Intrauterine Growth Restriction and other pregnancy complications following covid-19 infection

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Pirastehfar, Nasim Nouri, Sadaf Saket, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3967898/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background The WHO, reported world widespread coronavirus disease (COVID-19) as an international public health emergency. Pregnancy is associated with immunological changes that may make women susceptible to COVID-19. The present study was conducted to clarify the impacts of the pandemic on intra uterine growth restriction (IUGR) and other complications of pregnancy. Material & methods In a historical cohort study, COVID-19-positive cases who were hospitalized and a subgroup of Intensive Care Unit (ICU)-admitted (severe) cases were compared with those who had no history of COVID-19 infection, regarding IUGR and other complications of pregnancy. Results Among 1010 pregnant women enrolled in the study, 43 (4.3%) had a history of hospitalization due to COVID-19 (including 28 ICU-admitted severe cases) through pregnancy and the other 967 cases who had no history of infection were compared. In the comparison of COVID-19 with non-COVID-19 groups, IUGR, and preterm laborwere more frequent in the COVID-19 group(16.3% versus 6.9%) and (51.2% versus 19.9%), respectively. Also, the cesarean section rate was higher (75% versus 55.3%) and the low APGAR score was more frequent (16.3% versus 3.3–3.7%) Conclusion Complications of COVID-19 infection in pregnancy such as IUGR, preterm labor, higher rate of cesarean section,and low APGAR score might make pregnant women more vulnerable to the COVID-19 pandemic and probable future versions of viral pandemics. COVID-19 growth restriction preterm pregnancy Introduction The first cases ofCOVID-19 pneumonia from a novel coronavirus appeared in Wuhan, China in December 2019 ( 1 , 2 ).The coronavirus disease (COVID-19) has spread rapidly worldwide as a result of infection with acute respiratory syndrome SARS-CoV-2.( 3 ). The WHO reported this condition as an International Public Health Emergency ( 1 , 4 ). This disorder has also affected pregnant women and pregnancy outcomes.( 5 , 6 ) Pregnancy is associated with immunological changes that may make women susceptible to COVID-19( 7 ). Despite the 2019 Covid-19 pandemic and extensive studies in this field, the impact of SARS-CoV-2 on the developing fetus is not completely clear.Physiological changes in the mother during pregnancy have a significant effect on the coagulation, immune, respiratory, and cardiovascular systems of the fetus and may have positive or negative effects on the course ofthe disease (COVID-19). Studies have shown that pregnant women may be vulnerable to the adverse effects of COVID-19( 8 ). Definitive evidence of Mother-to-child vertical transmission of SARS-CoV infection is not available in the available data, but some pregnancy complications such as premature birth, risk of miscarriage, intrauterine death, intrauterine growth restriction (IUGR),low birth weight, spontaneous abortion, and mortality have been reported through mothers with Covid-19( 8 , 9 ). Some studies have also shown that maternal covid-19 can affect fetal oxygen supply and lead to placental insufficiency, IUGR, or fetal death( 8 ).Children with IUGR are at greater risk for long-term problems such as short stature, metabolic syndrome, type 2 diabetes, insulin resistance, and cardiovascular diseases( 10 , 11 ). Studies also show that these children may have puberty disorders, reproductive function,and adrenal secretion disorders. During pregnancy, several viral infections are known to increase the risk of fetal malformations, including IUGR, without significant long-term effects on the health of the offspring( 11 ). Considering the long-term effects of IUGR on a person's life Infected during the fetal period and the lack of sufficient information regarding the relationship between COVID-19 and IUGR in the studies, the present study was conducted to clarify the uncertainties in this field. Materials and method The study is a historical cohort and was conducted under the supervision of the Obstetrics and Gynecology Department of Imam Hossein Hospital in Tehran, Iran including pregnant cases who visited for labor pain between 2019 and 2021 during the COVID-19 pandemic. Since the study was conducted in a university hospital, an informed consent form was obtained from all patients for the use of information. Patients with intrauterine growth restriction risk factors such as addiction, chronic hypertension, and other systemic diseases, including pre-eclampsia were excluded from the study. Those with a history of mild Covid-19 infection who didn’t need to be hospitalized (mild cases) were excluded from the study. Age, height, weight, BMI, type of delivery, gravid, para, live children, gestational age, date of delivery, alcohol use, cocaine use, addiction, chronic blood pressure, preeclampsia, diabetes, lupus, Chronic kidney disease, epilepsy, drug history, history of IUGR, previous birth weight, multiple pregnancy, definite anomaly, APGAR score, history of infection with Covid-19 followed by hospitalization, and/or hospitalization in ICU, symptoms of cough, fever, weakness, shortness of breath, and taking Remdesivir in positive history cases were extracted from the patients documented data in each group and was entered in the questionnaire for each patient. We defined moderate disease as hospitalized cases and severe cases as subgroup of ICU-admitted covid-19 infected patients. We comparedCOVID-19-positive hospitalized patients(moderate) and the subgroup of COVID-19-positiveICU-admitted(severe) patients with those who had no history of Covid-19 infection regarding IUGR. IUGR criterion was considered less than the 10 th percentile birth weight of newborns. This study was in accordance with the ethical issues for human subject research and confirmed by the Shahid Beheshti University of Medical Sciences by an ethical committee (IR.SBMU.RETECH.REC.1402.176) . Informed consent was obtained from all subjects. The datasets used and/or analysed during the current study available from the corresponding author on reasonable request. consent for publication: not applicable Statistical analysis: Data were analyzed with Software Package for the Social Sciences (SPSS, version 19.0). After checking the normality of continuous variables, an independent t-test was used to compare continuous variables Chi-square test or Fisher exact test was used to compare dichotomous variables Binary logistic regression analysis was done to detect independent predictors of IUGR. The significant level was set at 0.05. Results Among 1010 pregnant women who entered the study, 43 (4.3%) were moderate or severe and hospitalized due to Covid-19 (COVID-19 group).In these cases,the cough was the most frequent symptom (72.1%) followed by fever (65.1%), weakness (63.4%), and dyspnea (62.8%). Two