Coronavirus disease 2019 infection and hypertensive disorders of pregnancy

Rosenbloom, Joshua I.; Raghuraman, Nandini; Carter, Ebony B.; Kelly, Jeannie C.

doi:10.1016/j.ajog.2021.03.001

Cited by 58 publications

(57 citation statements)

References 5 publications

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“…Overall, 31.4% of patients with a COVID-19 during their pregnancy developed a HDP, compared to 13.3% of controls. Our results are consistent with the available literature 18,24 . While one meta-analysis 9 did not demonstrate this association, the studies included had heterogenous designs, different primary outcomes, and most lacked a control group.…”

Section: Discussionsupporting

confidence: 94%

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

Baracy

Afzal

Szpunar

et al. 2021

Hypertension in Pregnancy

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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.

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Section: Discussionsupporting

confidence: 94%

“…Rosenbloom and Raghuraman (2021) found that a COVID-19 diagnosis conferred an approximate 2-fold risk of HDP (hazard ratio (HD) 1.93; CI 1.13-3.31) [24]. This was especially true if COVID-19 was diagnosed prior to 32 weeks' gestation, with the HR of 2.17 (CI 1.…”

Section: Discussionmentioning

confidence: 99%

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

Baracy

Afzal

Szpunar

et al. 2021

Hypertension in Pregnancy

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“…Because COVID-19 has been shown to increase the risk for adverse pregnancy outcomes, including preeclampsia, 4 , 5 , 6 the concept of a COVID-19–associated preeclampsia-like syndrome, which includes similar placental pathology, has been proposed. 7 , 8 , 9 However, it is important to note that COVID-19 during pregnancy and preeclampsia share the same set of risk factors, namely preexisting hypertension, obesity, and diabetes. 10 , 11 , 12 Thus, the association between COVID-19 and preeclampsia could be confounded by common underlying risk factors.…”

Section: Introductionmentioning

confidence: 99%

Preeclampsia and COVID-19: results from the INTERCOVID prospective longitudinal study

Papageorghiou

Deruelle

Gunier

et al. 2021

American Journal of Obstetrics and Gynecology

221

177

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Background It is unclear whether the suggested link between COVID-19 during pregnancy and preeclampsia is an independent association or if these are caused by common risk factors. Objective This study aimed to quantify any independent association between COVID-19 during pregnancy and preeclampsia and to determine the effect of these variables on maternal and neonatal morbidity and mortality. Study Design This was a large, longitudinal, prospective, unmatched diagnosed and not-diagnosed observational study assessing the effect of COVID-19 during pregnancy on mothers and neonates. Two consecutive not-diagnosed women were concomitantly enrolled immediately after each diagnosed woman was identified, at any stage during pregnancy or delivery, and at the same level of care to minimize bias. Women and neonates were followed until hospital discharge using the standardized INTERGROWTH-21 st protocols and electronic data management system. A total of 43 institutions in 18 countries contributed to the study sample. The independent association between the 2 entities was quantified with the risk factors known to be associated with preeclampsia analyzed in each group. The outcomes were compared among women with COVID-19 alone, preeclampsia alone, both conditions, and those without either of the 2 conditions. Results We enrolled 2184 pregnant women; of these, 725 (33.2%) were enrolled in the COVID-19 diagnosed and 1459 (66.8%) in the COVID-19 not-diagnosed groups. Of these women, 123 had preeclampsia of which 59 of 725 (8.1%) were in the COVID-19 diagnosed group and 64 of 1459 (4.4%) were in the not-diagnosed group (risk ratio, 1.86; 95% confidence interval, 1.32–2.61). After adjustment for sociodemographic factors and conditions associated with both COVID-19 and preeclampsia, the risk ratio for preeclampsia remained significant among all women (risk ratio, 1.77; 95% confidence interval, 1.25–2.52) and nulliparous women specifically (risk ratio, 1.89; 95% confidence interval, 1.17–3.05). There was a trend but no statistical significance among parous women (risk ratio, 1.64; 95% confidence interval, 0.99–2.73). The risk ratio for preterm birth for all women diagnosed with COVID-19 and preeclampsia was 4.05 (95% confidence interval, 2.99–5.49) and 6.26 (95% confidence interval, 4.35–9.00) for nulliparous women. Compared with women with neither condition diagnosed, the composite adverse perinatal outcome showed a stepwise increase in the risk ratio for COVID-19 without preeclampsia, preeclampsia without COVID-19, and COVID-19 with preeclampsia (risk ratio, 2.16; 95% confidence interval, 1.63–2.86; risk ratio, 2.53; 95% confidence interval, 1.44–4.45; and risk ratio, 2.84; 95% confidence interval, 1.67–4.82, respectively). Similar findings were found for the composite adverse maternal outcome with risk ratios of 1.76 (95% confidence interval, 1.32–2.35), 2.07 (95% confidence interval, 1.20–3.57), and 2...

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“…Indeed, pregnant women with covid-19 are at increased risk of admission to an intensive care unit and are more likely to experience preterm birth [ 6 ]. There are growing arguments for an increased risk of fetal death (2) and hypertensive complications of pregnancy [ 7 ]. Intra-uterine growth restriction (IUGR) seems to be three times more frequent than in COVID negative patients [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Placental lesions and SARS-Cov-2 infection: Diffuse placenta damage associated to poor fetal outcome

et al. 2021

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Introduction Pregnant women with covid-19 are more likely to experience preterm birth. The virus seems to be associated with a wide range of placental lesions, none of them specific. Method We collected cases of Covid-19 maternal infection during pregnancy associated with poor pregnancy outcomes, for which we received the placenta. We studied clinical data and described pathological findings of placenta and post-mortem examination of fetuses. We performed an immunohistochemical study and RT-PCR of SARS-Cov-2 on placenta samples. Results We report 5 cases of poor fetal outcome, 3 fetal deaths and 2 extreme premature neonates, one with growth restriction, without clinical and biological sign of SARS-Cov-2 infection. All placenta presented massive perivillous fibrin deposition and large intervillous thrombi associated with strong SARS-Cov-2 expression in trophoblast and SARS-CoV-2 PCR positivity in amniotic fluid or on placenta samples. Chronic histiocytic intervillositis was present in 4/5 cases. Placental ultrasound was abnormal and the sFLT1-PIGF ratio was increased in one case. Timing between mothers’ infection and the poor fetal outcome was ≤10 days in 4 cases. The massive placental damage are directly induced by the virus whose receptors are expressed on trophoblast, leading to trophoblast necrosis and massive inflammation in villous chamber, in a similar way it occurs in diffuse alveolar damage in adults infected by SARS-Cov-2. Discussion SARS-Cov-2 can be associated to a rare set of placental lesions which can lead to fetal demise, preterm birth, or growth restriction. Stronger surveillance of mothers infected by SARS-Cov-2 is required.

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Coronavirus disease 2019 infection and hypertensive disorders of pregnancy

Cited by 58 publications

References 5 publications

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

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

Preeclampsia and COVID-19: results from the INTERCOVID prospective longitudinal study

Placental lesions and SARS-Cov-2 infection: Diffuse placenta damage associated to poor fetal outcome

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