Is COVID-19 a Risk Factor for Hypertensive Disorders of Pregnancy?

Abstract

Objective: This study aims to assess whether COVID-19 infection during pregnancy is a risk factor for hypertensive disorders of pregnancy, including gestational hypertension, preeclampsia, HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome, and eclampsia. Methods: A retrospective evaluation was conducted on obstetric patients who gave birth between March 2020 and December 2021 at Augusta University Medical Center, an academic urban referral center in Augusta, GA. The patients were categorized into two groups: those who were COVID-19 positive during pregnancy and those who were COVID-19 negative. The primary outcome was the development of a hypertensive disorder of pregnancy. Secondary outcomes included preterm delivery, mode of delivery, maternal death, maternal ICU admission, NICU admission, intrauterine fetal demise/stillbirth, fetal growth restriction, and prolonged hospital stay. The association between COVID-19 status and categorical outcomes was assessed using Chi-squared and Fisher’s exact tests. Mean differences between groups were evaluated using Student’s two-sample tests. Additionally, a multinomial multiple logistic regression was performed to assess whether COVID-19 is a risk factor for hypertensive disorders of pregnancy when adjusting for potential confounding effects. Results: Out of the 2760 charts reviewed, 2426 (87.9%) met the inclusion criteria. Of those 2426 patients, 203 were COVID-positive and 2223 were COVID-negative . There were no significant differences in patient sociodemographic information between the COVID-19 positive and negative groups. After adjusting for potential confounding effects, COVID-19 was determined to be a risk factor for combined hypertensive disorders of pregnancy (OR 1.93, 95% CI 1.39-2.66) and preeclampsia specifically (OR 2.01, 95% CI 1.38-2.88). For the observed secondary outcomes, COVID-19 infection during pregnancy was associated with an increased risk of cesarean delivery (p = 0.046), maternal ICU admission (p = 0.008), and prolonged hospital stay (p < 0.001). Conclusion: The findings of this study suggest that COVID-19 infection during pregnancy is linked to an increased risk of developing preeclampsia. COVID-19 was not a statistically significant risk factor for gestational hypertension when controlling for confounding effects. The study was unable to draw conclusions about more severe hypertensive conditions of pregnancy (HELLP, Eclampsia), likely due to their low prevalence in the study sample. COVID-19 was shown to be a risk factor for cesarean delivery, prolonged hospital stay, and maternal ICU admission in secondary outcome analysis. This research contributes to existing knowledge by examining the association between COVID-19 and hypertensive disorders of pregnancy during a period encompassing multiple strains of the COVID-19 virus.