COVID-19 not Hypertension or Diabetes increases the risk of Preeclampsia among a high-risk population

Elsevier

Available online 10 January 2023

Pregnancy HypertensionAuthor links open overlay panelAbstractObjectives

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection has been associated with greater morbidity and increased mortality in certain populations, such as those with chronic medical conditions, the elderly, and pregnant women. COVID-19 infection in pregnancy is associated with greater rates of hospitalization, ICU admission, need for mechanical ventilation, and death. Pregnancy related morbidity such as preterm delivery, fetal growth restriction, preeclampsia and stillbirth are increased in mothers with COVID-19 illness. To determine if COVID-19 infection during pregnancy increased the risk of preeclampsia in a population of women with increased risk factors for preeclampsia.

Study DESIGN

We present a prospective observational matched case-control study of the first 100 deliveries with nasopharyngeal swab PCR confirmed SARS-CoV2 at the University of Mississippi Medical Center’s Winfred L. Wiser Hospital for Women & Infants. Specifically, we investigated the maternal and neonatal outcomes in a high-risk population of Mississippi pregnant women. COVID-19 infection during pregnancy is associated with greater rates of developing preeclampsia in mothers with pre-existing diabetes or chronic hypertension.

Main OUTCOME MEASURES

Results

Among women with COVID-19, the severity of symptoms was associated with the incidence of preeclampsia, but not with pre-existing diabetes or hypertension. Women with more severe symptoms were more likely to delivery pre-term (p=0.006) and had smaller babies (p=0.04). There were no significant differences in maternal demographic characteristics between matched groups. After adjusting for diabetes, hypertensive women with COVID-19 had an increased risk of preeclampsia aOR4.3 [95%CI 1.5, 12.4] compared to non-hypertensive women with COVID-19. After adjusting for hypertension, women with diabetes and COVID-19 had an increased risk of preeclampsia aOR3.9 [95%CI 1.2, 12.5]. This relationship was not seen among women without COVID-19.

Conclusion

Women with COVID-19 and severe symptoms were at a higher risk to delivery preterm. For women who had pre-existing diabetes or hypertension, the risk of developing PreE was only increased if they were also diagnosed with COVID-19, suggesting that in our population of women the risk of PreE is not associated with pre-existing diabetes or hypertension.

Introduction

Pregnant women with coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are at higher risk of severe disease and adverse clinical outcomes compared to nonpregnant women with COVID-19[1], [2]. Surveillance data from the Centers for Disease Control and Prevention suggest that pregnancies complicated by COVID-19 are associated with an increased risk of hospitalization, ICU admission, and mechanical ventilation[3]. A report of pregnant women in the United States found that in comparison to women without COVID-19, those infected with COVID-19 during pregnancy had an increased risk of several adverse obstetrical outcomes[4]. It was found that women with COVID-19 had an increased risk of preterm delivery, stillbirth, preeclampsia (PreE) and placental abruption. Similar findings have also been reported from other studies, where authors have reported that COVID-19 during pregnancy increased the risk of preterm delivery, stillbirth, PreE and premature rupture of membranes[5], [6].

From early in the COVID-19 pandemic it was recognized that certain factors increased the severity of COVID-19 infection. These risk factors included Black race or Hispanic ethnicity, obesity, and chronic comorbidities such as hypertension and/or diabetes[7]. These are among the same factors that have been associated with increased risk of preterm birth and PreE[8]. What is interesting about these studies evaluating obstetric outcomes in women with COVID-19 is that the data was collected from general populations and not high-risk populations[4], [5]. The aim of the current study was to determine if COVID-19 increased the risk of PreE in a population of women at increased risk for PreE.

Section snippetsMethods

This is a prospective observational matched case-control study conducted at the University of Mississippi Medical Center’s Winfred L. Wiser Hospital for Women & Infants. Electronic medical records from women who were part of an approved Institutional Review Board COVID-19 Registry (IRB# 2020-0134) were selected for the current analysis. From April 14 – October 17, 2020 100 women with COVID-19 or who had a diagnosis of COVID-19 during the current pregnancy were admitted for delivery. This period

Results

We first examined the impact of COVID-19 to see if there were differences in delivery outcome based on race, comorbid risk factors and severity of COVID-19. Women were diagnosed with COVID-19 at 33.7±5.7 weeks and delivered at 36.82±3.7 weeks. Women who tested positive for COVID-19 in the 2nd trimester (17%) were significantly more likely to deliver prematurely relative to women testing positive in their 3rd trimester (35.02±4.9 vs. 37.57±2.4 weeks, p=0.05). When severity of COVID-19 was

Discussion

This study examined the risk factors between COVID-19 and poor maternal and neonatal outcomes in an at risk population. We demonstrated that in women with chronic hypertension and/or diabetes, COVID-19 infection increases the incidence of PreE. We were also able to demonstrate a relationship between COVID-19 severity and the incidence of PreE. A significant finding in our study is the relationship of maternal obesity, COVID-19 infection and the risk PreE. As the implications and long term

Conclusions

To conclude, patients with COVID-19 and chronic hypertension or diabetes mellitus are more likely to develop PreE. Furthermore, the more severe the disease state the higher the risk of PreE. More work in our population has to be done to protect pregnant patients from COVID-19 as the pregnancy implications of preterm birth and lifelong maternal cardiac risks are significant.

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Acknowledgements:

We would like to acknowledge Sherrina Dixon, RN (University of Mississippi Medical Center, Department of Ob/Gyn) for her help with building the COVID-19 pregnancy registry.

Funding: This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.

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© 2023 Published by Elsevier B.V. on behalf of International Society for the Study of Hypertension in Pregnancy.

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