{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T02:46:01Z","timestamp":1760150761398,"version":"build-2065373602"},"reference-count":44,"publisher":"MDPI AG","issue":"24","license":[{"start":{"date-parts":[[2023,12,15]],"date-time":"2023-12-15T00:00:00Z","timestamp":1702598400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Despite the existing body of evidence, there is still limited knowledge about the impact of SARS-CoV-2 positivity on delivery outcomes. We aimed to assess the impact of SARS-CoV-2 infection in women who gave birth at the University Hospital \u201cFederico II\u201d of Naples, Italy, between 2020 and 2021. We conducted a retrospective single-center population-based observational study to assess the differences in the caesarean section and preterm labor rates and the length of stay between women who tested positive for SARS-CoV-2 and those who tested negative at the time of labor. We further stratified the analyses considering the time period, dividing them into three-month intervals, and changes in SARS-CoV-2 as the most prevalent variant. The study included 5236 women with 353 positive cases. After vaccination availability, only 4% had undergone a complete vaccination cycle. The Obstetric Comorbidity Index was higher than 0 in 41% of the sample. When compared with negative women, positive ones had 80% increased odds of caesarean section, and it was confirmed by adjusting for the SARS-CoV-2 variant. No significant differences were found in preterm birth risks. The length of stay was 11% higher in positive cases but was not significant after adjusting for the SARS-CoV-2 variant. When considering only positive women in the seventh study period (July\u2013September 2021), they had a 61% decrease in the odds of receiving a caesarean section compared to the fourth (October\u2013December 2020). Guidelines should be implemented to improve the safety and efficiency of the delivery process, considering the transition of SARS-CoV-2 from pandemic to endemic. Furthermore, these guidelines should aim to improve the management of airborne infections in pregnant women.<\/jats:p>","DOI":"10.3390\/jcm12247709","type":"journal-article","created":{"date-parts":[[2023,12,15]],"date-time":"2023-12-15T11:26:52Z","timestamp":1702639612000},"page":"7709","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of SARS-CoV-2 Positivity on Delivery Outcomes for Pregnant Women between 2020 and 2021: A Single-Center Population-Based Analysis"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3437-812X","authenticated-orcid":false,"given":"Raffaele","family":"Palladino","sequence":"first","affiliation":[{"name":"Department of Public Health, University \u201cFederico II\u201d of Naples, 80131 Naples, Italy"},{"name":"Department of Primary Care and Public Health, Imperial College School of Public Health, London SW7 2BX, UK"},{"name":"Interdepartmental Research Center in Healthcare Management and Innovation in Healthcare (CIRMIS), University \u201cFederico II\u201d of Naples, 80131 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Federica","family":"Balsamo","sequence":"additional","affiliation":[{"name":"Department of Public Health, University \u201cFederico II\u201d of Naples, 80131 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5227-6012","authenticated-orcid":false,"given":"Michelangelo","family":"Mercogliano","sequence":"additional","affiliation":[{"name":"Department of Public Health, University \u201cFederico II\u201d of Naples, 80131 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7915-8270","authenticated-orcid":false,"given":"Michele","family":"Sorrentino","sequence":"additional","affiliation":[{"name":"Department of Public Health, University \u201cFederico II\u201d of Naples, 80131 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marco","family":"Monzani","sequence":"additional","affiliation":[{"name":"Department of Public Health, University \u201cFederico II\u201d of Naples, 80131 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rosanna","family":"Egidio","sequence":"additional","affiliation":[{"name":"Clinical Directorate, Academic Hospital \u201cFederico II\u201d of Naples, 80131 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonella","family":"Piscitelli","sequence":"additional","affiliation":[{"name":"Azienda Ospedaliera di Rilievo Nazionale (AORN) Dei Colli, Vincenzo Monaldi Hospital, 80122 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna","family":"Borrelli","sequence":"additional","affiliation":[{"name":"Clinical Directorate, Academic Hospital \u201cFederico II\u201d of Naples, 80131 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giuseppe","family":"Bifulco","sequence":"additional","affiliation":[{"name":"Department