Ci a ion: Vila-Candel, R.;
González-Cho dá, V.M.;
So iano-Vidal, F.J.; Cas o-Sánchez, E.;
Rod íguez-Blanco, N.; Gómez-Seguí,
A.; And eu-Pejó, L.; Ma ínez-Po ca ,
C.; Rod íguez Gonzál ez, C.;
To en -Ramos, P.; e al.
Obs e ic–Neona al Ca e du ing Bi h
and Pos pa um in Symp oma ic and
Asymp oma ic Women In ec ed wi h
SARS-CoV-2: A Re ospec i e
Mul icen e S udy. In . J. En i on. Res.
Public Heal h 2022,19, 5482. h ps://
doi.o g/10.3390/ije ph19095482
Academic Edi o : Paul B. Tchounwou
Recei ed: 9 Ap il 2022
Accep ed: 28 Ap il 2022
Published: 30 Ap il 2022
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Copy igh : © 2022 by he au ho s.
Licensee MDPI, Basel, Swi ze land.
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A ibu ion (CC BY) license (h ps://
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In e na ional Jou nal o
En i onmen al Resea ch
and Public Heal h
A icle
Obs e ic–Neona al Ca e du ing Bi h and Pos pa um in
Symp oma ic and Asymp oma ic Women In ec ed wi h
SARS-CoV-2: A Re ospec i e Mul icen e S udy
Ra ael Vila-Candel 1,2,3 , Víc o M. González-Cho dá4,* , F ancisco Ja ie So iano-Vidal 2,3,5 ,
En ique Cas o-Sánchez 6,7 , Noelia Rod íguez-Blanco 8,9, Ana Gómez-Seguí10 , Lau a And eu-Pejó4,
C is ina Ma ínez-Po ca 11, Ca men Rod íguez Gonzál ez 12, Pa icia To en -Ramos 13,14,
Nie es Asensio-Tomás10, Yolanda He aiz-Sole 15,16, Ramon Escu ie 17,18 and Desi ée Mena-Tudela 4
1Depa men o Nu sing, Facul y o Nu sing and Podia y, Uni e si a de València, 46010 Valencia, Spain;
a ael. ila@u .es o [email p o ec ed]
2Depa men o Obs e ics and Gynaecology, Hospi al Uni e si a io de la Ribe a, 46600 Alci a, Spain;
[email p o ec ed]
3Founda ion o he P omo ion o Heal h and Biomedical Resea ch in he Valencian Region (FISABIO),
46020 Valencia, Spain
4GIENF-281 Nu sing Resea ch G oup, Nu sing Depa men , Uni esi a Jaume I,
12006 Cas ellóde la Plana, Spain; [email p o ec ed] (L.A.-P.); [email p o ec ed] (D.M.-T.)
5Depa men o Obs e ics and Gynaecology, Hospi al Lluis Alcanyís, 46800 Xà i a, Spain
6College o Nu sing, Midwi e y and Heal hca e, Uni e si y o Wes London, London TW8 9GB, UK;
[email p o ec ed]
7Heal h P o ec ion Resea ch Uni , Heal hca e-Associa ed In ec ions and An imic obial Resis ance, Impe ial
College London, London SW7 2BX, UK
8Depa men o Nu sing, Uni e sidad CEU Ca denal He e a, Plaza Reyes Ca ólicos, 19, 03204 Elche, Spain;
[email p o ec ed]
9Depa men o Obs e ics and Gynaecology, Hospi al Ma ina Baixa, 03570 Villajoyosa, Spain
10
Depa men o Obs e ics and Gynaecology, Hospi al Uni e si a io y Poli écnico La Fe, 46026 Valencia, Spain;
[email p o ec ed] (A.G.-S.); [email p o ec ed] (N.A.-T.)
