Coronavirus Disease 2019 (COVID-19) in Pregnancy and the Risk of
Hypertensive Disorders of Pregnancy: A Retrospective Cohort Study
Abstract
Objective: To evaluate the association of COVID-19 status in pregnant
women and hypertensive disorders of pregnancy. Design: Retrospective
Cohort Study Setting: Multicenter study from a large metropolitan
hospital system Population: Pregnant patients who tested positive for
COVID-19 Methods: Patients who tested positive for COVID-19 during their
pregnancy and delivered (index cases) were compared to the three
subsequent deliveries of patients who tested negative (controls) at the
same institution. We evaluated the impact of COVID-19 on the development
of hypertensive disorders of pregnancy. We also evaluated the
association of these disorders with maternal characteristics;
demographics; prior pregnancy complications; current pregnancy
complications; COVID-19 severity; laboratory values and inflammatory
markers; and maternal and fetal outcomes. Univariable analysis was
conducted with Student’s t-test, the chi-squared test and analysis of
variance. Multivariable analyses were done using linear and logistic
regression models. Main Outcome Measures: The incidence of hypertensive
disorders of pregnancy in SARs-CoV-2 positive patients compared to
SARs-CoV-2 negative patients. Results: Compared with pregnancies
negative for SARs-CoV-2 infection, maternal SARs-CoV-2 infection was
associated with an increased risk for hypertensive disorders of
pregnancy (OR 3.68, 95% CI 1.67 -8.10). Overall rates of preeclampsia
with severe features were significantly higher in patients with a
COVID-19 diagnosis (18.6% vs 7.1%, p=0.006). An early SARS-CoV-2
infection (prior to 32 week’s gestation) conferred a higher risk of
hypertensive disorders in pregnancy compared to SARs-CoV-2 infections
diagnosed after 32 weeks’ gestation(OR=6.29, CI 1.64-24.07; p=0.007).
Conclusion: COVID-19 is a risk factor for hypertensive disorders of
pregnancy. Funding: None Conflicts of Interest: None