groups (moderate to severe COVID-19 cases versus non-COVID-19 subjects) were not significantly different in terms of gestational diabetes (28.6% versus 26.3%), preeclampsia (2.3% versus 4.3%), and chronic hypertension (7.0% versus 6.1%), respectively, P > 0.1. No one in the COVID-19 group had diseases of SLE, chronic renal disease, and epilepsy. Three (0.3%) subjects from the non-COVID-19 group had SLE, 8 (0.8%) had chronic renal disease, and 11 (1.1%) had epilepsy, P > 0.1. In the COVID-19 group, 2.3% were smokers, 2.3% had an addiction, and no one used alcohol or cocaine. The frequency rate of smoking, alcohol use, cocaine use, and addiction was 1.4%, 0.3%, 0.5%, and 2.8% in the non-COVID-19 group, respectively (P > 0.1). Only two women in the non-COVID-19 group were on warfarin, 2 had a history of IUGR, and 5 had multiple pregnancies. Twenty-eight out of 43 cases (65.1%) of the COVID-19 group were admitted to the ICU. The median (range) of hospitalization days was 5 (1–20) and ICU days were 5 (1–38). COVID-19 and non-COVID-19 groups were compared.subgroup comparison of the COVID-19 ICU-admitted cases with non-COVID-19 cases isdone, as well. Both COVID-19 and COVID-19 ICU admitted subgroups were older than the COVID-19 group, P < 0.05. Neonates of the COVID-19, ICU-admitted subgroup of severe cases had significantly lower birth weights in comparison to the non-COVID-19 cases. IUGR(less than 10 percentile rate adjusted by gestational age ) was more frequent in the COVID-19 group (16.3%) and ICU-admitted subgroup of severe cases(21.4%) than in the non-COVID-19 group (6.9%).The mean gestational age at delivery was significantly lower in moderate COVID-19 (35.0 +/- 4.5) and ICU-admitted COVID-19 subgroup (33.4 +/- 4.7) in comparison with the non-COVID-19 cases (38.0 +/- 2.6), P < 0.001. Preterm labor rate was 51.2% and 71.4% in the COVID-19 group and ICU admitted subgroup, which was significantly higher than non- COVID-19 group (19.9%), P < 0.001.less than 7 Apgar score at 5 min and less than 9 in 10 min rate were16.3% in the COVID-19 group and 25% in the ICU admitted subgroup, which was significantly higher than non- COVID-19 group (3.3-3.7%).The Cesarean section rate was 75.0% in the COVID-19, 84.6% in the ICU admitted subgroup of severe cases versus 55.3% in the non-COVID-19 group, P = 0.014 and P = 0.003, respectively(Table 1). Table 1: Comparison of maternal and obstetric characteristics in the non-COVID-19 group with the COVID-19 group and with the subgroup of severe COVID-19 ICU admitted cases. Non - COVID-19 (n=967) COVID-19 (n=43) P * COVID-19 ICU admitted (n=28) P * Maternal age (year) 29.2 ( + 6.3) 31.5 ( + 5.9) 0.020 † 31.8 ( + 5.6) 0.034 † BMI 29.5 ( + 5.0) 30.0 ( + 4.9) 0.592 † 30.8 ( + 5.3) 0.216 † Nuliparous 317 (32.8) 11 (25.6) 0.322 ҳ 7 (25.0) 0.384 ҳ Previous birth weight 3160.3 ( + 549.0) 3095.4 ( + 495.5) 0.570 † 3076.9 ( + 501.9) 0.588 † gestational wk. at delivery 38.0 ( + 2.6) 35.0 ( + 4.5) <0.001 †† 33.4 ( + 4.7) <0.001 †† Preterm labor 192 (19.9) 22 (51.2) <0.001 ҳ 20 (71.4) <0.001 ҳ Apgar score at 5 min <7 36 (3.7) 7 (16.3) 0.002 ҳҳ 7 (25.0) <0.001 ҳҳ Apgar score at 10 min <9 32 (3.3) 7 (16.3) 0.001 ҳҳ 7 (25.0) <0.001 ҳҳ Birth weight (gram) 3076.5 ( + 636.3) 2441.4 ( + 495.5) <0.001 †† 2191.3 ( + 937.9) <0.001 †† IUGR 67 (6.9) 7 (16.3) 0.032 ҳҳ 6 (21.4) 0.013 ҳҳ C/S 488 (55.3) 30 (75.0) 0.014 ҳ 22 (84.6) 0.003 ҳ Data are shown as mean ( + SD) or frequency (%). GDM: Gestational Diabetes Mellitus, BMI: Body Mass Index, IUGR: Intra Uterine Growth Retardation, C/S: Cesarean /Section, * Versus Non-COVID-19. † based on independent-samples t test, Levene's Test for Equality of Variances, P>0.05, Equal variances assumed. †† based on independent-samples t test, Levene's Test for Equality of Variances, P<0.05, Equal variances not assumed. ҳ Chi-Square Test, ҳҳ Fisher's Exact Test In the binary logistic regression analysis, the chance of IUGR in the COVID-19 group was 2.6 times(95% CI: 1.1–6.1),and in the ICU-admitted subgroup was 3.7 times (95% CI: 1.4–9.3) more than in the non-COVID-19 group (table 2).Also, the chance of preterm labor in the COVID-19 group was 4.2 times(95% CI: 2.3 – 7.9),and in the ICU-admitted subgroup was 10.1 times (95% CI: 4.4 – 23.3) more than in the non-COVID-19 group (table 3). Table 2: The odds ratio (95%CI) of IUGR in binary logistic regression analysis Odds Ratio (95% CI) PV non COVID 19 reference 0.026 COVID 19 2.6 (1.1 – 6.1) non COVID 19 reference 0.007 ICU admitted COVID 19 3.7 ( 1.4 – 9.3) CI: Confidence Interval, ICU: Intensive Care Unite Table 3: The odds ratio (95%CI) of preterm labor in binary logistic regression analysis Odds Ratio (95% CI) PV non COVID 19 reference <0.001 COVID 19 4.2 (2.3 – 7.9) non COVID 19 reference <0.001 ICU admitted COVID 19 10.1 ( 4.4 – 23.3) CI: Confidence Interval, ICU: Intensive Care Unite Discussion SARS-CoV-2 infection is an inflammatory process that is presented with proinflammatory changes such as increased Th2 cell-associated cytokinesand the increase of IgG and IgA has been observed about 2 weeks after infection with human coronaviruswhich affects multiple organs and the systems of the body(1, 3).The effect of Covid-19 on pregnancy outcomes is not exactly specified(8).Due to changes in the immune and cardiorespiratory system during pregnancy, pregnant women and newborns may be more susceptibleand vulnerable to Covid-19infection(9). In the group of pregnant women under our investigation,in positive-covid-19 hospitalized pregnant women the average birth weight was lower. Furthermore,Preterm labor and cesarean section also were more in people with moderate and severe covid-19 infection(hospitalized and ICU-admitted covid-19 infected patients). Previous studies have also demonstrated that preterm labors were higher in COVID-19-infected women compared to non-infected women. (4) Some studies have also shown that in pregnant patients, the fetus’s oxygen supply can be affected by COVID-19 andmay lead to IUGR.(8)The studies that were conducted during the previous SARS and MERS pandemics on pregnancy showed an increased risk of IUGR.