11 Depa men o Paedia ics, Hospi al Uni e si a io de la Ribe a, 46600 Alzi a, Spain;
[email p o ec ed]
12 Depa men o Obs e ics and Gynaecology, Hospi al Uni e si a io de Vinalopó, 03293 Elche, Spain;
[email p o ec ed]
13
P e en i e Medicine Se ice, Hospi al Gene al de Cas ellón, 12071 Cas ellóde la Plana, Spain; p o [email p o ec ed]
14 Nu sing Depa men , Uni esi a Jaume I, 12006 Cas ellóde la Plana, Spain
15 Depa men o Obs e ics and Gynaecology, Conso cio Hospi al Gene al Uni e si a io Valencia,
46014 Valencia, Spain; [email p o ec ed]
16 Facul a d’In e me ia i Podologia, Uni e si a de València, 46100 Valencia, Spain
17
Ghende s Resea ch G oup, School o Heal h Sciences Blanque na, Uni e si a Ramon Lull, Ca e Padilla 326,
08025 Ba celona, Spain; [email p o ec ed]
18 Ca alan Heal h Se ice, Go e nmen o Ba celona, T a esse a de les Co s 131, 08028 Ba celona, Spain
*Co espondence: cho [email p o ec ed]
Abs ac :
This s udy analyses he obs e ic–neona al ou comes o women in labou wi h symp oma ic
and asymp oma ic COVID-19. A e ospec i e, mul icen e , obse a ional s udy was ca ied ou
be ween 1 Ma ch 2020 and 28 Feb ua y 2021 in eigh public hospi als in he Valencian communi y
(Spain). The chi-squa ed es compa ed he obs e ic–neona al ou comes and gene al ca e o symp-
oma ic and asymp oma ic women. In o al, 11,883 bi hs we e assis ed in pa icipa ing cen e s, wi h
10.9 pe 1000 ma e ni ies (n= 130) in ec ed wi h SARS-CoV-2. The 20.8% we e symp oma ic and
had mo e complica ions bo h upon admission (p= 0.042) and du ing pue pe ium (p= 0.042), as well
as ans e o he in ensi e ca e uni (ICU). The pe cen age o admission o he Neona al In ensi e
Ca e Uni (NICU) was g ea e among o sp ing o symp oma ic women compa ed o in an s bo n
o asymp oma ic women (p< 0.001). Compa ed wi h asymp oma ic women, hose wi h symp oms
unde wen less labou companionship (p= 0.028), less ea ly skin- o-skin con ac (p= 0.029) and
g ea e mo he –in an sepa a ion (p= 0.005). The o e all ma e nal mo ali y a e was 0.8%. No
e ical ansmission was eco ded. In conclusion, symp oma ic in ec ed women a e a inc eased isk
In . J. En i on. Res. Public Heal h 2022,19, 5482. h ps://doi.o g/10.3390/ije ph19095482 h ps://www.mdpi.com/jou nal/ije ph
In . J. En i on. Res. Public Heal h 2022,19, 5482 2 o 14
o lack o labou companionship, mo he –in an sepa a ion, and admission o he ICU, as well as o
ha e p e e m bi hs and o NICU admissions.
Keywo ds: COVID-19; SARS-CoV-2; obs e ic nu sing; neona al nu sing; labou ; obs e ic
1. In oduc ion
Disease due o se e e acu e espi a o y synd ome co ona i us-2 (SARS-CoV-2) in ec-
ion had caused o e 4.7 million dea hs wo ldwide by 2021 [
1
]. Al hough mos coun ies
adop ed measu es o con ain he pandemic, including lockdowns and p e en i e hygiene
p o ocols [
2
] as well as accina ion p og ams whe e e accines whe e a ailable [
3
], SARS-
CoV-2 in ec ion emains a signi ican global heal h h ea .
Wi h ega d o co ona i us disease-2019 (COVID-19), p egnan women do no seem
o be mo e suscep ible o in ec ion han he gene al popula ion [
4
]. Howe e , in he e en
o disease symp oms ha appea o be mo e se e e, pa icula ly du ing he hi d imes e
o p egnancy, he e a e mo e equen admissions o he In ensi e Ca e Uni (ICU) and
a g ea e isk o poo e ma e nal and neona al heal h ou comes (such as p e e m bi h,
caesa ean sec ions, and low bi h weigh ) [5–8].
Rou ine e idence-based clinical p ac ices o bene i o ma e nal and childbi h ca e
(labou companionship, ea ly skin- o-skin con ac , b eas eeding, and ooming-in in ma-
e ni y) ha e been modi ied o in e up ed du ing he pandemic, which could educe he
quali y o bi h ca e models [
9
,
10
]. Fu he mo e, e ical ansmission seems possible [
11
],
al hough he mechanisms o such ansmission emain unclea [
12
,
13
]. Whils se e e e en s
o newbo n in an s seem a e [
13
], pe haps hanks o he passi e ansmission o an i-
SARS-CoV-2 an ibodies ia he ansplacen al ou e and in b eas milk [
14
], he e may s ill
be conce n abou hese po en ial e ec s [15,16].
The p ima y aim o his s udy was o analyse he obs e ic–neona al ou comes o
women in labou wi h symp oma ic and asymp oma ic SARS-CoV-2 in ec ion. The s udy
also aimed o desc ibe and con as he ou ine ca e ecei ed by hese g oups o women
and hei newbo ns.
