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COVID-19 has been associated with hypertensive disorders of pregnancy (HDP). PCR testing underestimates the prevalence of exposure to SARS-CoV-2. We tested the hypothesis that exposure to SARS-CoV-2 increases the risk of HDP, using SARS-CoV-2 antibodies as well as PCR testing as evidence of infection.
This was a prospective cohort study of pregnant patients delivering at 2 urban tertiary care centers between 4/2020 and 12/2020. Seropositivity was defined as having SARS-CoV-2 antibodies (IgG, IgM, or both) using a previously validated ELISA. We also assessed COVID-19 infection by nasopharyngeal PCR tests performed clinically 1) for delivery admission (universal testing) and 2) anytime during pregnancy but >10 days prior to delivery admission. The primary outcome was HDP determined using previously validated diagnostic codes from medical charts. Chi-squared and rank-sum analyses were performed and p< 0.05 was considered statistically significant.
Of 6680 deliveries, serology testing was performed on 6192 (92.7%), and 568 (9.2%) were seropositive. Compared to the seronegative group, the seropositive group was younger (Table, p< 0.001), less likely to be non-Hispanic White (p< 0.001), had higher gravidity (p< 0.001), and had higher pre-pregnancy BMI (p< 0.001). There were no differences in diabetes (p=0.93) or chronic hypertension (cHTN, p=0.45). There was no difference in incidence of HDP by seropositivity (147 [25.9%] vs. 1433 [25.5%], p=0.83), nor were there differences between groups in cHTN with superimposed preeclampsia (PEC) or PEC with severe features (Figure). 5856 (94.6%) had COVID-19 testing at delivery admission and 693 (11.2%) had COVID-19 testing during pregnancy. Positive PCR test at the time of delivery was not associated with HDP (32.2% vs. 25.5%, p=0.06) nor was testing during pregnancy (20.7% vs. 27.3%, p=0.18). Severity of HDP was not associated with COVID-19 infection by PCR at delivery (p=0.65) or PCR during pregnancy (p=0.52).
In a cohort with high incidence of HDP, we found no association between COVID-19 infection and HDP.