of Public Health, University \u201cFederico II\u201d of Naples, 80131 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria","family":"Triassi","sequence":"additional","affiliation":[{"name":"Department of Public Health, University \u201cFederico II\u201d of Naples, 80131 Naples, Italy"},{"name":"Interdepartmental Research Center in Healthcare Management and Innovation in Healthcare (CIRMIS), University \u201cFederico II\u201d of Naples, 80131 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,12,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"658","DOI":"10.1038\/s41597-022-01782-9","article-title":"Benchmarking emergency department prediction models with machine learning and public electronic health records","volume":"9","author":"Xie","year":"2022","journal-title":"Sci. Data"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"799","DOI":"10.5858\/arpa.2020-0901-SA","article-title":"An Analysis of 38 Pregnant Women with COVID-19, Their Newborn Infants, and Maternal-Fetal Transmission of SARS-CoV-2 Maternal Coronavirus Infections and Pregnancy Outcomes","volume":"144","author":"Schwartz","year":"2020","journal-title":"Arch. Pathol. Lab. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"106054","DOI":"10.1016\/j.ijantimicag.2020.106054","article-title":"Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2): A global pandemic and treatment strategies","volume":"56","author":"Sharma","year":"2020","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1038\/s41579-020-00459-7","article-title":"Characteristics of SARS-CoV-2 and COVID-19","volume":"19","author":"Hu","year":"2020","journal-title":"Nat. Rev. Microbiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1152\/physrev.00024.2020","article-title":"Pregnancy and COVID-19","volume":"101","author":"Wastnedge","year":"2021","journal-title":"Physiol. Rev."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"m3320","DOI":"10.1136\/bmj.m3320","article-title":"Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: Living systematic review and meta-analysis","volume":"370","author":"Allotey","year":"2020","journal-title":"BMJ"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1641","DOI":"10.15585\/mmwr.mm6944e3","article-title":"Update: Characteristics of Symptomatic Women of Reproductive Age with Laboratory-Confirmed SARS-CoV-2 Infection by Pregnancy Status \u2014 United States, January 22\u2013October 3, 2020","volume":"69","author":"Zambrano","year":"2020","journal-title":"MMWR Morb. Mortal. Wkly. Rep."},{"key":"ref_8","first-page":"394","article-title":"Consequences and implications of the coronavirus disease (COVID-19) on pregnancy and newborns: A comprehensive systematic review and meta-analysis","volume":"156","author":"Sarmento","year":"2021","journal-title":"Int. J. Gynecol. Obstet."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1177\/10547738211064027","article-title":"Maternal and Neonatal Outcomes of Healthy Pregnant Women With COVID-19 Versus High-risk Pregnant Women: A Multi-Center Case-Control Comparison Study","volume":"31","author":"Khalaf","year":"2022","journal-title":"Clin. Nurs. Res."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"748","DOI":"10.1001\/jama.2022.1190","article-title":"Association of SARS-CoV-2 infection with serious maternal morbidity and mortality from obstetric complications","volume":"327","author":"Metz","year":"2022","journal-title":"JAMA"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1016\/j.ejogrb.2021.05.021","article-title":"EBCOG position statement on COVID-19 vaccination for pregnant and breastfeeding women","volume":"262","author":"Martins","year":"2021","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1342","DOI":"10.1111\/1471-0528.17110","article-title":"Characteristics and perceptions associated with COVID-19 vaccination hesitancy among pregnant and postpartum individuals: A cross-sectional study","volume":"129","author":"Kiefer","year":"2022","journal-title":"BJOG Int. J. Obstet. Gynaecol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"100403","DOI":"10.1016\/j.ajogmf.2021.100403","article-title":"COVID-19 vaccine acceptance among pregnant, breastfeeding, and nonpregnant reproductive-aged women","volume":"3","author":"Sutton","year":"2021","journal-title":"Am. J. Obstet. Gynecol. MFM"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1377","DOI":"10.1080\/14767058.2020.1749257","article-title":"Pregnant women in the exposure to COVID-19 infection outbreak: The unseen risk factors and preventive healthcare patterns","volume":"35","author":"Mirzadeh","year":"2022","journal-title":"J. Matern. Fetal Neonatal Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2362","DOI":"10.1080\/14767058.2020.1781809","article-title":"Pregnancy and COVID-19: A systematic review of maternal, obstetric and neonatal outcomes","volume":"35","author":"Trocado","year":"2022","journal-title":"J. Matern. Fetal Neonatal Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"100049","DOI":"10.1016\/j.xagr.2021.100049","article-title":"Systematic review and meta-analysis of COVID-19 maternal and neonatal clinical features and pregnancy outcomes up to 3 June 2021","volume":"2","author":"Marchand","year":"2022","journal-title":"AJOG Glob. Rep."