2. Ma e ials and Me hods
2.1. S udy Popula ion and Sampling C i e ia
A e ospec i e, mul icen e , obse a ional s udy was ca ied ou based on he e iew
o he clinical eco ds o p egnan women assis ed du ing labou and bi h, wi h a posi i e
eal- ime polyme ase chain eac ion (RT-PCR) es esul o SARS-CoV-2 in nasopha yngeal
exuda e a he ime o admission. The s udy was ca ied ou in eigh s a e- unded hospi als
o he Valencian communi y in Spain. These hospi als ( ou in Valencia, one in Cas ellón,
h ee in Alican e) we e all e e ence cen e s o hei p o ince, and ca ed o a leas
1000 bi hs
pe yea , o we e loca ed in u al a eas wi h la ge ca chmen popula ions.
O e all, he pa icipa ing hospi als se ed one million people and a ended ~12,000 bi hs
in he p e ious yea . The in o ma ion abou he s udy was dissemina ed ia he egional
esea ch ne wo k and sui able heal h ca e o ganiza ions app oached by he esea che s.
The s udy pe iod was om 1 Ma ch 2020 o 28 Feb ua y 2021.
The s udy popula ion comp ised women gi ing bi h in any o he pa icipa ing
hospi als. The inclusion c i e ia we e: (a) women wi h a posi i e RT-PCR es o SARS-
CoV-2 RNA in nasopha yngeal exuda e pe o med on hospi al admission o labou and
bi h; and (b) in an s bo n o in ec ed mo he s, wi h RT-PCR es ing o SARS-CoV-2 in
nasopha yngeal exuda e du ing hospi al admission (<48 h, no ex ac ed om he placen a
o amnio ic luid).
P egnan women in ec ed wi h SARS-CoV-2 and admi ed o he hospi al o medical
easons o he han bi h we e excluded om he s udy.
In . J. En i on. Res. Public Heal h 2022,19, 5482 3 o 14
2.2. Measu emen s
The esea ch s a a each pa icipa ing cen e e iewed he obs e ic his o y, neona al
and pos pa um ou comes, and gene al labou ca e eco ds o all he posi i e pa ien s
assis ed du ing he s udy pe iod. The a iables ela ed o bi h and pos pa um we e
collec ed om he O ion Logis
®
elec onic heal h eco ds, while he da a o mo he s and
newbo ns ela ed o ollow-up du ing he i s six weeks a e bi h we e ob ained om
he Abucasis II
®
heal h da abase. Any eadmission ia he eme gency oom o mo he s
o newbo ns egis e ed a he same hospi als we e iden i ied du ing he 6 weeks om he
Abucasis II
®
da abase. Bo h elec onic medical eco ds a e ou inely used by all he heal h
acili ies in he Valencian Communi y, including all he cen e s pa icipa ing in he s udy.
The ollowing a iables we e collec ed:
•
Demog aphic a iables: ma e nal age, coun y o o igin, and he hospi al whe e he
bi h occu ed.
•
Obs e ic–neona al a iables: Ges a ional age a he ime o bi h, pa i y (p imi-
pa ous/mul ipa ous), p e ious ma e nal his o y o heal h p oblems (diabe es melli-
us/hype ension/ca diac diseases/neu ological diseases/ h ombo ic diseases/ hy oid
diseases/d ugs misuse/COVID-no ela ed in ec ion diseases), ges a ional disease
(p eeclampsia/eclampsia/ges a ionalhype ension/ges a ional diabe es/hypo hy oidism/
hype hy oidism/COVID-no ela ed in ec ious diseases), e al al e a ions iden i ied
by heal h ca e p o ide s (p e e m bi h, small o ges a ional age/la ge o ges a-
ional age/ e al g ow h es ic ion/congeni al abno mali y), s a o labou (spon-
aneous/induced/elec i e caesa ean sec ion), ype o bi h (eu ocic, ins umen al
bi h/caesa ean sec ion [CS]), cause o CS, ma e nal complica ions p io labou and
du ing pue pe ium ( espi a o y, ca diac, neu ologic, h ombo ic mani es a ions, and
COVID- ela ed coagulopa hy), ma e nal admission o he in ensi e ca e uni (ICU)
p io o bi h and/o pue pe ium, cause o ma e nal admission o he ICU, and Apga
sco e a one and i e minu es. Mo he o child ansmission can occu in di e en
s ages, including in u e o, in apa um, o pos na al. Ou s udy de ined e ical ans-
mission in he ea ly pos na al pe iod (<48 h) as a posi i e es o SARS-CoV-2 ma e nal
in ec ion a admission, coupled wi h a con i med posi i e es o he newbo n [
17
],
in an admission o he neona al ICU (NICU), and cause o admission o he NICU.
•
Symp oma ic wi h SARS-Co -2: Pa icipan s wi h SARS-CoV-2 in ec ion ha p esen
symp oms such as e e , cough, sho ness o b ea h, a igue, body aches, headache,
anosmia, ageusia, nausea o omi ing, and dia hea.
