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Martinez Perez, OscarAuthorEncinas Pardilla MbAuthor

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March 9, 2022
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Article

The association between SARS-CoV-2 infection and preterm delivery: a prospective study with a multivariable analysis

Publicated to: BMC Pregnancy and Childbirth. 21 (1): 273-273 - 2021-01-01 21(1), DOI: 10.1186/s12884-021-03742-4

Authors: Martinez-Perez O, Prats Rodriguez P, Muner Hernandez M, Encinas Pardilla MB, Perez Perez N, Vila Hernandez MR, Villalba Yarza A, Nieto Velasco O, Del Barrio Fernandez PG, Forcen Acebal L, Orizales Lago CM, Martinez Varea A, Muñoz Abellana B, Suarez Arana M, Fuentes Ricoy L, Martinez Diago C, Janeiro Freire MJ, Alférez Alvarez-Mallo M, Casanova Pedraz C, Alomar Mateu O, Lesmes Heredia C, Wizner de Alva JC, Bernardo Vega R, Macia Badia M, Alvarez Colomo C, Sanchez Muñoz A, Pratcorona Alicart L, Alonso Saiz R, Lopez Rodriguez M, Del Carmen Barbancho Lopez M, Meca Casbas MR, Vaquerizo Ruiz O, Moran Antolin E, Nuñez Valera MJ, Fernandez Fernandez C, Tubau Navarra A, Cano Garcia AM, Baena Luque C, Soldevilla Perez S, Gastaca Abasolo I, Adanez Garcia J, Teulon Gonzalez M, Puertas Prieto A, Ostos Serna R, Del Pilar Guadix Martin M, Catalina Coello M, Ferriols Perez E, Caño Aguilar A, De la Cruz Conty ML, Sainz Bueno JA, Spanish Obstetric Emergency Group

Affiliations

Department Gynaecology and Obstetrics, Arnau de Vilanova University Hospital, Lleida, Catalunya, Spain. - Author
Department Gynaecology and Obstetrics, Doce de Octubre University Hospital, Comunidad de Madrid, Madrid, Spain. - Author
Department Gynaecology and Obstetrics, Doctor Josep Trueta University Hospital of Girona, Girona, Catalunya, Spain. - Author
Department Gynaecology and Obstetrics, General University Hospital of Ciudad Real, Ciudad Real, Castilla-La Mancha, Spain. - Author
Department Gynaecology and Obstetrics, Getafe University Hospital, Getafe, Madrid, Spain. - Author
Department Gynaecology and Obstetrics, Infanta Margarita Hospital, Andalucía, Cabra, Spain. - Author
Department Gynaecology and Obstetrics, Infanta Sofia University Hospital, San Sebastian de los Reyes, Madrid, Spain. - Author
Department Gynaecology and Obstetrics, La Fe University and Polytechnic Hospital, Comunidad Valenciana, Valencia, Spain. - Author
Department Gynaecology and Obstetrics, La Paz University Hospital. Madrid, Madrid, Spain. - Author
Department Gynaecology and Obstetrics, Puerta de Hierro University Hospital of Majadahonda, Majadahonda, Madrid, Spain. - Author
Department Gynaecology and Obstetrics, Puerta de Hierro University Hospital of Majadahonda, Majadahonda, Madrid, Spain. Oscarmartinezgine@gmail.com. - Author
Department Gynaecology and Obstetrics, Regional University Hospital of Malaga, Malaga, Andalucía, Spain. - Author
Department Gynaecology and Obstetrics, Rio Hortega University Hospital, Valladolid, Castilla y León, Spain. - Author
Department Gynaecology and Obstetrics, San Carlos University Hospital. Madrid, Madrid, Spain. - Author
Department Gynaecology and Obstetrics, San Pedro de Alcántara Hospital, Caceres, Extremadura, Spain. - Author
Department Gynaecology and Obstetrics, Santa Caterina Hospital, Girona, Catalunya, Spain. - Author
Department Gynaecology and Obstetrics, Severo Ochoa University Hospital, Leganes, Madrid, Spain. - Author
Department Gynaecology and Obstetrics, University Assistance Complex of Leon, Leon, Castilla y Leon, Spain. - Author
Department Gynaecology and Obstetrics, University Hospital of Burgos, Burgos, Castilla y León, Spain. - Author
Department Gynaecology and Obstetrics, University Hospital of El Tajo, Aranjuez, Madrid, Spain. - Author
Department Gynaecology and Obstetrics, University Hospital of Salamanca, Salamanca, Castilla y León, Spain. - Author
Department Gynaecology and Obstetrics, University Hospital of Torrejon, Torrejon de Ardoz, Madrid, Spain. - Author
Department Gynaecology and Obstetrics, Valladolid University Hospital, Valladolid, Castilla y León, Spain. - Author
Department Obstetrics and Gynaecology, Germans Trias i Pujol University Hospital, Barcelona, Catalunya, Spain. - Author
Department Obstetrics and Gynaecology, HM Hospitals, Madrid, Spain. - Author
Department Obstetrics and Gynaecology, Joan XXIII University Hospital of Tarragona, Tarragona, Catalunya, Spain. - Author
Department Obstetrics and Gynaecology, Parc Taulí Hospital, Barcelona, Catalunya, Spain. - Author
Department Obstetrics and Gynaecology, Poniente Hospital of Almería, El Ejido, Andalucía, Spain. - Author
Department Obstetrics and Gynaecology, Quironsalud Madrid University Hospital. Madrid, Madrid, Spain. - Author
Department Obstetrics and Gynaecology, Regional Hospital of Inca, Inca, Illes Balears, Spain. - Author
Department Obstetrics and Gynaecology, Sant Joan de Reus University Hospital, Reus, Catalunya, Spain. - Author
Department Obstetrics and Gynaecology, Son Espases University Hospital, Palma de Mallorca, Illes Balears, Spain. - Author
Department Obstetrics and Gynaecology, Son Llatzer University Hospital, Palma de Mallorca, Illes Balears, Spain. - Author
Department Obstetrics and Gynaecology, Txagorritxu University Hospital of Araba, Vitoria-Gasteiz, País Vasco, Spain. - Author
Department Obstetrics and Gynaecology, University Hospital Complex of A Coruña, A Coruña, Spain. - Author
Department Obstetrics and Gynaecology, University Hospital of Cabueñes, Gijon, Asturias, Spain. - Author
Department Obstetrics and Gynaecology, University Hospital of Ferrol, Ferrol, A Coruña, Spain. - Author
Department Obstetrics and Gynaecology, University Hospital of Jerez de la Frontera, Jerez de la Frontera, Andalucía, Spain. - Author
Department Obstetrics and Gynaecology, Virgen de la Luz Hospital, Cuenca, Castilla-La Mancha, Spain. - Author
Department Reproductive Medicine and Gynaecology, Obstetrics, Dexeus University Hospital, Barcelona, Catalunya, Spain. - Author
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Abstract

