Increased risk of fetal left-right asymmetry disorders associated with maternal SARS-CoV-2 infection during the first trimester

Sci Rep. 2024 May 19;14(1):11422. doi: 10.1038/s41598-024-61778-w.

Abstract

Our center has observed a substantial increase in the detection rate of fetal left-right(LR) asymmetry disorders between March and May 2023. This finding has raised concerns because these pregnant women experienced the peak outbreak of SARS-CoV-2 in China during their first trimester. To explore the relationship between maternal SARS-CoV-2 infection and fetal LR asymmetry disorders. A retrospective collection of clinical and ultrasound data diagnosed as fetal LR asymmetry disorders was conducted from January 2018 to December 2023. The case-control study involved fetuses with LR asymmetry disorders and normal fetuses in a 1:1 ratio. We evaluated and compared the clinical and fetal ultrasound findings in pregnant women with SARS-CoV-2 infection and pregnant women without infection. The Student t-test was utilized to compare continuous variables, while the chi-squared test was employed for univariable analyses. The incidence rate of LR asymmetry disorders from 2018 to 2023 was as follows: 0.17‰, 0.63‰, 0.61‰, 0.57‰, 0.59‰, and 3.24‰, respectively. A total of 30 fetuses with LR asymmetry disorders and 30 normal fetuses were included. This case-control study found that SARS-CoV-2 infection (96.67% vs 3.33%, P = .026) and infection during the first trimester (96.55% vs 3.45%, P = .008) were identified as risk factors. The odds ratio values were 10.545 (95% CI 1.227, 90.662) and 13.067 (95% CI 1.467, 116.419) respectively. In cases of SARS-CoV-2 infection in the first trimester, the majority of infections (88.1%, 37/42) occurred between 5 and 6 weeks of gestation. We found that 43.7% (66/151) of fetuses with LR asymmetry disorder had associated malformations, 90.9% (60/66) exhibited cardiac malformations. SARS-CoV-2 infection during the first trimester significantly increases the risk of fetal LR asymmetry disorders, particularly when the infection occurs between 5 and 6 gestation weeks. The most common associated malformation is heart malformation.

Keywords: Fetal; Left–right asymmetry disorders; SARS-CoV-2; Ultrasound.

MeSH terms

  • Adult
  • COVID-19* / complications
  • COVID-19* / epidemiology
  • Case-Control Studies
  • China / epidemiology
  • Female
  • Fetal Diseases / epidemiology
  • Fetal Diseases / virology
  • Fetus / virology
  • Humans
  • Pregnancy
  • Pregnancy Complications, Infectious* / epidemiology
  • Pregnancy Trimester, First*
  • Retrospective Studies
  • Risk Factors
  • SARS-CoV-2*
  • Ultrasonography, Prenatal