•
Asymp oma ic wi h SARS-Co -2: Pa icipan s wi h SARS-Co -2 in ec ion bu who
did no de elop compa ible clinical mani es a ions.
•
Clinical a iables: Time o esul o he RT-PCR SARS-CoV-2 es o he mo he (an e-,
in a-, o pos pa um), he esul o he RT-PCR SARS-CoV-2 es o he newbo n in an
wi hin 48 h (posi i e o nega i e), and ollow-up o complica ions and eadmissions
(mo he /newbo n in an , wi h easons) du ing he i s six weeks a e bi h. Ma e nal
o newbo n dea h (up o 28 days) i COVID- ela ed.
•
Obs e ic and neona al gene al labou ca e: La e clamping (clamping and cu ing he
co d a leas one minu e om bi h, o when he umbilical co d s opped pulsa ing [
18
]),
ea ly skin- o-skin con ac [SSC] (de ined as p one placing o he naked in an on he
mo he ’s ba e ches a bi h, in he i s minu e a e bi h, o e y soon a e wa ds [
19
]),
labou companionship, mo he –in an sepa a ion du ing hospi al admission, and he
eason o sepa a ion.
•
B eas eeding- ela ed a iables: Type o eeding a discha ge and 6 weeks pos pa um
(exclusi e b eas eeding, o mula eeding, mixed eeding). Exclusi e b eas eeding
(EBF) was de ined as o e ing only b eas milk and excluding all o he ood o luids,
including wa e . This case de ini ion did, howe e , allow he in an o ecei e o al
ehyd a ion sal s, d ops, and sy ups ( i amins, mine als, and medicines) [
20
,
21
].
Mixed eeding was de ined as he combina ion o b eas eeding and o mula eed.
In . J. En i on. Res. Public Heal h 2022,19, 5482 4 o 14
Obs e ic and neona al ou comes we e compa ed be ween symp oma ic and asymp-
oma ic SARS-CoV-2 in ec ed women.
•
The obs e ic ou comes we e: P e e m bi h < 37 weeks; oe al g ow h es ic ion (bi h
weigh pe cen ile < 5); induced hype ension in p egnancy; ges a ional diabe es; CS; op-
e a i e bi h; ICU admission; ma e nal complica ions p io labou /du ing pue pe ium
COVID- ela ed: ca diac, neu ologic, h ombo ic, and espi a o y mani es a ions; and
ma e nal dea h.
The neona al ou comes we e: small o ges a ional age (bi h weigh below he 10 h
pe cen ile o babies o he same ges a ional age); la ge o ges a ional age (bi h weigh
beyond 90 h pe cen ile o babies o he same ges a ional age); Apga < 7 a 5 min; and
NICU admission.
The obs e ic and neona al gene al ca e we e compa ed be ween symp oma ic and
asymp oma ic SARS-CoV-2-in ec ed women we e: a labou companion; la e umbilical co d
clamping; ea ly SSC; mo he –in an sepa a ion; and EBF (a discha ge/6 weeks).
A common da abase was c ea ed h ough REDCap
®
, whe e all he esea che s espon-
sible o each hospi al we e en e ing he da a o la e analysis.
2.3. S a is ical Analysis
Basic desc ip i e s a is ics we e exp essed as he mean
±
s anda d de ia ion (SD) in he
case o con inuous a iables, and as equencies and pe cen ages in he case o ca ego ical
a iables. No mal da a dis ibu ion was assessed using he Kolmogo o –Smi no es .
The incidence a e was de e mined using he o al numbe o new posi i e SARS-
CoV-2 cases pe 1000 ma e ni ies and di ided by he numbe o bi hs du ing he s udy
pe iod. The chi-squa ed es was used o compa e he obs e ic–neona al gene al ca e a es
acco ding o he di e en quali a i e a iables, co ec ed by he Fishe exac es . Likewise,
he chi-squa ed es and c ude odds a io (OR) wi h 95% con idence in e als (CIs) we e
used o compa e he di e en s udy a iables be ween asymp oma ic SARS-CoV-2 posi i e
women and women who de eloped COVID-19 (symp oma ic cases). S a is ical signi icance
was conside ed o p< 0.05. Da a analysis was pe o med using he R s a is ical package
( e sion 4.0.5, R Founda ion o S a is ical Compu ing, Vienna, Aus ia).
2.4. E hical Conside a ions
Pa ien s we e no in ol ed in he de elopmen o he esea ch ques ions, he s udy’s
design, o he ec ui men o pa icipan s. Due o he e ospec i e s udy design, pa ien
in o med consen was no equi ed. All pa ien da a we e handled anonymously. The local
e hics commi ees app o ed he s udy p o ocols in he eigh cen e s. The e hical p inciples
o medical esea ch con empla ed by cu en Spanish legisla ion ha e been conside ed, and
he s udy was conduc ed ollowing he Decla a ion o Helsinki.
