“Early in the pandemic, clinical care and research efforts focused on prevention of the acute morbidity and mortality caused by SARS-CoV-2 infection. Over time, the lasting health implications of COVID-19 have become increasingly pressing with an ongoing need for further evidence to inform clinical care. Studies have consistently identified a host of symptoms described in nearly every organ system in the months following SARS-CoV-2 infection,” according to the investigators.
The study, encompassing 83,915 non-pregnant females with SARS-CoV-2 infection acquired outside of pregnancy and 5,397 pregnant females with SARS-CoV-2 infection, highlights intriguing disparities. Notably, pregnant individuals who contracted the virus exhibited a lower incidence of PASC (25.5% vs. 33.9%; adjusted hazard ratio (aHR) 0.85, 95% confidence interval (CI) 0.80–0.91) compared to their non-pregnant counterparts.
3 Key Takeaways
- Pregnant individuals who contracted COVID-19 exhibited a lower incidence of PASC compared to non-pregnant counterparts.
- Outcomes between pregnant individuals with and without SARS-CoV-2 infection highlight the increased risk of maternal mortality or severe morbidity associated with COVID-19 during pregnancy.
- The importance of tailored care for pregnant patients who have had COVID-19, and integrating the findings into clinical practice can improve care and outcomes for this vulnerable population.
The analysis also revealed an increased risk of specific PASC component diagnoses among pregnant individuals, such as abnormal heartbeat (aHR 1.67, 95% CI 1.43–1.94), abdominal pain (aHR 1.34, 95% CI 1.16–1.55), and thromboembolism (aHR 1.88, 95% CI 1.17–3.04). Conversely, pregnant individuals exhibited a decreased risk of other diagnoses, including malaise (aHR 0.35, 95% CI 0.27–0.47), pharyngitis (aHR 0.36, 95% CI 0.26–0.48), and cognitive problems (aHR 0.39, 95% CI 0.27–0.56).
Investigators compare this trial to another back in 2020, “in a retrospective cohort study of 14,104 individuals delivering across 17 US hospitals in 2020, those with SARS-CoV-2 infection were more likely to experience maternal mortality or severe morbidity from postpartum hemorrhage, infection, or hypertensive disorders of pregnancy than those without SARS-CoV-2 infection (13.4% vs 9.2%; aRR 1.41, 95% CI 1.23–1.61). SARS-CoV-2 infection in pregnancy has also been associated with increased risk for intensive care unit admission, need for mechanical ventilation, and cardiovascular complications among other acute sequelae.”
This retrospective cohort study, conducted as part of the Researching COVID to Enhance Recovery (RECOVER) Initiative Patient-Centered Clinical Research Network (PCORnet), leveraged electronic health record (EHR) data from 19 US health systems. Focusing on females aged 18–49 years with lab-confirmed SARS-CoV-2 infection between March 2020 and June 2022, the study identified pregnancies with deliveries at >20 weeks’ gestation. The primary outcome assessed was PASC identified 30–180 days post-SARS-CoV-2 infection.
“We evaluated PASC in individuals acquiring SARS-CoV-2 infection during pregnancy, which has not previously been reported,” according to investigators. “The selected PCORnet EHR-based study cohort reflects the geographic and racial diversity of the US increasing generalizability of the findings. A data-driven analysis approach using inverse probability of treatment weighting allowed for robust modeling and adjustment for confounders.”
Despite the study's strengths, including its use of a diverse and geographically representative cohort, certain limitations include potential biases such as misclassification, and under-ascertainment due to the reliance on ICD-10 codes in EHR datasets. Additionally, exclusions based on gestational age and data collection limitations may impact the findings' generalizability.
In conclusion, the study indicates that acquiring SARS-CoV-2 infection during pregnancy is associated with a lower incidence of PASC than acquiring the infection outside of pregnancy, within 30–180 days post-infection. These findings emphasize the need for tailored care for pregnant patients post-COVID-19 infection. Integrating these findings into clinical practice can improve care for pregnant patients post-COVID-19.
Reference
Bruno A, Zang C, Xu Z, et. al. Association between acquiring SARS-CoV-2 during pregnancy and post-acute sequelae of SARS-CoV-2 infection: RECOVER electronic health record cohort analysis. TheLancet. Published May 24, 2024. Accessed May 29, 2024. Doi: https://doi.org/10.1016/j.eclinm.2024.102654
