Effect of SARS-CoV-2 Infection on Preeclampsia Rates in a Single Academic Center ID 2683570

INTRODUCTION: Given the rise in preeclampsia during the COVID-19 pandemic, we aim to describe the effect of SARS-CoV-2 positivity during pregnancy on rates of preeclampsia with and without severe features. METHODS: This was an IRB-approved retrospective cohort study of patients receiving prenatal care and delivering at our academic hospital from January 1, 2019 to December 30, 2022. Primary outcomes were rates of preeclampsia and severe preeclampsia among those with and without SARS-CoV-2 infection during pregnancy. The secondary outcomes were placental pathology. RESULTS: Six thousand three hundred fifty-eight total charts were reviewed, and 5,525 patients met inclusion criteria. Of these, 12.1% tested positive for SARS-CoV-2 during pregnancy. Significantly more SARS-CoV-2-positive patients developed preeclampsia (16.1% versus 11.7%; P =.001). Of these, significantly more SARS-CoV-2-positive patients developed severe features (68.2% versus 55.0%; P =.011). Adjusted analysis showed SARS-CoV-2-positive patients 31% more likely to develop preeclampsia (95% CI, 1.03–1.67; P =.030) and 79% more likely to have severe features (95% CI, 1.14–2.80; P =.011). Placental pathology for 2,124 patients revealed SARS-CoV-2-positive patients 43% more likely to have intervillous thrombi than those without (95% CI, 1.02–2.01; P =.038). No other studied placental pathology differed. CONCLUSION: SARS-CoV-2 infection during pregnancy was associated with an increase in preeclampsia and severity compared to uninfected patients. Placental pathology from SARS-CoV-2-positive patients was more likely to show some vascular malperfusion, as evidenced by higher rates of intervillous thrombi. As COVID-19 becomes more endemic, these risks are important to note and discuss.