Catching Covid-19 in early pregnancy could increase risk of miscarriage

21 June 2022

Pregnant women who reported being infected with Covid-19 in their first trimester were more likely to have an early miscarriage, finds a new study led by 果冻影院 researchers.

However, despite the correlation observed in the COVID-19 Contraception and Pregnancy Study (CAP-COVID), researchers say further studies are needed to evaluate any causal association between SARS-CoV-2 infection in early pregnancy and miscarriage risk.

The CAP-COVID study, published in Human Reproduction, asked 3,041 women who were less than 13 weeks pregnant to record their current and past pregnancy complications, their medical history and whether anyone in their household had been diagnosed, or had symptoms of Covid-19, between 21^st May and 31^st December, 2020.

The results found that the rate of miscarriage amongst women who were presumed to be infected (had received a positive Covid-19 diagnosis) was 14%, compared to 8% in those presumed to be uninfected and 5% in those who were uncertain of whether they had the virus.

After adjusting for age, BMI, ethnicity, smoking status, gestational age and the number of previous miscarriages, the risk of early miscarriage appears to be higher (1.7 times more likely) in the 鈥榩resumed infected鈥� group.听

Co-lead author, Honorary Associate Professor Dimitrios Mavrelos who led the project alongside Honorary Senior Lecturer Ephia Yasmin (both 果冻影院 EGA Institute for Women's Health & 果冻影院H Reproductive Medicine Unit), said: 鈥淎s the Covid-19 epidemic reached pandemic status in mid-2020, little was known about the impact of infection on first trimester pregnancy.

鈥淚n order to help answer this question we set up an online survey that ran from late May 2020 to December 2020, asking women in early pregnancy to report whether they had suffered a Covid-19 infection and what the outcome of their pregnancy was.

鈥淥ver 3,000 women in the first trimester of their pregnancy registered and provided outcomes. Analysis of our data showed a potential association between Covid-19 infection and miscarriage of pregnancy in the first trimester. This is an important public health finding suggesting that women in early pregnancy may need to be more vigilant with infection prevention measures.鈥�

Previous studies have shown that viral infections during pregnancy such as herpes, HIV-1 and influenza can lead to foetal malformation, preterm labour, growth restriction, stillbirth and spontaneous abortion.

However this study, supported by a grant from the Elizabeth Garrett Anderson Hospital Charity, is the first to investigate the rates of early pregnancy loss during the Covid-19 outbreak to date.

Explaining the potential association between Covid-19 infection and early miscarriage, Honorary Associate Professor Mavrelos said: 鈥淐oronaviruses have also been shown to induce a proinflammatory cytokine storm in the body. Cytokines are thought the play a role in the development of recurrent pregnancy loss, which could explain the increased risk of early miscarriage in women infected with Covid-19.

鈥淪o, although the sample size of women with presumed Covid-19 in this study was too small to reach statistical significance, the findings still highlight the need for pregnant women to exercise social distancing measures and good hygiene throughout their pregnancy to limit their risk of infection.鈥�

Study limitations

Researchers relied on self-reported data on early pregnancy loss and SARS-CoV-2 infection without any means of checking validity. Some women in the 鈥榩resumed uninfected鈥� and 鈥榰ncertain鈥� groups may have had asymptomatic infections. The number of 鈥榩resumed infected鈥� in our study was low and therefore the study was relatively underpowered.

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Poppy Danby听

E: p.danby [at] ucl.ac.uk

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