Reproductive sequelae of parental severe illness before the pandemic: implications for the COVID-19 pandemic

Using data from 2007 to 2016, this analysis demonstrates that exposure of parents to severe systemic ill- ness during the preconception period is associated with adverse pregnancy outcomes.

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VOLUME 114, ISSUE 6, P1242-1249


Alex M. Kasman, M.D., M.S., Hriday P. Bhambhvani, B.S., Shufeng Li, M.S., Chiyuan A. Zhang, M.P.H., David K. Stevenson, M.D., Gary M. Shaw, Dr.P.H., Julia F. Simard, Sc.D., Michael L. Eisenberg, M.D.



To investigate, with pre–COVID-19 data, whether parental exposure to severe systemic infections near the time of conception is associated with pregnancy outcomes.


Retrospective cohort study.


Population-based study covering births within the United States from 2009 to 2016.


The IBM MarketScan Research database covers reimbursed health care claims data on inpatient and outpatient encounters that are privately insured through employment-sponsored health insurance. Our analytic sample included pregnancies to paired fathers and mothers.


Parental preconception exposure (0–6 months before conception) to severe systemic infection (e.g., sepsis, hypotension, respiratory failure, critical care evaluation).

Main Outcome Measure(s)

Preterm birth (i.e., live birth before 37 weeks) and pregnancy loss.


A total of 999,866 pregnancies were recorded with 214,057 pregnancy losses (21.4%) and 51,759 preterm births (5.2%). Mothers receiving intensive care in the preconception period had increased risk of pregnancy loss, as did fathers. Mothers with preconception sepsis had higher risk of preterm birth and pregnancy loss, and paternal sepsis exposure was associated with an increased risk of pregnancy loss. Similar results were noted for hypotension. In addition, a dose response was observed for both mothers and fathers between preconception time in intensive care and the risk of preterm birth and pregnancy loss.


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.

Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders.