COVID-19 in pregnancy by race and ethnicity: Implications for development of a vaccination strategy

Abstract

Objective: COVID-19 and associated morbidity and mortality has disproportionately affected minoritized populations. The epidemiology of spread of COVID-19 among pregnant women by race/ethnicity is not well described. Using data from a large healthcare system in California, we estimated prevalence and spread during pregnancy and recommend a vaccination approach based on minimizing adverse outcomes. Methods: Patients delivering at Sutter Health are tested (molecular) for COVID-19. These results were combined with antibody test results, using samples drawn at delivery. For each racial/ethnic group, we estimated prevalence of COVID-19, using logistic regression to adjust for known sociodemographic and comorbid risk factors. Testing for immunoglobulin G and immunoglobulin M provided insight into timing of infections. Results: Among 17,446 women delivering May–December, 460 (2.6%) tested positive (molecular). Hispanic women were at 2.6 times the odds of being actively infected as White women (odds ratio = 2.6, 95% confidence interval = 2.0–3.3). August and December were the highest risk periods for active infection (odds ratio = 3.5, 95% confidence interval = 2.1–5.7 and odds ratio = 6.1, 95% confidence interval = 3.8–9.9, compared with May, respectively). Among 4500 women delivering October–December, 425 (9.4%) had positive molecular or antibody tests, ranging from 4.0% (Asian) to 15.7% (Hispanic). Adjusting for covariables, compared with White patients, odds of infection was similar for Black and Asian patients, with Hispanic at 2.4 (1.8–3.3) times the odds. Conclusion: COVID-19 prevalence was higher among Hispanic women at delivery and in the last trimester than their White counterparts. Higher rates in Black patients are explained by other risk factors. Resources should be directed to increase vaccination rates among Hispanic women in early stages of pregnancy.

The association of race and ethnicity on obstetric patients’ COVID‐19 outcomes: A summary of current literature

“…Current literature reveals that racial and ethnic minority groups are disproportionately infected by COVID‐19 within the obstetric population 14–27 . This is evident by their large makeup of study populations, especially concerning Hispanic and Black patients 14–19 .…”

“…Literature also shows that Hispanic populations are more likely to test positive for COVID‐19 compared to non‐Hispanic populations 20–22 . Pressman et al.…”

“…Pressman et al. estimated that Hispanic pregnant women had 2.6 times greater odds of being infected compared to their white counterparts (odds ratio = 2.6, 95% CI = 2.0−3.3) 22 . Furthermore, several cohort studies report that SARS‐CoV‐2 infection rates during March 2020 to June 2020 ranged from 10.4% to 18.1% among Hispanic populations, 7% to 9.7% among Black populations, and 1% to 9.4% among Caucasian populations 23–25 …”

“…Current literature reveals that racial and ethnic minority groups are disproportionately infected by COVID-19 within the obstetric population. [14][15][16][17][18][19][20][21][22][23][24][25][26][27] This is evident by their large makeup of study populations, especially concerning Hispanic and Black patients. [14][15][16][17][18][19] One multicenter, retrospective cohort study in Washington State observed that 70.7% of 240 SARS-CoV-2 positive pregnant patients were from racial and ethnic minority groups.…”

Auxiliary Screening COVID-19 by Serology

“…However, the studies in Africa with lower specificity of IgG and IgM to predicting COVID-19 diagnosis. These results may be related to the intensity of immune response between different races to produce antibodies against the SARS-CoV-2 infection ( 35 , 36 ). Previous study has shown that Hispanics and Blacks had higher rates of SARS-CoV-2 antibodies than Whites, indicating that SARS-CoV-2 spread disproportionately in racial and ethnic minorities during the COVID-19 pandemic ( 37 , 38 ).…”