3. Resul s
In o al, 11,883 bi hs we e assis ed du ing he s udy pe iod in he pa icipa ing
hospi als. We included all women wi h SARS-CoV-2 in ec ion admi ed o he pa icipa ing
hospi als du ing he s udy pe iod (130; 10.9 pe 1000 ma e ni ies). The e was no loss o any
pa icipan . The case dis ibu ion acco ding o hospi als is shown in Table 1. Hospi al H4
had an incidence o 17.8 pe 1000 ma e ni ies, and hospi al H8 assis ed he la ges numbe
o posi i e cases. The majo i y o women we e bo n in Spain (53.8%), wi h a mean age o
32
±
5.1 yea s. The e we e s a is ically signi ican di e ences be ween symp oma ic and
asymp oma ic women o any ma e nal age (Table 2).
In . J. En i on. Res. Public Heal h 2022,19, 5482 5 o 14
Table 1. Bi hs and incidence o women wi h SARS-CoV-2 in ec ion du ing he s udy.
Hospi al To al Bi hs
Bi hs in Women
In ec ed wi h
SARS-CoV-2
Incidence
H1 1288 18 14.0
H2 1090 7 6.4
H3 1308 7 5.4
H4 1182 21 17.8
H5 1256 14 11.1
H6 679 11 16.2
H7 920 8 8.7
H8 4160 44 10.6
TOTAL 11,883 130 10.9
Table 2. Demog aphic cha ac e is ics o women in ec ed wi h SARS-CoV-2 in he s udy.
S udy Va iables
Women In ec ed wi h SARS-CoV-2
Asymp oma ic
(n= 103; 79.2%)
Symp oma ic
(n= 27; 20.8%) p*
Mean (SD) Mean (SD)
Age 31.5 (4.9) 33.9 (5.5) 0.049
n(%) n(%)
Coun y o o igin
0.287
Spain 64 (81.0) 6 (29.0)
Cen al and Sou h Ame ica 14 (70.0) 15 (30.0)
Res o EU coun ies 12 (80.0) 3 (20.0)
A ica 9 (81.8) 2 (18.2)
Asia 4 (80.0) 1 (20.0)
Hospi al o bi h
H8 34 (97.1) 1 (2.9)
0.112
H1 18 (100.0) 0 (0.0)
H4 15 (71.4) 6 (28.6)
H5 10 (71.4) 4 (28.6)
H6 8 (72.7) 3 (27.3)
H3 7 (70.0) 3 (30.0)
H2 6 (37.5) 10 (62.5)
* Chi-squa ed; se e e acu e espi a o y synd ome co ona i us-2 = SARS-CoV-2; EU = Eu opean Union;
H = Hospi al.
Rega ding he women’s cha ac e is ics, 50% we e p imipa ous, wi h a mean ges a-
ional age o 39.2
±
1.6 weeks, and mos had no p e ious ma e nal, ges a ional, o oe al
disease condi ions, wi hou signi ican di e ences be ween symp oma ic and asymp oma ic
women (p< 0.05). Posi i i y o SARS-CoV-2 was con i med be o e o du ing labou in
91.5% o cases, and 8.5% a e bi h; 56.2% had labou ed spon aneously, wi h an o e all
induc ion a e o 39.2%. Induc ion o labou was highe , bu wi hou signi ican di e -
ences, among symp oma ic women (44.4% s. 37.9%; p= 0.09). The 4.6% o women had
an elec i e CS, wi hou signi ican di e ences be ween symp oma ic and asymp oma ic
women (p= 0.09). The e we e no s a is ically signi ican di e ences be ween symp oma ic
and asymp oma ic women in e ms o ma e nal (p= 0.084), ges a ional (p= 0.089), o e al
disease condi ions (p= 0.719).
In e ms o he clinical pa ame e s, 20.8% o women had symp oms upon admission,
e e and cough (22.2% each) and headache (18.5%) being he mos equen mani es a ions.
O he symp oms we e 11.1% anosmia, 11.1% dyspnoea, 3.7% omi ing, 3.7% ageusia,
and 7.4% body aches. P io o bi h, 7.4% o symp oma ic women we e admi ed o he
In . J. En i on. Res. Public Heal h 2022,19, 5482 6 o 14
ICU wi h COVID- ela ed espi a o y dis ess e sus none o he asymp oma ic women
(p= 0.042); o hese women, 3.7% equi ed mechanical en ila ion due o dyspnoea and
COVID- ela ed h ombo ic s oke, while 7.4% o symp oma ic women we e admi ed o he
ICU du ing he pos pa um pe iod compa ed wi h 1.9% asymp oma ic women
(p= 0.042).
