Research question

Is there an association between SARS-CoV-2 infection and first-trimester miscarriage?

Design

This multicentre prospective study included a cohort of women with first-trimester miscarriages registered consecutively by seven Spanish hospitals where universal PCR screening for SARS-CoV-2 infection was implemented with both miscarriages and deliveries. The incidence of SARS-CoV-2 infection among women with first-trimester miscarriages was compared with the rate registered in women on admission to the delivery ward within the same time frame using a mixed-effects Poisson regression analysis, considering ‘hospital’ as random effect. The characteristics of SARS-CoV-2 positive and negative patients who miscarried were compared through two-sided univariable analyses.

Results

A total of 301 miscarriages were registered, 11 (3.7%) to SARS-CoV-2 infected and 290 to non-infected women. In the same time frame as the miscarriages, 1936 deliveries were registered, 44 [2.3%] of them were SARS-CoV-2 infected. No differences in terms of SARS-CoV-2 infection incidence were observed between infected miscarriages and infected deliveries (P = 0.233). Regarding the differences observed between miscarriages in SARS-CoV-2 positive and negative women, more inevitable miscarriages occurred in the group of infected women (36.4% versus 16.5% in non-infected women; P = 0.004), and there was greater surgical management of miscarriages (27.3% versus 8.2% in non-infected women; P = 0.036), probably in line with the greater number of inevitable miscarriages observed in this group.

Conclusions

No association between SARS-CoV-2 infection and risk of first-trimester miscarriage was observed; however, the type of miscarriage seems to differ between SARS-CoV-2 positive and negative women, with inevitable miscarriage being more frequent among infected women.

中文翻译：

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早孕早期流产中的 SARS-CoV-2 感染：一项前瞻性观察研究

研究问题

SARS-CoV-2 感染与妊娠早期流产之间是否存在关联？

设计

这项多中心前瞻性研究包括一组由西班牙七家医院连续登记的孕早期流产妇女，这些医院对流产和分娩实施了针对 SARS-CoV-2 感染的通用 PCR 筛查。使用混合效应泊松回归分析，将妊娠早期流产妇女的 SARS-CoV-2 感染率与同一时间范围内进入分娩病房的妇女登记的比率进行比较，考虑到“医院”是随机的影响。通过双边单变量分析比较了流产的SARS-CoV-2阳性和阴性患者的特征。

结果

共登记了 301 例流产，其中 11 例（3.7%）为 SARS-CoV-2 感染者，290 例为未感染的女性。在流产的同一时间范围内，登记了 1936 例分娩，其中 44 例 [2.3%] 感染了 SARS-CoV-2。在感染流产和感染分娩之间未观察到 SARS-CoV-2 感染发生率存在差异（P = 0.233）。关于观察到的 SARS-CoV-2 阳性和阴性女性流产之间的差异，感染女性组发生了更多不可避免的流产（36.4% 对未感染女性的 16.5%；P  = 0.004），并且有更多的手术治疗流产率（27.3% 对 8.2% 未感染女性；P = 0.036），可能与在该组中观察到的更多不可避免的流产一致。

结论

没有观察到 SARS-CoV-2 感染与妊娠早期流产风险之间存在关联；然而，SARS-CoV-2 阳性和阴性女性的流产类型似乎有所不同，不可避免的流产在受感染的女性中更为常见。