossrefPubMedGoogle Scholar
• 3 Wei SQ, Bilodeau-Bertrand M, Liu S. et al. The impact of COVID-19 on pregnancy outcomes: a systematic review and meta-analysis. CMAJ 2021; 193: E540-E548 DOI: 10.1503/cmaj.202604.
  CrossrefPubMedGoogle Scholar
• 4 Aabakke AJM, Petersen TG, Wojdemann K. et al. Risk factors for and pregnancy outcomes after SARS-CoV-2 in pregnancy according to disease severity: A nationwide cohort study with validation of the SARS-CoV-2 diagnosis. Acta Obstet Gynecol Scand 2023; 102: 282-293 DOI: 10.1111/aogs.14512.
  CrossrefPubMedGoogle Scholar
• 5 Allotey J, Stallings E, Bonet M. et al. Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis. BMJ 2020; 370: m3320 DOI: 10.1136/bmj.m3320.
  CrossrefPubMedGoogle Scholar
• 6 Kandemir H, Bulbul GA, Kirtis E. et al. Evaluation of long-COVID symptoms in women infected with SARS-CoV-2 during pregnancy. Int J Gynaecol Obstet 2023; DOI: 10.1002/ijgo.14972.
  CrossrefPubMedGoogle Scholar
• 7 Nalbandian A, Sehgal K, Gupta A. et al. Post-acute COVID-19 syndrome. Nat Med 2021; 27: 601-615 DOI: 10.1038/s41591-021-01283-z.
  CrossrefPubMedGoogle Scholar
• 8 Venkatesan P. NICE guideline on long COVID. Lancet Respir Med 2021; 9: 129 DOI: 10.1016/S2213-2600(21)00031-X.
  CrossrefPubMedGoogle Scholar
• 9 Chen C, Haupert SR, Zimmermann L. et al. Global Prevalence of Post-Coronavirus Disease 2019 (COVID-19) Condition or Long COVID: A Meta-Analysis and Systematic Review. J Infect Dis 2022; 226: 1593-1607 DOI: 10.1093/infdis/jiac136.
  CrossrefPubMedGoogle Scholar
• 10 Bellos I, Pandita A, Panza R. Maternal and perinatal outcomes in pregnant women infected by SARS-CoV-2: A meta-analysis. Eur J Obstet Gynecol Reprod Biol 2021; 256: 194-204 DOI: 10.1016/j.ejogrb.2020.11.038.
  CrossrefPubMedGoogle Scholar
• 11 Vasconez-Gonzalez J, Fernandez-Naranjo R, Izquierdo-Condoy JS. et al. Comparative analysis of long-term self-reported COVID-19 symptoms among pregnant women. J Infect Public Health 2023; 16: 430-440 DOI: 10.1016/j.jiph.2023.01.012.
  CrossrefPubMedGoogle Scholar
• 12 Excellence NIfHaC. COVID-19 Rapid Guideline: Managing the Long-Term Effects of COVID-19. National Institute for Health and Care Excellence (NICE). In. 2020
  Google Scholar
• 13 Pecks U, Kuschel B, Mense L. et al. Pregnancy and SARS-CoV-2 Infection in Germany-the CRONOS Registry. Dtsch Arztebl Int 2020; 117: 841-842 DOI: 10.3238/arztebl.2020.0841.
  CrossrefPubMedGoogle Scholar
• 14 Iannaccone A, Mand N, Schmidt B. et al. Is the risk of still and preterm birth affected by the timing of symptomatic SARS-CoV-2 infection during pregnancy? Data from the COVID-19 Related Obstetrics and Neonatal Outcome Study Network, Germany. Am J Obstet Gynecol 2023; 228: 351-352 e352 DOI: 10.1016/j.ajog.2022.11.1301.
  CrossrefPubMedGoogle Scholar
• 15 Mand N, Iannaccone A, Longardt AC. et al. Neonatal outcome following maternal infection with SARS-CoV-2 in Germany: COVID-19-Related Obstetric and Neonatal Outcome Study (CRONOS). Arch Dis Child Fetal Neonatal Ed 2022; 107: 454-456 DOI: 10.1136/archdischild-2021-322100.
