Pregnancy Outcomes and Child Development Effects of SARS-CoV-2 Infection (PROUDEST Trial): Protocol for a Multicenter, Prospective Cohort Study
Authors: Fernandes Geraldo Magela , Motta Felipe , Sasaki Lizandra Moura Paravidine , Silva Ângelo Pereira Da , Miranda Andreza Monforte , Carvalho Aleida Oliveira De , Gomides Ana Paula Monteiro , Soares Alexandre Anderson De Sousa Munhoz , Santos Jr Agenor De Castro Moreira Dos , Alves Caroline De Oliveira , Gomes Ciro Martins , Siracusa Clara Correia De , Araújo Jr David Alves De , Mendonça-Silva Dayde Lane , Jesus José Alfredo Lacerda De , Costa Karina Nascimento , Castro Maria Eduarda Canellas De , Kurizky Patricia Shu , França Paulo Sérgio , Tristão Rosana , Pereira Yacara Ribeiro , Castro Luiz Claudio Gonçalves De , Zaconeta Alberto Moreno , Albuquerque Cleandro Pires De , Mota Licia Maria Henrique Da 
Published: February 2021

Background
A growing body of evidence suggests that SARS-COV-2 infection during pregnancy may affect maternal-fetal outcomes and possibly result in implications for the long-term development of SARS-CoV-2–exposed children.

Objective
The PROUDEST (Pregnancy Outcomes and Child Development Effects of SARS-CoV-2 Infection Study) is a multicenter, prospective cohort study designed to elucidate the repercussions of COVID-19 for the global health of mothers and their children.

Methods
The PROUDEST trial comprises 2 prospective, sequential substudies. The PREGNANT substudy will clinically assess the effects of SARS-CoV-2 infection on pregnancy, childbirth, and puerperium from a mechanistic standpoint to elucidate the pregnancy-related inflammatory and immunological phenomena underlying COVID-19. Pregnant women aged 18-40 years who have been exposed (proven with laboratory tests) to SARS-CoV-2 (group A; n=300) will be compared to control subjects with no laboratory evidence of in-pregnancy exposure to the virus (group B; n=300). Subjects exposed to other infections during pregnancy will be excluded. The BORN substudy is a long-term follow-up study that will assess the offspring of women who enrolled in the prior substudy. It will describe the effects of SARS-CoV-2 exposure during pregnancy on children’s growth, neurodevelopment, and metabolism from birth up to 5 years of age. It includes two comparison groups; group A (exposed; n=300) comprises children born from SARS-CoV-2–exposed pregnancies, and group B (controls; n=300) comprises children born from nonexposed mothers.

Results
Recruitment began in July 2020, and as of January 2021, 260 pregnant women who were infected with SARS-CoV-2 during pregnancy and 160 newborns have been included in the study. Data analysis is scheduled to start after all data are collected.

Conclusions
Upon completion of the study, we expect to have comprehensive data that will provide a better understanding of the effects of SARS-CoV-2 infection and related inflammatory and immunological processes on pregnancy, puerperium, and infancy. Our findings will inform clinical decisions regarding the care of SARS-CoV-2–exposed mothers and children and support the development of evidence-based public health policies.

Trial Registration
Brazilian Register of Clinical Trials RBR65QXS2; https://ensaiosclinicos.gov.br/rg/RBR-65qxs2

International Registered Report Identifier (IRRID)
DERR1-10.2196/26477