To determine whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, the cause of COVID-19 disease) exposure in pregnancy, compared to non-exposure, is associated with infection-related obstetric morbidity.We conducted a multicentre prospective study in pregnancy based on a universal antenatal screening program for SARS-CoV-2 infection. Throughout Spain 45 hospitals tested all women at admission on delivery ward using polymerase-chain-reaction (PCR) for COVID-19 since late March 2020. The cohort of positive mothers and the concurrent sample of negative mothers was followed up until 6-weeks post-partum. Multivariable logistic regression analysis, adjusting for known confounding variables, determined the adjusted odds ratio (aOR) with 95% confidence intervals (95% CI) of the association of SARS-CoV-2 infection and obstetric outcomes.Preterm delivery (primary), premature rupture of membranes and neonatal intensive care unit admissions.Among 1009 screened pregnancies, 246 were SARS-CoV-2 positive. Compared to negative mothers (763 cases), SARS-CoV-2 infection increased the odds of preterm birth (34 vs 51, 13.8% vs 6.7%, aOR 2.12, 95% CI 1.32-3.36, p = 0.002); iatrogenic preterm delivery was more frequent in infected women (4.9% vs 1.3%, p = 0.001), while the occurrence of spontaneous preterm deliveries was statistically similar (6.1% vs 4.7%). An increased risk of premature rupture of membranes at term (39 vs 75, 15.8% vs 9.8%, aOR 1.70, 95% CI 1.11-2.57, p = 0.013) and neonatal intensive care unit admissions (23 vs 18, 9.3% vs 2.4%, aOR 4.62, 95% CI 2.43-8.94, p <  0.001) was also observed in positive mothers.This prospective multicentre study demonstrated that pregnant women infected with SARS-CoV-2 have more infection-related obstetric morbidity. This hypothesis merits evaluation of a causal association in further research.

Keywords

CoronavirusCovid-19Intensive care units, neonatalPregnancyPremature birthPremature rupture of membranesSars-cov-2

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal BMC Pregnancy and Childbirth due to its progression and the good impact it has achieved in recent years, according to the agency Scopus (SJR), it has become a reference in its field. In the year of publication of the work, 2021, it was in position , thus managing to position itself as a Q1 (Primer Cuartil), in the category Obstetrics and Gynecology.

From a relative perspective, and based on the normalized impact indicator calculated from World Citations provided by WoS (ESI, Clarivate), it yields a value for the citation normalization relative to the expected citation rate of: 7.4. This indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: ESI Nov 13, 2025)

This information is reinforced by other indicators of the same type, which, although dynamic over time and dependent on the set of average global citations at the time of their calculation, consistently position the work at some point among the top 50% most cited in its field:

  • Weighted Average of Normalized Impact by the Scopus agency: 9.83 (source consulted: FECYT Mar 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2025-12-13, the following number of citations:

  • WoS: 41
  • Scopus: 58
  • Europe PMC: 37

Impact and social visibility

From the perspective of influence or social adoption, and based on metrics associated with mentions and interactions provided by agencies specializing in calculating the so-called "Alternative or Social Metrics," we can highlight as of 2025-12-13:

  • The use, from an academic perspective evidenced by the Altmetric agency indicator referring to aggregations made by the personal bibliographic manager Mendeley, gives us a total of: 185.
  • The use of this contribution in bookmarks, code forks, additions to favorite lists for recurrent reading, as well as general views, indicates that someone is using the publication as a basis for their current work. This may be a notable indicator of future more formal and academic citations. This claim is supported by the result of the "Capture" indicator, which yields a total of: 187 (PlumX).

With a more dissemination-oriented intent and targeting more general audiences, we can observe other more global scores such as:

  • The Total Score from Altmetric: 164.
  • The number of mentions on the social network Facebook: 1 (Altmetric).
  • The number of mentions on the social network X (formerly Twitter): 33 (Altmetric).
  • The number of mentions in news outlets: 19 (Altmetric).

It is essential to present evidence supporting full alignment with institutional principles and guidelines on Open Science and the Conservation and Dissemination of Intellectual Heritage. A clear example of this is:

  • The work has been submitted to a journal whose editorial policy allows open Open Access publication.