  CrossrefPubMedGoogle Scholar
• 16 Harris PA, Taylor R, Minor BL. et al. The REDCap consortium: Building an international community of software platform partners. J Biomed Inform 2019; 95: 103208 DOI: 10.1016/j.jbi.2019.103208.
  CrossrefPubMedGoogle Scholar
• 17 Harris PA, Taylor R, Thielke R. et al. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42: 377-381 DOI: 10.1016/j.jbi.2008.08.010.
  CrossrefPubMedGoogle Scholar
• 18 Herdman M, Gudex C, Lloyd A. et al. Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual Life Res 2011; 20: 1727-1736 DOI: 10.1007/s11136-011-9903-x.
  CrossrefPubMedGoogle Scholar
• 19 Thompson AJ, Turner AJ. A Comparison of the EQ-5D-3L and EQ-5D-5L. Pharmacoeconomics 2020; 38: 575-591 DOI: 10.1007/s40273-020-00893-8.
  CrossrefPubMedGoogle Scholar
• 20 Chmielewska B, Barratt I, Townsend R. et al. Effects of the COVID-19 pandemic on maternal and perinatal outcomes: a systematic review and meta-analysis. Lancet Glob Health 2021; 9: e759-e772 DOI: 10.1016/S2214-109X(21)00079-6.
  CrossrefPubMedGoogle Scholar
• 21 Villar J, Ariff S, Gunier RB. et al. Maternal and Neonatal Morbidity and Mortality Among Pregnant Women With and Without COVID-19 Infection: The INTERCOVID Multinational Cohort Study. JAMA Pediatr 2021; 175: 817-826 DOI: 10.1001/jamapediatrics.2021.1050.
  CrossrefPubMedGoogle Scholar
• 22 Gobin L, Vallee A, Zucman D. et al. COVID-19 reinfection after pregnancy. Infect Dis Now 2022; 52: 101-103 DOI: 10.1016/j.idnow.2022.01.002.
  CrossrefPubMedGoogle Scholar
• 23 Townsend L, Dyer AH, Jones K. et al. Persistent fatigue following SARS-CoV-2 infection is common and independent of severity of initial infection. PLoS One 2020; 15: e0240784 DOI: 10.1371/journal.pone.0240784.
  CrossrefPubMedGoogle Scholar
• 24 Goertz YMJ, Van Herck M, Delbressine JM. et al. Persistent symptoms 3 months after a SARS-CoV-2 infection: the post-COVID-19 syndrome?. ERJ Open Res 2020; 6 DOI: 10.1183/23120541.00542-2020.
  CrossrefPubMedGoogle Scholar
• 25 Xianyu Y, Wang M, Yue F. et al. One-year follow-up of 18 women who infected COVID-19 while pregnant. J Med Virol 2022; 94: 2302-2306 DOI: 10.1002/jmv.27628.
  CrossrefPubMedGoogle Scholar
• 26 Henderson J, Alderdice F, Redshaw M. Factors associated with maternal postpartum fatigue: an observationalstudy. BMJ Open 2019; 9: e025927 DOI: 10.1136/bmjopen-2018-025927.
  CrossrefPubMedGoogle Scholar
• 27 Atkinson LS, Baxley EG. Postpartum fatigue. Am Fam Physician 1994; 50: 113-118
  PubMedGoogle Scholar
• 28 Corwin EJ, Arbour M. Postpartum fatigue and evidence-based interventions. MCN Am J Matern Child Nurs 2007; 32: 215-220 quiz 212-221 DOI: 10.1097/01.NMC.0000281959.71454.e5.
  CrossrefPubMedGoogle Scholar
• 29 Ma Y, Deng J, Liu Q. et al. Long-Term Consequences of COVID-19 at 6 Months and Above: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health 2022; 19 DOI: 10.3390/ijerph19116865.
  CrossrefPubMedGoogle Scholar
• 30 Smith P, De Pauw R, Van Cauteren D. et al. Post COVID-19 condition and health-related quality of life: a longitudinal cohort study in the Belgian adult population. BMC Public Health 2023; 23: 1433 DOI: 10.1186/s12889-023-16336-w.
  CrossrefPubMedGoogle Scholar