Coronavirus disease 2019 (COVID-19) and the risk of hypertensive disorders of pregnancy: a retrospective cohort study

Abstract

Purpose: To evaluate the association of hypertensive disorders of pregnancy with SARs-CoV-2 infection in pregnant women.Methods: We conducted a retrospective cohort study of all pregnant patients with positive SARs-CoV-2 molecular test at four participating hospitals located in a large metropolitan city and who delivered between February 1 st and November 24 th , 2020. Patients who tested positive 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.Results: A total of 280 patients were included in the study: 70 patients who tested positive for Coronavirus Disease-2019 and 210 matched controls. Compared with pregnancies negative for SARS-CoV-2 infection, COVID-19 was associated with an increased risk of developing a hypertensive disorders of pregnancy (OR 3.68, 95% CI 1.67 -8.10). Overall rates of preeclampsia with severe features were signi cantly higher in patients with a COVID-19 diagnosis (18.6% vs 7.1%, p=0.006). Of COVID-19 positive patients, an early SARS-CoV-2 infection (prior to 32 week's gestation) conferred a higher risk of hypertensive disorders in pregnancy (OR=6.29, CI 1.64-24.07; p=0.007). There was no difference in route of delivery, preterm birth, intrauterine growth restriction, intrauterine fetal demise, or pregnancy and fetal outcomes.Conclusion: COVID-19 is a risk factor for hypertensive disorders of pregnancy.

Evaluation of the effects of COVID‐19 disease and the trimester in which the disease is diagnosed on obstetric and neonatal outcomes: A retrospective cohort study

“…In sections of our study on the association between COVID‐19 and maternal hypertension states, including preeclampsia, we found that the probability of maternal hypertension was increased in pregnant women with COVID‐19. In some studies, including meta‐analyses, a relationship was found between COVID‐19 and maternal hypertensive diseases in parallel with our study 12–15 . The possible reasons for the relationship between COVID‐19 and maternal hypertension are not clearly known.…”

“…In some studies, including meta-analyses, a relationship was found between COVID-19 and maternal hypertensive diseases in parallel with our study. [12][13][14][15] The possible reasons for the relationship between COVID-19 and maternal hypertension are not clearly known. The source of this relationship may be due to the possibility that SARS-CoV-2 may bind to angiotensin-converting enzyme 2 receptors, leading to renin-angiotensin system dysfunction and vasoconstriction.…”

COVID-19 and Preeclampsia: A Systematic Review of Pathophysiological Interactions

“…The presence of both diseases likely had either a synergistic or an opportunistic effect, which may have led to severe clinical manifestations via the interplay of the renin-angiotensinogen-aldosterone system in their pathogenesis." Baracy et al 18 "When comparing only COVID-19 positive pregnancies, early infection conferred a significantly higher risk for HDP than late infection. This observation is consistent with the inflammatory explanation of increased HDP risk in COVID-19.…”

COVID-19 and Cerebrovascular Disease

“…Testing positive for SARS-CoV-2 during pregnancy has been shown to increase the risk of developing a hypertensive disorder of pregnancy (OR: 3.68). 73 This has significant potential impacts to both the mother and her child, as hypertensive disorders of pregnancy can lead to an increased risk of preterm birth, intrauterine growth restriction, miscarriage, stillbirth, and maternal complications including stroke and maternal death. 74 Long-term risks for the infant include neurodevelopmental delay and complications of prematurity.…”