1. In a large longitudinal, population-based cohort study, SARS-CoV-2 infection during pregnancy was associated with severe maternal morbidity, preterm birth, and venous thromboembolism.

2. Pregestational diabetes and Asian or Pacific Islander and Black race and ethnicity were associated with an increased risk of hospitalization.

Evidence Rating Level: 2 (Good)

Study Rundown: There is limited longitudinal data on perinatal risk factors and complications associated with SARS-CoV-2 infection during pregnancy. This population-based cohort study assessed the risk of perinatal complications associated with SARS-CoV-2 infection and described factors associated with hospitalizations in a large cohort of pregnant individuals with longitudinal data from preconception to delivery. Measures of perinatal complications included severe maternal morbidity, preterm birth, pregnancy hypertensive disorders, gestational diabetes, venous thromboembolism (VTE), stillbirth, cesarean delivery, and newborn birth weight and respiratory conditions. To estimate hazard ratios and association between SARS-CoV-2 infection and perinatal complications and hospitalization, Cox proportional hazards regression was performed. Among 43 886 pregnant individuals, SARS-CoV-2 infection during pregnancy was associated with severe maternal morbidity, preterm birth, especially medically indicated, early, and moderate preterm birth, and VTE. Additionally, pregestational diabetes and Asian or Pacific Islander and Black race and ethnicity were associated with an increased risk of hospitalization. A limitation of this study was that not all individuals in the control group tested negative for SARS-CoV-2 infection via polymerase chain reaction testing as classification was performed clinically. As a result, asymptomatic patients with SARS-CoV-2 infection may have been in the control group leading to possible confounding error in the associations.

Click to read the study in JAMA Internal Medicine

Relevant Reading: Clinical characteristics and outcomes of hospitalized women giving birth with and without COVID-19

In-Depth [retrospective cohort]: In this population-based cohort study of 43 886 pregnant mothers (mean [SD] age, 30.7 [5.2] years), 1332 (3.0%) tested positive for SARS-CoV-2 infection (from 30 days before conception to 7 days after delivery). The study was conducted at Kaiser Permanente Northern California between March 2020 and March 2021. After adjusting for possible confounding factors, SARS-CoV-2 infection during pregnancy was associated with an increased risk of severe maternal morbidity (HR, 2.45; 95%CI, 1.91-3.13), preterm birth (HR, 2.08; 95%CI, 1.75-2.47), and VTE (HR, 3.08; 95%CI, 1.09-8.74). Among individuals with SARS-CoV-2 infection and preterm birth, secondary analysis demonstrated an increased risk of medically indicated preterm birth (HR, 2.56; 95%CI, 2.06-3.19), spontaneous preterm birth (HR, 1.61; 95%CI, 1.22-2.13), and early (HR, 2.52; 95%CI, 1.49-4.24), moderate (HR, 2.18; 95%CI, 1.25-3.80), and late (HR, 1.95; 95%CI, 1.61-2.37) preterm birth. In total, 76 (5.7%) individuals were hospitalized, where those with pregestational diabetes (HR, 7.03; 95%CI, 2.22-22.2) and Asian or Pacific Islander (HR, 2.33; 95%CI, 1.06-5.11) and Black (HR, 3.14; 95%CI, 1.24-7.93) race and ethnicity were associated with an increased risk of hospitalization due to SARS-CoV-2 infection.

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