Antenatal SARS-CoV-2 infection causes significant maternal morbidity and mortality. Preeclampsia and SARS-CoV-2 infection share common pathophysiology that may worsen pregnancy outcomes when both coexist. The purpose of this study was to investigate the effect of gestational SARS-CoV-2 infection on the risk of developing hypertensive disease of pregnancy (pregnancy-induced hypertension [PIH]).
We performed a study of 307 participants from the IRB-approved Generation C prospective cohort study in New York City designed to examine the effect of SARS-CoV-2 infection on maternal, fetal, and neonatal outcomes. SARS-CoV-2 infection during pregnancy was ascertained using a combination of PCR, spike and nucleocapsid IgG antibodies, and chart review. Maternal symptoms were assessed in the original Generation C study. Pregnancy-induced hypertension status was defined using the American College of Obstetricians and Gynecologists diagnostic criteria and excluded participants with chronic hypertension. Logistic regression was used to estimate associations between SARS-CoV-2 infection and PIH after adjusting for age, body mass index, race, history of diabetes including gestational, chronic hypertension, and history of PIH.
Twenty-seven percent (n=84) of the 307 pregnant persons were infected with SARS-CoV-2 during pregnancy. No participants developed even moderate symptoms nor required hospitalization. Twelve percent (n=10) of those exposed developed any hypertensive disease of pregnancy. In participants without SARS-CoV-2 infection (n=223), 36 (16%) developed PIH. In adjusted multivariable models, gestational SARS-CoV-2 infection was not associated with PIH (odds ratio 0.53, 95% CI [0.22, 1.16], P=.13).
Despite recent publications suggesting an increased risk of PIH in pregnancies complicated by antenatal SARS-CoV-2 infection, our study fails to reveal an increased risk of PIH associated with asymptomatic or mild infection in a diverse prospective New York City pregnant cohort.