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1016\/j.cmi.2020.10.007","article-title":"Impact of COVID-19 on maternal and neonatal outcomes: A systematic review and meta-analysis","volume":"27","author":"Gjoka","year":"2021","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"456","DOI":"10.1136\/archdischild-2020-320682","article-title":"Increase of stillbirth and decrease of late preterm infants during the COVID-19 pandemic lockdown","volume":"106","author":"Villani","year":"2021","journal-title":"Arch. Dis. Child. Fetal Neonatal Ed."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1111\/1471-0528.17315","article-title":"Pregnancy outcomes in Italy during COVID-19 pandemic: A population-based cohort study","volume":"130","author":"Rusconi","year":"2022","journal-title":"BJOG Int. J. Obstet. Gynaecol."},{"key":"ref_20","unstructured":"(2023, December 12). Istituto Superiore di Sanit\u00e1, Rome. Prevalenza e Distribuzione Delle Varianti di SARS-CoV-2 di Interesse per la Sanit\u00e0 Pubblica in Italia. Available online: https:\/\/www.epicentro.iss.it\/coronavirus\/pdf\/sars-cov-2-monitoraggio-varianti-rapporti-periodici-1-luglio-2022.pdf."},{"key":"ref_21","unstructured":"(2023, December 12). Istituto Superiore di Sanit\u00e1, Rome. Prevalenza e Distribuzione Delle Varianti di SARS-CoV-2 di Interesse per la Sanit\u00e0 Pubblica in Italia Rapporto n. 5 del 23 luglio 2021. Available online: https:\/\/www.iss.it\/documents\/20126\/0\/versione+h++17+BOLLETTINO+VARIANTI+n.5+23+luglio.pdf\/."},{"key":"ref_22","unstructured":"(2021, June 12). Stima della Prevalenza delle Varianti VOC (Variants of Concern) in Italia: Beta, Gamma, Delta, Omicron e Altre Varianti di SARS-CoV-2. Available online: https:\/\/www.epicentro.iss.it\/coronavirus\/pdf\/sars-cov-2-monitoraggio-varianti-indagini-rapide-6-dicembre-2021.pdf."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"957","DOI":"10.1097\/AOG.0b013e3182a603bb","article-title":"Development of a Comorbidity Index for Use in Obstetric Patients","volume":"122","author":"Bateman","year":"2013","journal-title":"Obstet. Gynecol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"271.e1","DOI":"10.1016\/j.ajog.2019.06.025","article-title":"A comorbidity-based screening tool to predict severe maternal morbidity at the time of delivery","volume":"221","author":"Easter","year":"2019","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Choi, E.-Y., Jeong, H.E., Noh, Y., Choi, A., Yon, D.K., Han, J.Y., Sung, J.-H., Choe, S.-A., and Shin, J.-Y. (2023). Neonatal and maternal adverse outcomes and exposure to nonsteroidal anti-inflammatory drugs during early pregnancy in South Korea: A nationwide cohort study. PLoS Med., 20.","DOI":"10.1371\/journal.pmed.1004183"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1016\/j.ajog.2020.12.1208","article-title":"Critical care in obstetrics: A strategy for addressing maternal mortality","volume":"224","author":"Padilla","year":"2021","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Fern\u00e1ndez-De-Las-Pe\u00f1as, C., Notarte, K.I., Peligro, P.J., Velasco, J.V., Ocampo, M.J., Henry, B.M., Arendt-Nielsen, L., Torres-Macho, J., and Plaza-Manzano, G. (2022). Long-COVID Symptoms in Individuals Infected with Different SARS-CoV-2 Variants of Concern: A Systematic Review of the Literature. Viruses, 14.","DOI":"10.3390\/v14122629"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"105286","DOI":"10.1016\/j.ijmedinf.2023.105286","article-title":"Longitudinal dynamic clinical phenotypes of in-hospital COVID-19 patients across three dominant virus variants in New York","volume":"181","author":"Ho","year":"2024","journal-title":"Int. J. Med. Inform."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1016\/j.ijid.2022.12.018","article-title":"The impact of variant and vaccination on SARS-CoV-2 symptomatology; three prospective household cohorts","volume":"128","author":"Westerhof","year":"2023","journal-title":"Int. J. Infect. Dis."},{"key":"ref_30","unstructured":"(2023, December 02). Caesarean Section Rates Continue to Rise, Amid Growing Inequalities in Access. Available online: https:\/\/www.who.int\/news\/item\/16-06-2021-caesarean-section-rates-continue-to-rise-amid-growing-inequalities-in-access."