Reproductive Sequelae of Parental Severe Illness Before the Pandemic: implications for the COVID-19 pandemic

Kasman, Alex M.; Bhambhvani, Hriday P.; Li, Shufeng; Zhang, Chiyuan A.; Stevenson, David K.; Shaw, Gary M.; Simard, Julia F.; Eisenberg, Michael L.

Objective To investigate, with pre-COVID-19 data, whether parental exposure to severe systemic infections near the time of conception is associated with pregnancy outcomes. Design Retrospective cohort study. Setting Population based study covering births within the United States between 2009 and 2016. Participants IBM® MarketScan® Research database covers reimbursed healthcare claims data on inpatient and outpatient encounters who are privately insured through employment sponsored health insurance. Our analytic sample were pregnancies to paired fathers and mothers. Interventions Parental preconception exposure (0-6 months prior to conception) to severe systemic infection (e.g. sepsis, hypotension, respiratory failure, critical care evaluation). Main Outcome Measures Preterm birth (i.e. live birth before 37 weeks) and pregnancy loss. Results 999,866 pregnancies occurred with 214,057 (21.4%) pregnancy losses and 51,759 (5.2%) preterm births observed. Mothers receiving ICU care in the preconception period had increased risk of pregnancy loss (RR 1.99, 95% CI 1.69-2.34) as did fathers (RR 1.67, 95% CI 1.43-1.96). Mothers with preconception sepsis had higher risk of preterm birth (RR 1.61, 95% 1.02-2.54) and pregnancy loss (RR 1.38, 95% 1.07-1.78) while paternal sepsis exposure was associated with an increased risk of pregnancy loss (RR 1.55, 95% 1.22-1.98). Similar results were noted for hypotension. Additionally, a dose response was observed with preconception time in the ICU and the risk of preterm birth and pregnancy loss for both mothers and fathers. Conclusions In a pre-COVID-19 cohort, parental preconception severe systemic infection was associated with increased odds of preterm birth and pregnancy loss when conception was soon after the illness.