(5, 8, 11) . In the results of the present study, the percentage of IUGR is also significantly different inmoderate and severe covid-19 infection(hospitalized and subgroup ICU-admitted covid-19 infected patients) compared with non-covid- -19 women. Therefore, surveillance for IUGR in women with SARS-CoV-2 infection is recommended because IUGR is often observed in ongoing pregnancies with SARS-CoV-2. Preterm labor depends on various factors such as a history of previous preterm birth, multiple gestations, black race, and infection (12, 13).Any condition such as infections that can weaken the immune system can lead to preterm labor(12). As previous studies show, in the present study, the chance of preterm labor was higher in the COVID-19 group (14). New information about the maternal-fetal interface and the interactions between the maternal immune system and the placenta might explain these findings(12). Cesarean section(C/S) is associated with a higher risk of uterine rupture, ectopic pregnancy, abnormal placentation, stillbirth, and preterm labor. Also, thereisa higher rate of maternal mortality and morbidity and short-term and long-term negative effects on the life of the fetus in C/Sthan vaginal birth (15). The current study showed that cesarean section was more in the COVID-19 group and considering the many complications of the cesarean section that were mentioned, COVID-19 can also be troublesome in this regard.Apgar score of the fetus can be related to uteroplacental function, and because COVID-19 is a systemic and immunological disease, it can leave its inflammatory effects everywhere, including in the placenta and in the Uteroplacental unit. In this study, it was seen that COVID-19 has an effect on the Apgar score of the fetus and in this way it can have a negative effect. So finally, the fetus is affected by this inflammatory process, and covid - 19 can affect the pregnancy outcome by increasing the risk of IUGR,preterm labor, lower APGAR score,and cesarean section.This study revealed that pregnant women are more vulnerable to covid-19, and if there are new strains of covid in the future, special attention is necessary to protect pregnant women. Thelimitation of our study was the retrospective pattern of the study,Since the pandemic had subsided at the time of designing the study, we could not plan a prospective type of study. Conclusion In conclusion, the viral pandemic of COVID-19 affects pregnant women throughmore occurrence of IUGR (defined by less than 10 percentile), preterm labor, and cesarian section.Therefore,moreprecautionsduring pregnancy might be recommended to avoid SARS-2-Covid infections and probably new versions of it and even new viral pandemics. Declarations Conflict of Interest: The authors declare no conflict of interest a. Ethics approval and consent to participate This study was in accordance with the ethical issues for human subject research and confirmed by the Shahid Beheshti University of Medical Sciences by an ethical committee (IR.SBMU.RETECH.REC.1402.176) b. Consent for publication ok c. Availability of data and materials The datasets used and/or analysed during the current study available from the corresponding author on reasonable request. d. Competing interests 'Not applicable e. Funding 'Not applicable f. Authors' contributions Maliheh Arab : Supervision, Project administration Zanbagh Pirastehfar: Investigation, Data Curation Nasim Noori: Data Curation, Writing - Original Draft, Writing Sadaf Saket: Software, Validation, Formal analysis, Investigation Nafiseh Faghih: Writing - Review & Editing Behnaz Ghavami: Validation, Formal analysis, Writing References Prochaska E, Jang M, Burd I. COVID-19 in pregnancy: Placental and neonatal involvement. Am J Reprod Immunol. 2020;84(5):e13306. Khan M, Adil SF, Alkhathlan HZ, Tahir MN, Saif S, Khan M et al. COVID-19: A Global Challenge with Old History, Epidemiology and Progress So Far. Molecules. 2020;26(1). Mirbeyk M, Saghazadeh A, Rezaei N. A systematic review of pregnant women with COVID-19 and their neonates. Arch Gynecol Obstet. 2021;304(1):5–38. Zimmermann P, Curtis N. COVID-19 in Children, Pregnancy and Neonates: A Review of Epidemiologic and Clinical Features. Pediatr Infect Dis J. 2020;39(6):469–77. Sahu S, Laishram G, Rannaware A, Choudhari SG. Impact of COVID-19 on Pregnancy and Maternal-Neonatal Outcomes: A Narrative Review. Cureus. 2022;14(11):e31397. Di Mascio D, Khalil A, Saccone G, Rizzo G, Buca D, Liberati M, et al. Outcome of coronavirus spectrum infections (SARS, MERS, COVID-19) during pregnancy: a systematic review and meta-analysis. Am J Obstet Gynecol MFM. 2020;2(2):100107. Saleh Gargari S, Rahmati N, Fateh R, Khandani A, Nikfar S, Ghafouri-Fard S. Investigation of maternal and perinatal outcome in a population of Iranian pregnant women infected with COVID-19. Sci Rep. 2022;12(1):9815. Bahrami R, Schwartz DA, Karimi-Zarchi M, Javaheri A, Dastgheib SA, Ferdosian F, et al. Meta-analysis of the frequency of intrauterine growth restriction and preterm premature rupture of the membranes in pregnant women with COVID-19. Turk J Obstet Gynecol. 2021;18(3):236–44. Shree P, Mittal N, Vishwakarma S, Verma V, Pandey V, Thadani E. Maternal and Perinatal Outcomes of COVID-19-Positive Pregnant Women. Cureus. 2022;14(6):e26411. Darendeliler FIUGR. Genetic influences, metabolic problems, environmental associations/triggers, current and future management. Best Pract Res Clin Endocrinol Metab. 2019;33(3):101260. Cavalcante MB, Cavalcante C, Sarno M, Barini R, Kwak-Kim J. Maternal immune responses and obstetrical outcomes of pregnant women with COVID-19 and possible health risks of offspring. J Reprod Immunol. 2021;143:103250. Silasi M, Cardenas I, Kwon JY, Racicot K, Aldo P, Mor G. Viral infections during pregnancy. Am J Reprod Immunol. 2015;73(3):199–213. Pschirrer ER, Monga M. Risk factors for preterm labor. Clin Obstet Gynecol. 2000;43(4):727–34. Male V. SARS-CoV-2 infection and COVID-19 vaccination in pregnancy. Nat Rev Immunol. 2022;22(5):277–82. Sandall J, Tribe RM, Avery L, Mola G, Visser GH, Homer CS, et al. Short-term and long-term effects of caesarean section on the health of women and children. Lancet. 2018;392(10155):1349–57. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3967898","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":280948655,"identity":"e129acb5-5c8f-42d8-bb8e-224c633a3dd6","order_by":0,"name":"Maliheh Arab","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAxElEQVRIiWNgGAWjYDCCAxBSjkECKsBGrBZj0rUkNkjgV4cAfLdPJ36uqLmTPn92d5oEQ40dA5/0AfxaJM/lbpY8c+xZ7oY7Z7dJMBxLZmDjS8CvxeAM7wbJBrbDuRskcoFa2A4wsPEQcBhQy+afDf8Op8vPAGn5R5yWbZKNbYcTGG4AtTC2EaFFEqjFsrHvmSHQL5stEvuSeQhq4QM67GbDtzvy8rN7N9748M1OTr6HgBZUkMDAQMiOUTAKRsEoGAXEAAA1p0OtDoDxWwAAAABJRU5ErkJggg==","orcid":"","institution":"Shahid Beheshti University of Medical Sciences and Health Services","correspondingAuthor":true,"prefix":"","firstName":"Maliheh","middleName":"","lastName":"Arab","suffix":""},{"id":280948656,"identity":"c957c5ab-0ed2-4dc9-9091-8382fe266434","order_by":1,"name":"Zanbagh . 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MD","lastName":"Obstetri","suffix":"MD"}],"badges":[],"createdAt":"2024-02-18 20:14:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3967898/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3967898/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":62639043,"identity":"207223ed-9873-43b9-96af-7920233a9f55","added_by":"auto","created_at":"2024-08-16 18:07:27","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":420851,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3967898/v1/5b77e7f0-3f91-43e6-9174-8a7fd600185a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Intrauterine Growth Restriction and other pregnancy complications following covid-19 infection","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe first cases ofCOVID-19 pneumonia from a novel coronavirus appeared in Wuhan, China in December 2019 (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).The coronavirus disease (COVID-19) has spread rapidly worldwide as a result of infection with acute respiratory syndrome SARS-CoV-2.