Mechanical en ila ion was no equi ed o any asymp oma ic women admi ed o he
ICU. The admissions we e no COVID- ela ed (one p eeclampsia, and one pos pa um
haemo hage). Howe e , bo h symp oma ic women equi ed mechanical en ila ion. The
mo ali y a e was 0.8%; among all pa icipan s, dea h was eco ded in a woman wi h
symp oms (speci ic mo ali y a e = 3.7%) (Table 3).
Table 3. Obs e ic–neona al cha ac e is ics o he s udy sample.
Va iable
Women In ec ed wi h SARS-CoV-2 (n/%)
Asymp oma ic Symp oma ic
p*
(103/79.2%) (27/20.8%)
Mean (SD) Mean (SD)
Ges a ional age (weeks) 39.4 (1.4) 38.8 (2.2) 0.595
Apga 1 min 9.63 (0.8) 9.56 (1.0) 0.694
Apga 5 min 9.93 (0.4) 9.93 (0.4) 0.825
n(%) n(%)
Pa i y
Mul ipa ous 52 (50.5) 13 (48.2) 0.829
P imipa ous 51 (49.5) 14 (51.8)
P e ious ma e nal disease
No 94 (91.3) 21 (77.8) 0.084
Yes 9 (8.7) 6 (22.2)
Ges a ional disease
No 88 (85.4) 19 (70.4) 0.089
Yes 15 (14.6) 8 (29.6)
Foe al disease
No 94 (91.3) 24 (88.9) 0.713
Yes 9 (8.7) 3 (11.1)
S a o labou
Elec i e caesa ean sec ion 5 (4.8) 1 (3.7)
0.09
Spon aneous 59 (57.3) 14 (51.9)
Induced 39 (37.9) 12 (44.4)
COVID- ela ed Ma e nal complica ions p io o labou
Asymp oma ic 103 (100.0) 23 (85.2)
0.002
Respi a o y dis ess 0 (0.0) 3 (11.1)
Th ombo ic s oke 0 (0.0) 1 (13.7)
Type o bi h
Elec i e caesa ean sec ion 5 (4.9) 1 (3.7)
0.269
U gen caesa ean sec ion 11 (10.7) 6 (22.2)
Eu ocic 75 (72.8) 15 (55.6)
Ins umen al bi h 12 (11.6) 5 (18.5)
Cause o caesa ean sec ion (n= 23)
O he 10 (58.8) 6 (85.7) 0.366
NRFHR 7 (41.2) 1 (14.3)
In . J. En i on. Res. Public Heal h 2022,19, 5482 7 o 14
Table 3. Con .
Va iable
Women In ec ed wi h SARS-CoV-2 (n/%)
Asymp oma ic Symp oma ic
p*
(103/79.2%) (27/20.8%)
Mean (SD) Mean (SD)
Ma e nal complica ions COVID- ela ed be o e discha ge
No complica ions 101 (98.1) 23 (85.2)
0.002
Dyspnoea 0 (0.0) 1 (3.7)
Respi a o y dis ess 0 (0.0) 2 (7.4)
O he s 2 (1.9) 0 (0.0)
Dea h 0 (0.0) 1 (3.7)
RT-PCR es ing o newbo n in an on day 1 o li e
Posi i e 0 (0.0) 0 (0.0) 1
Nega i e 103 (100.0) 27 (100.0)
Mo he equi ed ICU admission p io o labou
No 103 (100.0) 25 (92.6) 0.042
Yes 0 (0.0) 2 (7.4)
Mo he equi ed ICU admission be o e discha ge
No 101 (98.1) 25 (92.6) 0.042
Yes 2 (1.9) 2 (7.4)
Newbo n in an equi ed admission o NICU be o e discha ge
No 88 (85.4) 16 (59.3) 0.005
Yes 15 (14.6) 11 (40.7)
Mo he equi ing eme gency eadmission a e discha ge in i s 6 weeks
No 102 (99.0) 27 (100.0) 1
Yes 1 (1.0) 0 (0.0)
Newbo n in an equi ing eme gency eadmission a e discha ge in i s 6 weeks
No 100 (97.1) 26 (96.3) 1
Yes 3 (2.9) 1 (3.7)
Reason o ma e nal eadmission a e discha ge in i s 6 weeks
Pue pe al e e 1 (0.9) 0 (0.0) 1
No 102 (99.1) 27 (100.0)
Reason o newbo n in an eadmission a e discha ge in i s 6 weeks
No eason 100 (97.0) 26 (96.3)
Choking 1 (1.0) 0 (0.0)
1
Non-COVID-19 espi a o y in ec ion 0 (0.0) 1 (3.7)
SARS-CoV-2 + (hospi al admission) 1 (1.0) 0 (0.0)
SARS-CoV-2 + (eme gency oom ca e) 1 (1.0) 0 (0.0)
* chi-squa ed; se e e acu e espi a o y synd ome co ona i us-2 = SARS-CoV-2; NRFHR = non- eassu ing oe al
hea pa e n; RT-PCR = eal- ime polyme ase chain eac ion; ICU = In ensi e Ca e Uni ; NICU = Neona al
In ensi e Ca e Uni .
