Risk factors for severe acute respiratory syndrome coronavirus 2 infection in pregnant women

Abstract

BACKGROUND: Risk factors for severe acute respiratory syndrome coronavirus 2 infection in pregnancy remain poorly understood. Identifying and understanding populations at a heightened risk of acquisition is essential to more effectively target outreach and prevention efforts. OBJECTIVE: This study aimed to compare sociodemographic and clinical characteristics of pregnant women with and without severe acute respiratory syndrome coronavirus 2 infection and, among those with severe acute respiratory syndrome coronavirus 2, to compare characteristics of those who reported coronavirus disease symptoms and those who were asymptomatic at diagnosis. STUDY DESIGN: This retrospective cohort study includes pregnant women who delivered or intended to deliver at Northwestern Memorial Hospital after initiation of a universal testing protocol on admission (April 8, 2020eMay 31, 2020). Women were dichotomized by whether they had a positive test result for severe acute respiratory syndrome coronavirus 2. Among women with a positive test result, women were further dichotomized by whether they reported symptoms of coronavirus disease 2019. Bivariable analysis and parametric tests of trend were used for analyses. Logistic regression was used to control for potential confounders and to examine effect modification between race and ethnicity and any other identified risk factors. RESULTS: During the study period, 1418 women met inclusion criteria, of whom 101 (7.1%) had a positive test result for severe acute respiratory syndrome coronavirus 2. Of the 101 women who had a positive test result, 77 (76.2%) were symptomatic at the time of diagnosis. Compared with women who had a negative test result for severe acute respiratory syndrome coronavirus 2, those with a positive test result were younger and were more likely to have public insurance, to identify as black or African American or Latina, to be unmarried, to be obese, to have preexisting pulmonary disease, and to have living children. An increasing number of living children was associated with an increasing risk of severe acute respiratory syndrome coronavirus 2 infection, and this finding persisted after controlling for potential confounders. There was no effect modification between race or ethnicity and having living children with regard to the risk of infection. There were no significant differences identified between women who were symptomatic and asymptomatic. CONCLUSION: Many risk factors for severe acute respiratory syndrome coronavirus 2 infection in pregnancy are similar to the social and structural determinants of health that have been reported in the general population. The observed association between severe acute respiratory syndrome coronavirus 2 infection and having children raises the possibility of children themselves being vectors of viral spread or behavior patterns of parents being mediators of acquisition.

Racial-ethnic disparities and pregnancy outcomes in SARS-CoV-2 infection in a universally-tested cohort in Houston, Texas

“…SARS-CoV-2-positive pregnant patients were more likely to be Hispanic and to have public insurance. The majority of pregnant patients diagnosed on admission for delivery were asymptomatic, which is consistent with other universally-tested cohorts, though rates vary [ 3 , 4 ]. Pregnancy complications and perinatal transmission were rare.…”

Patient characteristics associated with SARS‐CoV‐2 infection in parturients admitted for labour and delivery in Massachusetts during the spring 2020 surge: A prospective cohort study

“…With over 1500 documented severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) cases per 100 000 residents at the end of June 2020, 1 women in the United States are not well characterised. [3][4][5][6][7][8][9][10][11][12][13][14][15][16] Now that the height of the spring COVID-19 surge is past, after action reports can help elucidate epidemiological factors associated with SARS-CoV-2 infection in pregnant women that may provide insight into patterns of infection which may be relevant for communities that subsequently experience a similar surge in infection. The aim of this study was therefore to determine the prevalence of, and factors associated with, SARS-CoV-2 infection in patients admitted for labour and delivery at four Boston-area hospitals.…”

“…While studies from large cities affected by coronavirus disease 2019 (COVID‐19), including this population, have reported on the prevalence of SARS‐CoV‐2 in the context of universal testing during admission for delivery, patient demographic, social and clinical factors associated with SARS‐CoV‐2 infection in pregnant women in the United States are not well characterised 3‐16 . Now that the height of the spring COVID‐19 surge is past, after action reports can help elucidate epidemiological factors associated with SARS‐CoV‐2 infection in pregnant women that may provide insight into patterns of infection which may be relevant for communities that subsequently experience a similar surge in infection.…”

Social determinants of health and coronavirus disease 2019 in pregnancy

“…Pregnant patients from minoritized racial and ethnic groups have been disproportionately affected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (COVID-19). [1][2][3][4][5] Reported risk factors for infection during pregnancy include public health insurance, obesity, higher parity, and preexisting pulmonary disease. 3 However, individual patient characteristics likely provide an incomplete understanding of the mechanisms contributing to viral transmission and dissemination.…”

“…[1][2][3][4][5] Reported risk factors for infection during pregnancy include public health insurance, obesity, higher parity, and preexisting pulmonary disease. 3 However, individual patient characteristics likely provide an incomplete understanding of the mechanisms contributing to viral transmission and dissemination. The social and physical environments in which people live affect the emergence, prevalence and severity of both infectious and non-infectious diseases.…”