},{"key":"ref_31","unstructured":"Certificato di Assistenza al Parto (CeDAP) (2023, December 02). Analisi Dell\u2019evento Nascita\u2014Anno 2020, Available online: https:\/\/www.salute.gov.it\/portale\/documentazione\/p6_2_2_1.jsp?lingua=italiano&id=3149."},{"key":"ref_32","unstructured":"OECD (2017). Tackling Wasteful Spending on Health, OECD."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Colais, P., Fantini, M.P., Fusco, D., Carretta, E., Stivanello, E., Lenzi, J., Pieri, G., and A Perucci, C. (2012). Risk adjustment models for interhospital comparison of CS rates using Robson\u2019s ten group classification system and other socio-demographic and clinical variables. BMC Pregnancy Childbirth, 12.","DOI":"10.1186\/1471-2393-12-54"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Longo, V.L., Odjidja, E.N., Beia, T.K., Neri, M., Kielmann, K., Gittardi, I., Di Rosa, A.I., Boldrini, M., Melis, G.B., and Scambia, G. (2020). \u2018An unnecessary cut?\u2019 multilevel health systems analysis of drivers of caesarean sections rates in Italy: A systematic review. BMC Pregnancy Childbirth, 20.","DOI":"10.1186\/s12884-020-03462-1"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1016\/S1473-3099(20)30157-2","article-title":"Guidelines for pregnant women with suspected SARS-CoV-2 infection","volume":"20","author":"Favre","year":"2020","journal-title":"Lancet Infect. Dis."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"748","DOI":"10.1017\/ice.2020.84","article-title":"Impact of COVID-19 infection on pregnancy outcomes and the risk of maternal-to-neonatal intrapartum transmission of COVID-19 during natural birth","volume":"41","author":"Khan","year":"2020","journal-title":"Infect. Control Hosp. Epidemiol."},{"key":"ref_37","unstructured":"(2023, July 21). Sorveglianza Integrata COVID-19: I Principali dati Nazionali. Available online: https:\/\/www.epicentro.iss.it\/coronavirus\/sars-cov-2-sorveglianza-dati."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"e759","DOI":"10.1016\/S2214-109X(21)00079-6","article-title":"Effects of the COVID-19 pandemic on maternal and perinatal outcomes: A systematic review and meta-analysis","volume":"9","author":"Chmielewska","year":"2021","journal-title":"Lancet Glob. Health"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"e604","DOI":"10.1016\/S2468-2667(20)30223-1","article-title":"Impact of COVID-19 mitigation measures on the incidence of preterm birth: A national quasi-experimental study","volume":"5","author":"Been","year":"2020","journal-title":"Lancet Public Health"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"105242","DOI":"10.1016\/j.envint.2019.105242","article-title":"Maternal ambient air pollution exposure with spatial-temporal variations and preterm birth risk assessment during 2013\u20132017 in Zhejiang Province, China","volume":"133","author":"Sun","year":"2019","journal-title":"Environ. Int."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1319","DOI":"10.1093\/aje\/kwp061","article-title":"Stress Pathways to Spontaneous Preterm Birth: The Role of Stressors, Psychological Distress, and Stress Hormones","volume":"169","author":"Kramer","year":"2009","journal-title":"Am. J. Epidemiol."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Dubey, P., Thakur, B., Reddy, S., Martinez, C.A., Manuel, S.L., Chheda, S., Bracamontes, C., and Dwivedi, A.K. (2021). Current trends and geographical differences in therapeutic profile and outcomes of COVID-19 among pregnant women\u2014A systematic review and meta-analysis. BMC Pregnancy Childbirth, 21.","DOI":"10.1186\/s12884-021-03685-w"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1016\/j.ajog.2020.02.017","article-title":"Coronavirus Disease 2019 (COVID-19) and pregnancy: What obstetricians need to know","volume":"222","author":"Rasmussen","year":"2020","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Alserehi, H., Wali, G., Alshukairi, A., and Alraddadi, B. (2016). Impact of Middle East Respiratory Syndrome coronavirus (MERS-CoV) on pregnancy and perinatal outcome. BMC Infect. Dis., 16.","DOI":"10.1186\/s12879-016-1437-y"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/24\/7709\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:39:24Z","timestamp":1760132364000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/24\/7709"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,15]]},"references-count":44,"journal-issue":{"issue":"24","published-online":{"date-parts":[[2023,12]]}},"alternative-id":["jcm12247709"],"URL":"https:\/\/doi.org\/10.3390\/jcm12247709","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2023,12,15]]}}}