Trimester and severity of SARS-CoV-2 infection during pregnancy and risk of hypertensive disorders in pregnancy

ABSTRACT

Objective

SARS-CoV-2 infection during pregnancy has been linked with an increased risk of hypertensive disorders of pregnancy (HDP). The aim of this study was to examine how both trimester and severity of SARS-CoV-2 infection impact HDP.

Methods

We conducted a cohort study of SARS-CoV-2-infected individuals during pregnancy (n = 205) and examined the association between trimester and severity of infection with incidence of HDP using modified Poisson regression models to calculate risk ratios (RR) and 95% confidence intervals (CI). We stratified the analysis of trimester by severity to understand the role of timing of infection among those with similar symptomatology and also examined timing of infection as a continuous variable.

Results

Compared to a reference cohort from 2018, SARS-CoV-2 infection did not largely increase the risk of HDP (RR: 1.17; CI:0.90, 1.51), but a non-statistically significant higher risk of preeclampsia was observed (RR: 1.33; CI:0.89, 1.98), in our small sample. Among the SARS-CoV-2 cohort, severity was linked with risk of HDP, with infections requiring hospitalization increasing the risk of HDP compared to asymptomatic/mild infections. Trimester of infection was not associated with risk of HDP, but a slight decline in the risk of HDP was observed with later gestational week of infection. Among patients with asymptomatic or mild symptoms, SARS-CoV-2 in the first trimester conferred a higher risk of HDP compared to the third trimester (RR: 1.70; CI:0.77, 3.77), although estimates were imprecise.

Conclusion

SARS-CoV-2 infection in early pregnancy may increase the risk of HDP compared to infection later in pregnancy.

KEYWORDS:

• COVID-19
• gestational hypertension
• preeclampsia
• pregnancy
• trimester

Acknowledgments

We are grateful to the BUSPH Epidemiology COVID-19 Response Corps for creating a network that catalyzed the formation of the team that conducted this epidemiologic research on COVID-19.

Highlights

• SARS-CoV-2 infection in pregnancy did not largely increase the risk of hypertensive disorders of pregnancy.

• SARS-CoV-2 infection with severe symptoms was associated with a higher risk of hypertensive disorders of pregnancy compared to infection with mild symptoms.

• As gestational week at the time of infection increased a slight decline in the risk of hypertensive disorders of pregnancy was observed.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the Boston University Clinical and Translational Science Institute (1UL1TR001430); Dr. Parker is supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health under award 5K01HL133600-05.