(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). The WHO reported this condition as an International Public Health Emergency (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). This disorder has also affected pregnant women and pregnancy outcomes.(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) Pregnancy is associated with immunological changes that may make women susceptible to COVID-19(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Despite the 2019 Covid-19 pandemic and extensive studies in this field, the impact of SARS-CoV-2 on the developing fetus is not completely clear.Physiological changes in the mother during pregnancy have a significant effect on the coagulation, immune, respiratory, and cardiovascular systems of the fetus and may have positive or negative effects on the course ofthe disease (COVID-19). Studies have shown that pregnant women may be vulnerable to the adverse effects of COVID-19(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Definitive evidence of Mother-to-child vertical transmission of SARS-CoV infection is not available in the available data, but some pregnancy complications such as premature birth, risk of miscarriage, intrauterine death, intrauterine growth restriction (IUGR),low birth weight, spontaneous abortion, and mortality have been reported through mothers with Covid-19(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Some studies have also shown that maternal covid-19 can affect fetal oxygen supply and lead to placental insufficiency, IUGR, or fetal death(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).Children with IUGR are at greater risk for long-term problems such as short stature, metabolic syndrome, type 2 diabetes, insulin resistance, and cardiovascular diseases(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Studies also show that these children may have puberty disorders, reproductive function,and adrenal secretion disorders. During pregnancy, several viral infections are known to increase the risk of fetal malformations, including IUGR, without significant long-term effects on the health of the offspring(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Considering the long-term effects of IUGR on a person's life Infected during the fetal period and the lack of sufficient information regarding the relationship between COVID-19 and IUGR in the studies, the present study was conducted to clarify the uncertainties in this field.\u003c/p\u003e"},{"header":"Materials and method","content":"\u003cp\u003eThe study is a historical cohort and was conducted under the supervision of the Obstetrics and Gynecology Department of Imam Hossein Hospital in Tehran, Iran including pregnant cases who visited for labor pain between 2019 and 2021 during the COVID-19 pandemic.\u0026nbsp;Since the study was conducted in a university hospital, an informed consent form was obtained from all patients for the use of information. Patients with intrauterine growth restriction risk factors such as addiction, chronic hypertension, and other systemic diseases, including pre-eclampsia were excluded from the study. Those with a history of mild Covid-19 infection who didn\u0026rsquo;t need to be hospitalized (mild cases) were excluded from the study. Age, height, weight, BMI, type of delivery, gravid, para, live children, gestational age, date of delivery, alcohol use, cocaine use, addiction, chronic blood pressure, preeclampsia, diabetes, lupus, Chronic kidney disease, epilepsy, drug history, history of IUGR, previous birth weight, multiple pregnancy, definite anomaly, APGAR score, history of infection with Covid-19 followed by hospitalization, and/or hospitalization in ICU, symptoms of cough, fever, weakness, shortness of breath, and taking Remdesivir in positive history cases were extracted from the patients documented data in each group and was entered in the questionnaire for each patient. We defined moderate disease as\u0026nbsp;hospitalized cases and severe cases as subgroup of ICU-admitted covid-19 infected patients. We comparedCOVID-19-positive hospitalized patients(moderate) and the subgroup of COVID-19-positiveICU-admitted(severe) patients with those who had no history of Covid-19 infection regarding IUGR. IUGR criterion was considered less than the 10\u003csup\u003eth\u003c/sup\u003e percentile birth weight of newborns.\u003c/p\u003e\n\u003cp\u003eThis study was in accordance with the ethical issues for human subject research and confirmed by the Shahid Beheshti University of Medical Sciences\u0026nbsp;by an ethical committee\u003cstrong\u003e\u0026nbsp;(IR.SBMU.RETECH.REC.1402.176)\u003c/strong\u003e. Informed consent was obtained from all subjects.\u0026nbsp;The datasets used and/or analysed during the current study available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003econsent for publication:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003enot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were analyzed with Software Package for the Social Sciences (SPSS, version 19.0). After checking the normality of continuous variables, an independent t-test was used to compare continuous variables Chi-square test or Fisher exact test was used to compare dichotomous variables Binary logistic regression analysis was done to detect independent predictors of IUGR. The significant level was set at 0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eAmong 1010 pregnant women who entered the study, 43 (4.3%) were moderate or severe and hospitalized due to Covid-19 (COVID-19 group).In these cases,the cough was the most frequent symptom (72.1%) followed by fever (65.1%), weakness (63.4%), and dyspnea (62.8%). Two groups (moderate to severe COVID-19 cases versus non-COVID-19 subjects) were not significantly different in terms of gestational diabetes (28.6% versus 26.3%), preeclampsia (2.3% versus 4.3%), and chronic hypertension (7.0% versus 6.1%), respectively, P \u0026gt; 0.1. No one in the COVID-19 group had diseases of SLE, chronic renal disease, and epilepsy. Three (0.3%) subjects from the non-COVID-19 group had SLE, 8 (0.8%) had chronic renal disease, and 11 (1.1%) had epilepsy, P \u0026gt; 0.1. In the COVID-19 group, 2.3% were smokers, 2.3% had an addiction, and no one used alcohol or cocaine. The frequency rate of smoking, alcohol use, cocaine use, and addiction was 1.4%, 0.3%, 0.5%, and 2.8% in the non-COVID-19 group, respectively (P \u0026gt; 0.1). Only two women in the non-COVID-19 group were on warfarin, 2 had a history of IUGR, and 5 had multiple pregnancies.