The impact of the COVID-19 pandemic on the diagnosis and management of pre-eclampsia: Identifying healthcare delays.

To compare the prevalence of pre-eclampsia with and without severe features, and maternal and perinatal outcomes before and during the COVID-19 pandemic. Cross-sectional study based on medical chart review of pregnant women admitted to a referral maternity hospital for childbirth between September 2019 to February 2020 (before the pandemic) and March 2020 to August 2021 (during the pandemic, subdivided into three 6-month periods). The prevalence of pre-eclampsia, maternal, and perinatal outcomes were compared. A total of 3914 deliveries were considered, 1059 pre-pandemic and 2855 during the pandemic. The overall prevalence of pre-eclampsia was 10.9%, not differing significantly among periods (9.3%-14.3%, P = 0.144). Social and demographic characteristics were similar between groups. The use of anti-hypertensive therapy during pregnancy decreased significantly (69.9% pre-pandemic versus 47.1%-54.0% during the pandemic, P = 0.007). The diagnosis of early-onset pre-eclampsia reduced significantly (37.9% before and 19.3%-30.2% during the pandemic, P = 0.025), and so did the proportion of severe pre-eclampsia (61.1% before and 38.1%-58.3% during the pandemic, P = 0.001). However, the gestational age at birth was similar between groups, around 36 weeks. COVID-19 positivity increased from 0.9% to 12.0% during the pandemic periods (P < 0.001). There were no maternal deaths. Newborns were less often admitted to intensive care during the pandemic, and over 60% of these admissions were the result of prematurity in all periods studied. Other perinatal outcomes remained similar. The prevalence of pre-eclampsia increased during the study period, with diagnoses occurring at later gestational ages, likely due to delays in healthcare access.