Effect of SARS-CoV-2 Infection on Pregnancy Outcomes in an Inner-City Black Patient Population

Abstract

While data have shown that Black populations are disproportionately affected by COVID-19, few studies have evaluated birth outcomes in these understudied populations. This study hypothesized that SARS-CoV-2 infection would confer worse maternal and neonatal outcomes in a predominantly Black and underserved population in Brooklyn, New York City. In particular, SARS-CoV-2 is associated with higher rates of preterm birth, cesarean delivery, postpartum hemorrhage, lower APGAR scores, and neonatal resuscitation. Demographic factors and comorbidities were compared between the SARS-CoV-2 positive and negative groups. A retrospective cohort study was conducted in hospitalized patients who gave birth at Kings County Hospital from April 10 through June 10, 2020. Demographic and clinical data were obtained from the electronic medical record. Patients were categorized based on SARS-CoV-2 infection status and peripartum outcomes were analyzed. We used the Fisher exact test for categorical variables and the Wilcoxon rank-sum test for continuous variables. P < 0.05 was considered significant. There were no differences in obstetric or neonatal outcomes between the SARS-CoV-2 positive and negative cohorts. Most SARS-CoV-2 positive patients were asymptomatic on admission. The rates of maternal comorbidities were similar in the SARS-CoV-2 positive and negative groups. In this predominantly Black population in Brooklyn, SARS-CoV-2 infection did not confer increased risk of adverse obstetric or neonatal outcomes, despite the prevalence of comorbidities. The impact of SARS-CoV-2 infection on pregnancy outcomes is complex and may differ on a community level. Determining how COVID-19 is associated with perinatal outcomes in this minoritized patient population will augment our understanding of health disparities in order to improve care.

Adverse Perinatal Outcomes in COVID-19 Infected Pregnant Women: A Systematic Review and Meta-Analysis

“…Two thousand seven hundred ninety-five (2795) studies were identified through the search engines for the title and abstract reviews after removing 1254 duplicates. Out of the total screened abstracts, 120 were selected for full-text screening, of which 99 studies were excluded (mainly due to lack of a comparison group or the presentation of inadequate data), and 21 [ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ] studies were included in this systematic review and meta-analysis ( Figure 1 ).…”

“…There were nine (42.9%) articles from single-center studies [ 14 , 15 , 16 , 17 , 20 , 21 , 22 , 25 , 27 ], eight (38.1%) from multicenter studies [ 18 , 19 , 23 , 24 , 26 , 29 , 31 , 32 ] and three (14.3%) from nationwide [ 28 , 30 , 34 ] studies. The remaining one (4.7%) was a multinational study [ 33 ].…”

“…The remaining one (4.7%) was a multinational study [ 33 ]. Of the 20 studies included except the multinational study, eight (40%) were from the United States of America (USA) [ 15 , 16 , 20 , 23 , 24 , 25 , 29 , 31 ] three (15%) were from Spain [ 18 , 19 , 26 ], two (10%) each from Mexico [ 17 , 30 ] and India [ 21 , 27 ] and one (5%) each from Iran [ 14 ], United Kingdom (UK) [ 34 ], France [ 22 ], Sweden [ 28 ] and Canada [ 32 ]. Among the total included studies, 18 (85.7%) used cohort study design [ 14 , 15 , 18 , 19 , 20 , 21 , 22 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ], while one cohort study used a historical comparison cohort [ 34 ].…”

Validity of Apgar Score as an Indicator of Neonatal SARS-CoV-2 Infection: A Scoping Review

“…This disagreement about reporting times is evident in the literature; many recent papers only report 5 mins Apgar scores, omitting 1 min scores without providing explanation for their absence ( 7 , 26 , 28 , 33 ). In keeping with the intended testing scheme, however, the vast majority of studies commonly report both 1 and 5 mins scores ( 2 , 24 , 27 , 34 ).…”

Health Care Disparities in the COVID-19 Pandemic in the United States: A Focus on Obstetrics

“… 21 In a cross-sectional study of diverse patients in New York tested for SARS-CoV-2, the odds of SARS-CoV-2 infection in patients whose preferred language was Spanish compared with those whose preferred language was English was 1.67 (95% confidence interval: 1.44-2.43). 12 While not analyzed separately, Liu et al 29 note that the top primary languages in their population of disproportionately infected minority patients were non-English languages including Haitian Creole, Spanish, Arabic, Bengali, Russian, French, and French Creole.…”