\u003c/p\u003e\n\u003cp\u003eTwenty-eight out of 43 cases (65.1%) of the COVID-19 group were admitted to the ICU. The median (range) of hospitalization days was 5 (1\u0026ndash;20) and ICU days were 5 (1\u0026ndash;38). COVID-19 and non-COVID-19 groups were compared.subgroup comparison of the COVID-19 ICU-admitted cases with non-COVID-19 cases isdone, as well. Both COVID-19 and COVID-19 ICU admitted subgroups were older than the COVID-19 group, P \u0026lt; 0.05.\u003c/p\u003e\n\u003cp\u003eNeonates of the COVID-19, ICU-admitted subgroup of severe cases had significantly lower birth weights in comparison to the\u0026nbsp;non-COVID-19\u0026nbsp;cases. IUGR(less than 10 percentile rate adjusted by gestational age ) was more frequent in the COVID-19 group (16.3%) and ICU-admitted subgroup of severe cases(21.4%) than in the\u0026nbsp;non-COVID-19\u0026nbsp;group (6.9%).The mean gestational age at delivery was significantly lower in moderate COVID-19 (35.0 +/- 4.5) and ICU-admitted COVID-19 subgroup (33.4 +/- 4.7) in comparison with the non-COVID-19 cases (38.0 +/- 2.6), P \u0026lt; 0.001. Preterm labor rate was 51.2% and 71.4% in the COVID-19 group and ICU admitted subgroup, which was significantly higher than non- COVID-19 group (19.9%), P \u0026lt; 0.001.less than 7 Apgar score at 5 min and less than 9 in 10 min rate were16.3% in the COVID-19 group and 25% in the ICU admitted subgroup, which was significantly higher than non- COVID-19 group (3.3-3.7%).The Cesarean section rate\u0026nbsp;was\u0026nbsp;75.0% in the\u0026nbsp;COVID-19, 84.6% in the ICU admitted subgroup of severe cases versus 55.3% in the non-COVID-19 group, P = 0.014 and P = 0.003, respectively(Table 1).\u003c/p\u003e\n\u003cp\u003eTable 1: \u0026nbsp;Comparison of maternal and obstetric characteristics in the non-COVID-19 group with the COVID-19 group and with the subgroup of severe COVID-19 ICU admitted cases.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"559\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.792486583184257%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.246869409660107%\"\u003e\n \u003cp\u003eNon - COVID-19 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;(n=967)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.100178890876567%\"\u003e\n \u003cp\u003eCOVID-19 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;(n=43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.847942754919499%\"\u003e\n \u003cp\u003eP\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.059033989266547%\"\u003e\n \u003cp\u003eCOVID-19 ICU admitted \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;(n=28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.953488372093023%\"\u003e\n \u003cp\u003eP\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.792486583184257%\"\u003e\n \u003cp\u003eMaternal age (year)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.246869409660107%\"\u003e\n \u003cp\u003e29.2 (\u003cu\u003e+\u003c/u\u003e 6.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.100178890876567%\"\u003e\n \u003cp\u003e31.5 (\u003cu\u003e+\u003c/u\u003e 5.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.847942754919499%\"\u003e\n \u003cp\u003e0.020\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.059033989266547%\"\u003e\n \u003cp\u003e31.8 (\u003cu\u003e+\u003c/u\u003e 5.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.953488372093023%\"\u003e\n \u003cp\u003e0.034\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.792486583184257%\"\u003e\n \u003cp\u003eBMI\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.246869409660107%\"\u003e\n \u003cp\u003e29.5 (\u003cu\u003e+\u003c/u\u003e 5.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.100178890876567%\"\u003e\n \u003cp\u003e30.0 (\u003cu\u003e+\u003c/u\u003e 4.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.847942754919499%\"\u003e\n \u003cp\u003e0.592\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.059033989266547%\"\u003e\n \u003cp\u003e30.8 (\u003cu\u003e+\u003c/u\u003e 5.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.953488372093023%\"\u003e\n \u003cp\u003e0.216\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.792486583184257%\"\u003e\n \u003cp\u003eNuliparous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.246869409660107%\"\u003e\n \u003cp\u003e317 (32.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.100178890876567%\"\u003e\n \u003cp\u003e11 (25.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.847942754919499%\"\u003e\n \u003cp\u003e0.322\u003csup\u003eҳ\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.059033989266547%\"\u003e\n \u003cp\u003e7 (25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.953488372093023%\"\u003e\n \u003cp\u003e0.384\u003csup\u003eҳ\u0026nbsp;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.792486583184257%\"\u003e\n \u003cp\u003ePrevious birth weight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.246869409660107%\"\u003e\n \u003cp\u003e3160.3 (\u003cu\u003e+\u003c/u\u003e 549.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.100178890876567%\"\u003e\n \u003cp\u003e3095.4 (\u003cu\u003e+\u003c/u\u003e 495.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.847942754919499%\"\u003e\n \u003cp\u003e0.570\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.059033989266547%\"\u003e\n \u003cp\u003e3076.9 (\u003cu\u003e+\u003c/u\u003e 501.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.953488372093023%\"\u003e\n \u003cp\u003e0.588\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.792486583184257%\"\u003e\n \u003cp\u003egestational wk. at delivery\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.246869409660107%\"\u003e\n \u003cp\u003e38.0 (\u003cu\u003e+\u003c/u\u003e 2.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.100178890876567%\"\u003e\n \u003cp\u003e35.0 (\u003cu\u003e+\u003c/u\u003e 4.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.847942754919499%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003csup\u003e\u0026dagger;\u0026dagger;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.059033989266547%\"\u003e\n \u003cp\u003e33.4 (\u003cu\u003e+\u003c/u\u003e 4.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.953488372093023%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003csup\u003e\u0026dagger;\u0026dagger;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.792486583184257%\"\u003e\n \u003cp\u003ePreterm labor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.246869409660107%\"\u003e\n \u003cp\u003e192 (19.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.100178890876567%\"\u003e\n \u003cp\u003e22 (51.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.847942754919499%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003csup\u003e\u0026nbsp;ҳ\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.059033989266547%\"\u003e\n \u003cp\u003e20 (71.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.953488372093023%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003csup\u003e\u0026nbsp;ҳ\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.792486583184257%\"\u003e\n \u003cp\u003eApgar score at 5 min \u0026lt;7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.246869409660107%\"\u003e\n \u003cp\u003e36 (3.