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Pregnancy Outcomes in Individuals With Long COVID
Torri D Metz1, Grecio J Sandoval, Amanda A Allshouse
1University of Utah Health, Salt Lake City, Utah; George Washington University, Washington DC; RECOVER Patient, Caregiver, or Community Representative, the NYU Grossman School of Medicine, Mount Sinai Medical Center, Columbia University, and NewYork-Presbyterian in Queens, New York, New York; the Vermont Center for Independent Living, Montpelier, Vermont; the University of Alabama at Birmingham, Birmingham, Alabama; the University of Iowa, Iowa City, Iowa; the University of Arizona College of Medicine, Phoenix, Arizona; the Yale School of Medicine, New Haven, Connecticut; WakeMed Health and Hospitals, Raleigh, Duke University, Durham, and the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; the University of California, San Francisco, San Francisco, California; The Ohio State University, Columbus, the MetroHealth System, Case Western Reserve University, Cleveland, and the Wright State University Boonshoft School of Medicine, Dayton, Ohio; the University of Colorado School of Medicine, Aurora, Colorado; Christiana Care Health System, Newark, Delaware; the University of Texas at Houston, Houston, and the University of Texas Medical Branch at Galveston, Galveston, Texas; the Medical College of Wisconsin, Milwaukee, Wisconsin; Saint Peter's University Hospital, New Brunswick, New Jersey; the University of Pennsylvania, Philadelphia, and the University of Pittsburgh, Pittsburgh, Pennsylvania; Endeavor Health, Evanston, and Northwestern University, Chicago, Illinois; Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Brown University, Providence, Rhode Island; and East Virginia Medical School, Norfolk, Virginia.
Objective:
To evaluate whether there is an association between a maternal classification of Long COVID and adverse pregnancy outcomes.
Methods:
RECOVER (Researching COVID to Enhance Recovery)-Adult is a multicenter prospective longitudinal cohort study of adults with and without prior severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection enrolled from October 2021 to January 2024. This analysis included participants with a SARS-CoV-2 infection and at least one symptom survey for classification of Long COVID status recorded before or during pregnancy. Participants were classified as either likely having Long COVID (LCRI [Long COVID Research Index] score of 11 or higher) or as having Long COVID-indeterminate (LCRI score 0-10), with comparisons made between groups. The primary outcome was preterm birth before 37 weeks of gestation. Secondary outcomes included hypertensive disorders of pregnancy, cesarean delivery, neonatal intensive care admission, and small-for-gestational-age birth weight (below the 10th percentile). Propensity score methods with full matching were used to balance differences in baseline characteristics in estimating an average treatment effect, with a sensitivity analysis estimating the average treatment effect among the treated.
Results:
Among 603 participants, 118 (19.6%) were classified as likely having Long COVID before or during pregnancy. Participants classified as likely having Long COVID were more likely to have specific adverse social determinants of health (difficulty covering expenses and paying bills, food insecurity, missed care because of cost, medical discrimination) and had higher prepregnancy body mass index (BMI) than those who were classified as having Long COVID-indeterminate. In the primary average treatment effect analysis, there was no association between likely Long COVID and preterm delivery (adjusted outcome rate 8.1% exposed vs 9.6% unexposed, absolute risk reduction [ARR] 0.82, 95% CI, 0.36-1.90) or secondary outcomes. In average treatment effect among the treated sensitivity analyses, likely Long COVID was similarly not associated with preterm delivery (ARR 1.11, 95% CI, 0.60-2.06) but was associated with an increased risk of hypertensive disorders of pregnancy (adjusted outcome rate 39.0% exposed vs 25.9% unexposed, ARR 1.51, 95% CI, 1.12-2.03) but not with other secondary outcomes.
Conclusion:
A classification of likely Long COVID was not significantly associated with preterm birth or several other adverse pregnancy outcomes. However, the association with hypertensive disorders of pregnancy in the average treatment effect among the treated analysis highlights the need for further research.
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