COVID‐19 as a risk factor for hypertensive disorders of pregnancy: A retrospective cohort study

Abstract Objective The aim of this study was to assess whether coronavirus disease 2019 (COVID‐19) infection during pregnancy is a risk factor for hypertensive disorders of pregnancy. Methods A retrospective evaluation was conducted on obstetric patients who gave birth between March 2020 and December 2021 at an academic urban referral center. The patients were categorized as COVID‐19‐positive or COVID‐19‐negative during pregnancy. The primary outcome was the development of a hypertensive disorder of pregnancy. Secondary outcomes included preterm delivery, mode of delivery, maternal death, maternal intensive care unit (ICU) admission, neonatal ICU admission, intrauterine fetal demise/stillbirth, fetal growth restriction and prolonged hospital stay. χ 2 tests, Fisher's exact tests, Student's two‐sample tests and multiple logistic regressions were used to evaluate the association between COVID‐19 status and outcomes. Results Of 2760 reviewed charts, 2426 (87.9%) met the inclusion criteria. Of 2426 patients, 203 were COVID‐positive and 2223 were COVID‐negative. There were no significant demographic differences between the two groups. After adjusting for confounding effects, COVID‐19 was determined to be a risk factor for combined hypertensive disorders of pregnancy (odds ratio OR 1.93, 95% confidence interval CI: 1.39–2.66) and pre‐eclampsia specifically (OR 2.01, 95% CI 1.38–2.88). COVID‐19 infection during pregnancy was weakly associated with an increased risk of caesarean delivery ( p = 0.046) on univariate analysis but not on multivariate analysis, whereas it was associated with an increased risk of maternal ICU admission ( p = 0.003), and prolonged hospital stay ( p < 0.001) both before and after multivariate analysis. Conclusion This study suggests that COVID‐19 infection during pregnancy is a risk factor for pre‐eclampsia. The study was unable to draw conclusions about more severe hypertensive conditions of pregnancy hemolysis, elevated liver enzymes and low platelet count; Eclampsia. COVID‐19 was determined to be a risk factor for prolonged hospital stay and maternal ICU admission, but there was no significant correlation between COVID‐19 and caesarean delivery on multivariate analysis.