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.100178890876567%\"\u003e\n \u003cp\u003e7 (16.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.847942754919499%\"\u003e\n \u003cp\u003e0.002\u003csup\u003e\u0026nbsp;ҳҳ\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.059033989266547%\"\u003e\n \u003cp\u003e7 (25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.953488372093023%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003csup\u003e\u0026nbsp;ҳҳ\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.792486583184257%\"\u003e\n \u003cp\u003eApgar score at 10 min \u0026lt;9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.246869409660107%\"\u003e\n \u003cp\u003e32 (3.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.100178890876567%\"\u003e\n \u003cp\u003e7 (16.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.847942754919499%\"\u003e\n \u003cp\u003e0.001\u003csup\u003e\u0026nbsp;ҳҳ\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.059033989266547%\"\u003e\n \u003cp\u003e7 (25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.953488372093023%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003csup\u003e\u0026nbsp;ҳҳ\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.792486583184257%\"\u003e\n \u003cp\u003eBirth weight (gram)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.246869409660107%\"\u003e\n \u003cp\u003e3076.5 (\u003cu\u003e+\u003c/u\u003e 636.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.100178890876567%\"\u003e\n \u003cp\u003e2441.4 (\u003cu\u003e+\u003c/u\u003e 495.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.847942754919499%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003csup\u003e\u0026dagger;\u0026dagger;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.059033989266547%\"\u003e\n \u003cp\u003e2191.3 (\u003cu\u003e+\u003c/u\u003e 937.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.953488372093023%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003csup\u003e\u0026dagger;\u0026dagger;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.792486583184257%\"\u003e\n \u003cp\u003eIUGR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.246869409660107%\"\u003e\n \u003cp\u003e67 (6.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.100178890876567%\"\u003e\n \u003cp\u003e7 (16.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.847942754919499%\"\u003e\n \u003cp\u003e0.032\u003csup\u003e\u0026nbsp;ҳҳ\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.059033989266547%\"\u003e\n \u003cp\u003e6 (21.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.953488372093023%\"\u003e\n \u003cp\u003e0.013\u003csup\u003e\u0026nbsp;ҳҳ\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.792486583184257%\"\u003e\n \u003cp\u003eC/S\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.246869409660107%\"\u003e\n \u003cp\u003e488 (55.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.100178890876567%\"\u003e\n \u003cp\u003e30 (75.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.847942754919499%\"\u003e\n \u003cp\u003e0.014\u003csup\u003e\u0026nbsp;ҳ\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.059033989266547%\"\u003e\n \u003cp\u003e22 (84.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.953488372093023%\"\u003e\n \u003cp\u003e0.003\u003csup\u003e\u0026nbsp;ҳ\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eData are shown as mean (\u003cu\u003e+\u003c/u\u003e SD) or frequency (%). GDM: Gestational Diabetes Mellitus, BMI: Body Mass Index, IUGR: Intra Uterine Growth Retardation, C/S: Cesarean /Section, * Versus Non-COVID-19. \u003csup\u003e\u0026dagger;\u0026nbsp;\u003c/sup\u003ebased on independent-samples t test, Levene\u0026apos;s Test for Equality of Variances, P\u0026gt;0.05, Equal variances assumed. \u003csup\u003e\u0026dagger;\u0026dagger;\u0026nbsp;\u003c/sup\u003ebased on independent-samples t test, Levene\u0026apos;s Test for Equality of Variances, P\u0026lt;0.05, Equal variances not assumed. \u003csup\u003eҳ\u0026nbsp;\u003c/sup\u003eChi-Square Test, \u003csup\u003eҳҳ\u003c/sup\u003e Fisher\u0026apos;s Exact Test\u003c/p\u003e\n\u003cp\u003eIn the binary logistic regression analysis, the chance of IUGR in the COVID-19 group was 2.6 times(95% CI: 1.1\u0026ndash;6.1),and in the ICU-admitted subgroup was 3.7 times (95% CI: 1.4\u0026ndash;9.3) more than in the non-COVID-19 group (table 2).Also, the chance of preterm labor in the COVID-19 group was 4.2 times(95% CI: 2.3 \u0026ndash; 7.9),and in the ICU-admitted subgroup was 10.1 times (95% CI: 4.4 \u0026ndash; 23.3) more than in the non-COVID-19 group (table 3).\u003c/p\u003e\n\u003cp\u003eTable 2: The odds ratio (95%CI) of IUGR in binary logistic regression analysis\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"462\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"49.35064935064935%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"33.76623376623377%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOdds Ratio (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.883116883116884%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePV\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"49.35064935064935%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003enon COVID 19\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.76623376623377%\" valign=\"top\"\u003e\n \u003cp\u003ereference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.883116883116884%\" valign=\"top\"\u003e\n \u003cp\u003e0.026\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"49.35064935064935%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCOVID 19\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.76623376623377%\" valign=\"top\"\u003e\n \u003cp\u003e2.6 (1.1 \u0026ndash; 6.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.883116883116884%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"49.35064935064935%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003enon COVID 19\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.76623376623377%\" valign=\"top\"\u003e\n \u003cp\u003ereference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.883116883116884%\" valign=\"top\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"49.35064935064935%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eICU admitted COVID 19\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.76623376623377%\" valign=\"top\"\u003e\n \u003cp\u003e3.7 ( 1.4 \u0026ndash; 9.