Objective To identify risk factors for and outcomes after SARS-CoV-2 infection and severe COVID-19 in pregnancy Design Prospective population-based cohort study Setting Denmark Population All pregnancies between 1 March and 31 October 2020 Methods Using data from the Danish National Patient Register and Danish Microbiology Database and prospectively registered data from medical records, we compared women with a positive SARS-CoV-2 test during pregnancy to non-infected pregnant women. Severe infection was defined as hospital admission due to COVID-19. Main Outcome Measures Pregnancy, delivery, maternal, and neonatal outcomes. Results Among 82,682 pregnancies, 418 women had SARS-CoV-2 infection during pregnancy, corresponding to an incidence of 5.1 per 1000 pregnancies, 23 (5.5%) of which required hospital admission due to COVID-19. Risk factors for infection were asthma (OR 2.19 [1.41–3.41]) and being foreign born (OR 2.12 [1.70–2.64]). Risk factors for hospital admission due to COVID-19 included obesity (OR 2.74 [1.00–7.51]), smoking (OR 4.69 [1.58–13.90]), infection after gestational age in weeks (GA) 22 (GA 22–27: OR 3.77 [1.16–12.29]; GA 28–36: OR 4.76 [1.60–14.12]) and having asthma (OR 4.53 [1.39–14.79]). We found no difference in any obstetric or neonatal outcomes. Conclusions Severe outcomes of SARS-CoV-2 infection in pregnancy are rare. Funding The Danish Ministry of Higher Education and Science (Reg. 0237-00007B) and The Region of Southern Denmark and Region Zealand’s shared fund for joint health research projects (Reg. A767) Keywords Severe acute respiratory syndrome coronavirus 2; COVID-19; Obstetric delivery; Pregnancy complications; Pregnancy outcome; Cohort studies; Prospective studies.

Objective: To investigate programming effects of maternal testosterone on offspring birth anthropometrics. Design: Population-based prospective cohort study. Setting: University Hospital. Population: 1,486 mother-child dyads from Odense Child Cohort. Methods: Maternal blood samples were collected at gestational week 27-30 and free testosterone (FT) levels were calculated using the Vermeulen equation from total testosterone (TT) analyzed by mass spectrometry and sex hormone binding globulin (SHBG). Associations between FT or TT levels and birth anthropometrics were analyzed with multiple linear regression models according to offspring sex with adjustment for maternal age, parity, smoking and educational level. Analyses were repeated with polycystic ovary syndrome (PCOS) as exposure for offspring birth anthropometrics. Main outcome measures: Offspring birth weight (BW), birth length, abdominal- and head circumferences. Results: Maternal mean (SD) age was 30.2 (4.5) years and pre-pregnancy body mass index (BMI) was 23.5 (5.3) kg/m2. In boys (n=787), higher FT was associated with lower BW (adjusted doubling constant=-65.53, p=0.010), shorter birth length (adjusted doubling constant=-0.43, p<0.001), and lower abdominal circumference (adjusted doubling constant=-0.39, p<0.001); Higher TT was associated with lower abdominal circumference (adjusted doubling constant=-0.25, p=0.028). In girls, no associations were found between maternal FT or TT and offspring anthropometrics. Conclusions: Higher maternal free testosterone exposure was linked to reduced birth weight, length and abdominal circumference in boys, whereas girls were not susceptible to maternal testosterone exposure.

Objective: Midwives in Greenland observe that people give birth faster, with fewer complications tentatively due to early maternal expulsive efforts in second stage. Our aim was to quantify these observations and potential geographical differences. Design: Bicentre observational prospective cohort study. Method: Between October and December 2020, 50 participants in labour in Aabenraa (Denmark) and Nuuk (Greenland) participated. Transperineal head-perineum distance was measured with a handheld ultrasound scanner. Negative binomial regression was used to calculate incidence rate ratio. Fetomaternal outcome was recorded and compared Results: The median duration of maternal expulsive efforts was 23 minutes in Denmark compared to 10 minutes in Greenland (p=0.046). This was adjusted for parity, epidural use and gestational age. In Denmark 22 % and in Greenland 81 % started maternal expulsive efforts before the fetal head was at the pelvic floor (p-value< 0.001). Conclusion: Although the duration of maternal expulsive efforts and head-perineum distance was significantly different in the univariate analysis, in the multivariate analysis this was not affected by ethnicity. There was no significant difference in bleeding, perineal tears, or Apgar scores. There is a tendency of a shorter duration of maternal expulsive efforts in the active phase of the second stage of labour distance in Greenland compared to practice in Denmark. However, it seems that epidural and parity could be the main confounders to explain the difference between the two groups, but this needs further investigation.