COVID-19 PANDEMIC EFFECT ON EARLY PREGNANCY – ARE MISCARRIAGE RATES ALTERED, IN ASYMPTOMATIC WOMEN?

Olshinka K; Volodarsky-Perel A; Steiner N; Rubenfeld E; Dahan M

COVID-19 PANDEMIC EFFECT ON EARLY PREGNANCY – ARE MISCARRIAGE RATES ALTERED, IN ASYMPTOMATIC WOMEN?

Olshinka K, Volodarsky-Perel A, Steiner N, Rubenfeld E, Dahan M

Fertility and sterility · 2020 · PMC7548728

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A retrospective cohort study found no significant difference in first-trimester miscarriage or viable pregnancy rates between asymptomatic women during the COVID-19 pandemic lockdown and a pre-pandemic control group.

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This retrospective cohort study evaluated whether the COVID-19 pandemic environment influenced early first-trimester pregnancy outcomes in asymptomatic women attending a university fertility center. Researchers compared viability scans from March to May 2020 against a pre-pandemic control group from the same period, adjusting for confounders such as age and fertility diagnosis. The analysis revealed no significant differences in viable clinical pregnancy rates, miscarriage frequencies, or ectopic pregnancy occurrences between the two cohorts. While baseline TSH levels differed slightly, they remained within normal ranges, and the authors noted that higher donor sperm use in the control group may have favored lower miscarriage rates there. This paper is centrally about endometriosis — specifically listed as one of the infertility diagnoses among participants, though the study's primary focus remains on pandemic effects rather than endometriosis pathology itself.

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Design

Retrospective cohort study conducted in a University fertility center.

Results

113 women were scanned in the study, and 172 in the control periods (5-11 weeks gestational age). The groups had similar demographics, gestational history, fertility diagnosis and treatment characteristics (Table). No significant differences were noted in the rate of recurrent pregnancy loss (RPL). Viable clinical pregnancy rates were not different between the groups (76.1% vs. 80.2% in the pandemic and pre-pandemic groups p= 0.41). No significant difference was seen in number of 1 st trimester miscarriage (14.2% vs 12.8% p=0.76), biochemical pregnancies (3.5% vs 1.7% p=0.34), or in total miscarriage rate (22.1% vs 16.9% p=0.32), nor in EP rates (0.9% vs 2.3% p=0.36) Mean serum TSH levels were higher in the control but fell in the normal range for both groups. Use of donor sperm was higher in the control and may have favored lower miscarriage rates in that group.

Materials

All 1 ST trimester viability scans done since the COVID-19 shut down, March13-May 6, 2020 (Study group), and between March 1-May 17, 2019 (pre-pandemic Control), were reviewed. Early 1 st trimester pregnancy outcomes (Viable pregnancy, Arrested pregnancy including biochemical pregnancy loss and miscarriage, and ectopic pregnancy (EP)) were measured. A multivariate analysis was performed to control for significant confounders. Power analysis revealed that a sample size of 58 patients per group has a 90% power with a 15% difference in outcomes and α=5%. The study group denied symptoms of COVID-19.

Objective

To evaluate the effect of the COVID-19 pandemic state on early, 1 st trimester pregnancies, in light of a link described between war-induced stress and adverse pregnancy outcomes.

Conclusions

The COVID-19 pandemic environment does not seem to affect early first-trimester miscarriage rates in asymptomatic patients. Characteristic Study(n=113) Pre-pandemic Control (n=172) P -value Female Age, Years, mean±SD 36.5 ± 4.5 37.2 ± 5.4 0.28 RPL History, N(%) 15 (13.3) 15 (8.7) 0.22 Fertility diagnosis, N(%) Unexplained 24 (21.4) 32 (19.6) 0.21 Male Factor 36 (32.1) 58 (35.6) Tubal factor 5 (4.5) 11 (6.8) Polycystic ovarian syndrome 21 (18.8) 25 (15.3) Decreased ovarian reserve 23 (20.5) 20 (12.3) Endometriosis 1 (0.9) 4 (2.5) Base line testing, median(IQR) AMH ng/ml 2.5 (1.0 – 4.4) 2.5 (1.2 – 5.4) 0.75 TSH mIU/L 1.3 (0.9 – 1.8) 1.7 (1.2 – 2.3) 0.001 Antral follicular count (AFC) 16 (9 – 29) 14 (9 – 25) 0.27 Total motile sperm count, median(IQR) 18 (6 – 43) 12 (5 – 47) 0.23 Sperm donation, N (%) 2 (1.8) 17 (9.9) 0.01 Pregnancy, N (%) Spontaneous 34 (30.1) 54 (31.4) 0.97 IUI 34 (30.1) 51 (29.7) IVF 45 (39.8) 67 (38.9) ICSI (percentage of IVF patients) 31 (79.5) 52 (77.6) 0.82 Blastocyst transferred 39 (86.7) 56 (83.6) 0.65

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