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.883116883116884%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eCI: Confidence Interval, ICU: Intensive Care Unite\u003c/p\u003e\n\u003cp\u003eTable 3: The odds ratio (95%CI) of preterm labor in binary logistic regression analysis\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"486\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.91358024691358%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOdds Ratio\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;(95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.753086419753085%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePV\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.91358024691358%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003enon COVID 19\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003ereference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.753086419753085%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.91358024691358%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCOVID 19\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e4.2 (2.3 \u0026ndash; 7.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.753086419753085%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.91358024691358%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003enon COVID 19\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003ereference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.753086419753085%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.91358024691358%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eICU admitted COVID 19\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e10.1 ( 4.4 \u0026ndash; 23.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.753086419753085%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eCI: Confidence Interval, ICU: Intensive Care Unite\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eSARS-CoV-2 infection is an inflammatory process that is presented with proinflammatory changes such as increased Th2 cell-associated cytokinesand the increase of IgG and IgA has been observed about 2 weeks after infection with human coronaviruswhich affects multiple organs and the systems of the body(1, 3).The effect of Covid-19 on pregnancy outcomes is not exactly specified(8).Due to changes in the immune and cardiorespiratory system during pregnancy, pregnant women and newborns may be more susceptibleand vulnerable to Covid-19infection(9).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn the group of pregnant women under our investigation,in positive-covid-19 hospitalized pregnant women the average birth weight was lower. Furthermore,Preterm labor and\u003cspan dir=\"RTL\"\u003ecesarean\u003c/span\u003e section also were more in people with moderate and severe covid-19 infection(hospitalized and ICU-admitted covid-19 infected patients). Previous studies\u0026nbsp;\u003cspan dir=\"RTL\"\u003ehave\u003c/span\u003ealso demonstrated that preterm labors were higher in COVID-19-infected women compared\u0026nbsp;\u003cspan dir=\"RTL\"\u003eto\u003c/span\u003enon-infected women.\u0026nbsp;(4)\u003c/p\u003e\n\u003cp\u003eSome studies\u0026nbsp;\u003cspan dir=\"RTL\"\u003ehave\u003c/span\u003e also\u0026nbsp;\u003cspan dir=\"RTL\"\u003eshown\u003c/span\u003e that in pregnant patients, the fetus\u0026rsquo;s oxygen supply can be affected by COVID-19 andmay lead to IUGR.(8)The studies that were conducted during the previous SARS and MERS pandemics on pregnancy showed an increased risk of IUGR.(5, 8, 11)\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003eIn the results of the present study, the percentage of IUGR is also significantly different inmoderate and severe covid-19 infection(hospitalized and subgroup ICU-admitted covid-19 infected patients) compared with\u0026nbsp;\u003cspan dir=\"RTL\"\u003enon-covid-\u003c/span\u003e-19 women.\u0026nbsp;Therefore, surveillance for IUGR in women with SARS-CoV-2 infection is recommended because IUGR is often observed in ongoing pregnancies with SARS-CoV-2.\u003c/p\u003e\n\u003cp\u003ePreterm labor depends on various factors such as a history of previous preterm birth, multiple gestations, black race, and infection\u0026nbsp;(12, 13).Any condition such as infections that can weaken the immune system can lead to preterm labor(12). As previous studies show, in the present study, the chance of preterm labor was higher in the COVID-19 group\u0026nbsp;(14). New information about the maternal-fetal interface and the interactions between the maternal immune system and the placenta might explain these findings(12).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCesarean section(C/S) is associated with a higher risk of uterine rupture, ectopic pregnancy, abnormal placentation, stillbirth, and preterm labor. Also, thereisa higher rate of maternal mortality and morbidity and short-term and long-term negative effects on the life of the fetus in C/Sthan vaginal birth\u0026nbsp;(15). The current study showed that cesarean section was more in the COVID-19 group and considering the many complications of the cesarean section that were mentioned, COVID-19 can also be troublesome in this regard.Apgar score of the fetus can be related to uteroplacental function, and because COVID-19 is a systemic and immunological disease, it can leave its inflammatory effects everywhere, including in the placenta and in the Uteroplacental unit. In this study, it was seen that COVID-19 has an effect on the Apgar score of the fetus and in this way it can have a negative effect.\u003c/p\u003e\n\u003cp\u003eSo finally, the fetus is affected by this inflammatory process, and covid\u003cspan dir=\"RTL\"\u003e-\u003c/span\u003e19 can affect the pregnancy outcome\u0026nbsp;\u003cspan dir=\"RTL\"\u003eby\u003c/span\u003e increasing the risk of IUGR,preterm labor, lower APGAR score,and\u0026nbsp;\u003cspan dir=\"RTL\"\u003ecesarean\u003c/span\u003e section.This study revealed that pregnant women are more vulnerable to covid-19, and if there are new strains of covid in the future, special attention is necessary to protect pregnant women.\u003c/p\u003e\n\u003cp\u003eThelimitation of our study was the retrospective pattern of the study,Since the pandemic had subsided at the time of designing the study, we could not plan a prospective type of study.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, the viral pandemic of COVID-19 affects pregnant women throughmore occurrence of IUGR (defined by less than 10 percentile), preterm labor, and cesarian section.Therefore,moreprecautionsduring pregnancy might be recommended to avoid SARS-2-Covid infections and probably new versions of it and even new viral pandemics.