None o he newbo n in an s es ed posi i e o SARS-CoV-2 in ec ion du ing hospi al
admission. O ganiza ional issues caused he easons o admission o newbo ns o he
NICU be o e discha ge (19.2%), and none o hem conce ned a disease associa ed wi h
ma e nal COVID-19. The easons we e sepa a ion ollowing p o ocol ac i e on he da e
(26.9%), p ema u i y (23.1%), s abiliza ion o maladap a ion a e bi h (15.4%), hype bili u-
binemia (11.5%), social se ices/adop ion (7.6%), 3.8% sepsis (3.8%), obse a ion ollowing
ce eb al- ascula e en (3.8%), and ma e nal d ug misuse (3.8%).
The obs e ic and neona al gene al ca e is p esen ed in Table 4. Ea ly SSC occu ed
in 75.4% o bi hs, and la e clamping was pe o med in 55.6%. Mo he –in an sepa a ion
In . J. En i on. Res. Public Heal h 2022,19, 5482 8 o 14
occu ed in 19.2% o he cases, wi h no clinical indica ion in 5.4% and wi h a ma e nal accom-
panimen a e o 53.8%. On he o he hand, asymp oma ic women had a g ea e pe cen age
o ea ly SSC (79.6% s. 59.3%; p= 0.029), a g ea e labou companion a e (64.1% s. 40.7%;
p= 0.028), and less mo he –in an sepa a ion (13.6% s. 40.7%;
p< 0.001).
The e we e no
s a is ically signi ican di e ences in la e umbilical co d clamping
(asymp oma ic = 57.3%;
symp oma ic = 40.7%; p= 0.125).
Table 4. Obs e ic–neona al gene al ca e o he s udy pa icipan s.
Va iable
Women In ec ed wi h SARS-CoV-2
Asymp oma ic (n/%) Symp oma ic (n/%) *p
(103/79.2%) (27/20.8%)
Labou companion
0.028
No 37 (35.9) 16 (59.3)
Yes 66 (64.1) 11 (40.7)
La e umbilical co d clamping
0.125
No 44 (42.7) 16 (59.3)
Yes 59 (57.3) 11 (40.7)
Ea ly skin- o-skin con ac
0.029
No 21 (20.4) 11 (40.7)
Yes 82 (79.6) 16 (59.3)
Mo he -in an sepa a ion du ing
hospi al admission <0.001
No 89 (86.4) 16 (59.3)
Yes 14 (13.6) 11 (40.7)
Reason o mo he –in an sepa a ion
<0.001
No sepa a ion 89 (86.4) 16 (59.3)
Moni o ing and con ol 2 (1.9) 2 (7.4)
O he 5 (4.9) 9 (33.3)
P o ocol o da e 7 (6.8) 0 (0.0)
Feeding a discha ge
0.450
Fo mula eeding (ma e nal decision) 12 (11.6) 5 (18.5)
Fo mula eeding (medical
ecommenda ion) 1 (0.9) 3 (11.1)
Exclusi e b eas eeding 76 (73.8) 16 (59.3)
Mixed eeding (ma e nal decision) 6 (5.8) 2 (7.4)
Mixed eeding (medical
ecommenda ion) 8 (7.9) 1 (3.7)
Feeding a six weeks
0.408
Fo mula eeding 26 (25.2) 9 (33.3)
Exclusi e b eas eeding 55 (53.4) 14 (51.6)
Mixed eeding 22 (21.4) 4 (14.8)
* chi-squa ed; SARS-CoV-2 = se e e acu e espi a o y synd ome co ona i us-2.
Conce ning EBF, he pe cen age a he ime o hospi al discha ge was 70.8%. The EBF
a e a six weeks a e bi h was 53.1%. We eco ded no s a is ically signi ican di e ences
in he ype o eeding a hospi al discha ge o he ype o eeding a six weeks a e bi h,
be ween women wi h and wi hou COVID-19 symp oms.