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConflict of Interest:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflict of interest\u003c/p\u003e\n\u003cp\u003ea. Ethics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eThis study was in accordance with the ethical issues for human subject research and confirmed by the Shahid Beheshti University of Medical Sciences by an ethical committee (IR.SBMU.RETECH.REC.1402.176)\u003c/p\u003e\n\u003cp\u003eb. Consent for publication\u003c/p\u003e\n\u003cp\u003eok\u003c/p\u003e\n\u003cp\u003ec. Availability of data and materials\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003ed. Competing interests\u003c/p\u003e\n\u003cp\u003e\u0026apos;Not applicable\u003c/p\u003e\n\u003cp\u003ee. Funding\u003c/p\u003e\n\u003cp\u003e\u0026apos;Not applicable\u003c/p\u003e\n\u003cp\u003ef. Authors\u0026apos; contributions\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003e\u003cu\u003eMaliheh Arab :\u0026nbsp;\u003c/u\u003e\u003cstrong\u003eSupervision, Project administration\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003e\u003cu\u003eZanbagh Pirastehfar:\u0026nbsp;\u003c/u\u003e\u003cstrong\u003eInvestigation, Data Curation\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003e\u003cu\u003eNasim Noori:\u0026nbsp;\u003c/u\u003e\u003cstrong\u003eData Curation, Writing - Original Draft, Writing\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003e\u003cu\u003eSadaf Saket:\u0026nbsp;\u003c/u\u003e\u003cstrong\u003eSoftware, Validation, Formal analysis, Investigation\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003e\u003cu\u003eNafiseh Faghih: \u0026nbsp;\u003c/u\u003e\u003cstrong\u003eWriting - Review \u0026amp; Editing\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003eBehnaz Ghavami: \u003cstrong\u003eValidation, Formal analysis, Writing\u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eProchaska E, Jang M, Burd I. COVID-19 in pregnancy: Placental and neonatal involvement. Am J Reprod Immunol. 2020;84(5):e13306.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhan M, Adil SF, Alkhathlan HZ, Tahir MN, Saif S, Khan M et al. COVID-19: A Global Challenge with Old History, Epidemiology and Progress So Far. Molecules. 2020;26(1).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMirbeyk M, Saghazadeh A, Rezaei N. A systematic review of pregnant women with COVID-19 and their neonates. Arch Gynecol Obstet. 2021;304(1):5\u0026ndash;38.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZimmermann P, Curtis N. COVID-19 in Children, Pregnancy and Neonates: A Review of Epidemiologic and Clinical Features. Pediatr Infect Dis J. 2020;39(6):469\u0026ndash;77.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSahu S, Laishram G, Rannaware A, Choudhari SG. Impact of COVID-19 on Pregnancy and Maternal-Neonatal Outcomes: A Narrative Review. Cureus. 2022;14(11):e31397.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDi Mascio D, Khalil A, Saccone G, Rizzo G, Buca D, Liberati M, et al. Outcome of coronavirus spectrum infections (SARS, MERS, COVID-19) during pregnancy: a systematic review and meta-analysis. Am J Obstet Gynecol MFM. 2020;2(2):100107.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSaleh Gargari S, Rahmati N, Fateh R, Khandani A, Nikfar S, Ghafouri-Fard S. Investigation of maternal and perinatal outcome in a population of Iranian pregnant women infected with COVID-19. Sci Rep. 2022;12(1):9815.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBahrami R, Schwartz DA, Karimi-Zarchi M, Javaheri A, Dastgheib SA, Ferdosian F, et al. Meta-analysis of the frequency of intrauterine growth restriction and preterm premature rupture of the membranes in pregnant women with COVID-19. Turk J Obstet Gynecol. 2021;18(3):236\u0026ndash;44.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShree P, Mittal N, Vishwakarma S, Verma V, Pandey V, Thadani E. Maternal and Perinatal Outcomes of COVID-19-Positive Pregnant Women. Cureus. 2022;14(6):e26411.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDarendeliler FIUGR. Genetic influences, metabolic problems, environmental associations/triggers, current and future management. Best Pract Res Clin Endocrinol Metab. 2019;33(3):101260.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCavalcante MB, Cavalcante C, Sarno M, Barini R, Kwak-Kim J. Maternal immune responses and obstetrical outcomes of pregnant women with COVID-19 and possible health risks of offspring. J Reprod Immunol. 2021;143:103250.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSilasi M, Cardenas I, Kwon JY, Racicot K, Aldo P, Mor G. Viral infections during pregnancy. Am J Reprod Immunol. 2015;73(3):199\u0026ndash;213.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePschirrer ER, Monga M. Risk factors for preterm labor. Clin Obstet Gynecol. 2000;43(4):727\u0026ndash;34.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMale V. SARS-CoV-2 infection and COVID-19 vaccination in pregnancy. Nat Rev Immunol. 2022;22(5):277\u0026ndash;82.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSandall J, Tribe RM, Avery L, Mola G, Visser GH, Homer CS, et al. Short-term and long-term effects of caesarean section on the health of women and children. Lancet. 2018;392(10155):1349\u0026ndash;57.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"COVID-19, growth restriction, preterm, pregnancy","lastPublishedDoi":"10.21203/rs.3.rs-3967898/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3967898/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe WHO, reported world widespread coronavirus disease (COVID-19) as an international public health emergency. Pregnancy is associated with immunological changes that may make women susceptible to COVID-19. The present study was conducted to clarify the impacts of the pandemic on intra uterine growth restriction (IUGR) and other complications of pregnancy.\u003c/p\u003e\u003ch2\u003eMaterial \u0026amp; methods\u003c/h2\u003e \u003cp\u003eIn a historical cohort study, COVID-19-positive cases who were hospitalized and a subgroup of Intensive Care Unit (ICU)-admitted (severe) cases were compared with those who had no history of COVID-19 infection, regarding IUGR and other complications of pregnancy.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAmong 1010 pregnant women enrolled in the study, 43 (4.3%) had a history of hospitalization due to COVID-19 (including 28 ICU-admitted severe cases) through pregnancy and the other 967 cases who had no history of infection were compared. In the comparison of COVID-19 with non-COVID-19 groups, IUGR, and preterm laborwere more frequent in the COVID-19 group(16.3% versus 6.9%) and (51.2% versus 19.9%), respectively. Also, the cesarean section rate was higher (75% versus 55.3%) and the low APGAR score was more frequent (16.3% versus 3.3\u0026ndash;3.7%)\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eComplications of COVID-19 infection in pregnancy such as IUGR, preterm labor, higher rate of cesarean section,and low APGAR score might make pregnant women more vulnerable to the COVID-19 pandemic and probable future versions of viral pandemics.\u003c/p\u003e","manuscriptTitle":"Intrauterine Growth Restriction and other pregnancy complications following covid-19 infection","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-20 08:43:50","doi":"10.21203/rs.3.rs-3967898/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e86739ab-c192-40a3-83db-279d6af8ba46","owner":[],"postedDate":"March 20th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-08-16T17:59:21+00:00","versionOfRecord":[],"versionCreatedAt":"2024-03-20 08:43:50","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3967898","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3967898","identity":"rs-3967898","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}