Table 5p esen s he obs e ic–neona al esul s and ca e ecei ed du ing labou , bi h,
and pue pe ium o women in ec ed wi h SARS-CoV-2. The e we e di e ences be ween
symp oma ic and asymp oma ic pa icipan s. The symp oma ic women we e nine imes
mo e likely o ha e a p e e m bi h (95% CI: 2.2–41.2) and eigh imes mo e likely o be
In . J. En i on. Res. Public Heal h 2022,19, 5482 9 o 14
admi ed o he ICU (95% CI: 1.5–50.9); hei in an s we e i e imes mo e likely o be
admi ed o he NICU (95% CI: 1.9–13.8).
Table 5. Obs e ic–neona al ou comes and gene al ca e o he pa icipan s.
Women In ec ed wi h SARS-CoV-2
Asymp oma ic Symp oma ic
(103/79.2%) (27/20.8%)
n%n%apbOR 95% CI
Obs e ic ou comes
P e e m bi h <37 w 3 2.9 6 22.2 <0.001 9.52 2.2–41.2
≥37 w 100 97.1 21 77.8
Foe al g ow h es ic ion No 102 99.3 26 96.3 0.304 3.92 0.2–64.8
Yes 1 0.7 1 3.7
Ges a ional diabe es No 100 97.1 26 96.3 0.832 1.28 0.1–12.8
Yes 3 2.9 1 3.7
Induced hype ension in p egnancy No 103
100.0
26 96.3 0.051 - -
Yes 0 0.0 1 3.7
Caesa ean sec ion No 87 84.5 20 74.1 0.208 1.90 0.7–5.2
Yes 16 15.5 7 25.9
Ope a i e deli e y No 91 88.3 22 81.5 0.346 1.72 0.6–5.4
Yes 12 11.7 5 18.5
ICU admission No 101 98.1 25 92.6 0.005 8.78 1.5–50.9
Yes 2 1.9 2 7.4
Ma e nal complica ions p io labou /du ing pue pe ium COVID- ela ed:
ca diac. neu ologic, h ombo ic, espi a o y mani es a ions
No 103
100.0
26 96.3 0.057 - -
Yes 0 0.0 1 3.7
Ma e nal dea h No 103
100.0
26 96.3 0.051 - -
Yes 0 0.0 1 3.7
Neona al ou comes
Small o ges a ional age No 97 94.2 27
100.0
0.199 - -
Yes 6 5.8 0 0.0
La ge o ges a ional age No 103
100.0
26 96.3 0.052 - -
Yes 0 0.0 1 3.7
Apga < 7 a 5 min No 100 97.1 26 96.3 0.832 1.28 0.1–12.8
Yes 3 2.9 1 3.7
NICU admission No 91 88.3 16 69.6 <0.001 5.21 1.9–13.8
Yes 12 11.7 11 30.4
SARS-CoV-2 in ec ion No 0 0.0 0 0.0 - - -
Yes 0 0.0 0 0.0
Gene al ca e
Mo he –in an sepa a ion du ing hospi al admission No 89 86.4 16 59.3 0.005 4.03 1.5–10.4
Yes 14 13.6 11 40.7
Ea ly skin- o-skin-con ac No 21 20.4 11 40.7 0.029 2.11 1.1–4.1
Yes 82 79.6 16 59.3
La e umbilical co d clamping No 44 42.7 16 59.3 0.125 1.69 0.9–3.4
Yes 59 57.3 11 40.7
Labou companion No 37 35.9 16 59.3 0.028 2.11 1.1–4.2
Yes 66 64.1 11 40.7
EBF a discha ge No 27 26.2 11 59.3 0.140 0.52 0.2–1.3
Yes 76 73.8 16 40.7
EBF a six weeks No 48 46.6 13 48.1 0.866 0.94 0.4–2.2
Yes 55 53.4 14 51.9
a
Chi-squa ed;
b
OR = c ude odds a io; CI = con idence in e al; SARS-CoV-2 = se e e acu e espi a o y synd ome
co ona i us-2; EBF = exclusi e b eas eeding; ICU = in ensi e ca e uni ; NICU = neona al in ensi e ca e uni .
Rega ding gene al ca e o symp oma ic women, hey we e mo e likely o be unaccom-
panied du ing labou (95% CI: 1.1–4.2), also ma kedly likely o expe ience mo he –child
sepa a ion (95% CI: 1.57–10.36) and wice as likely o expe ience non-pe o mance o ea ly
SSC (95% CI: 1.1–4.1) compa ed o asymp oma ic women.
CS was signi ican ly associa ed o p e e m bi h (OR = 12.2; 95% CI: 2.8–53.6), admis-
sion o he ICU (OR = 11.1; 95% CI: 1.9–64.7), and admission o he NICU (OR = 5.6; 95% CI:
