INTRODUCTION: Hypertensive disorders of pregnancy (HDP) are major contributors to cardiovascular severe maternal morbidity (cvSMM). COVID-19 infection in pregnancy has been linked to increased maternal morbidity, particularly in the setting of comorbidities. Whether COVID-19 modified the relationship between HDP and cvSMM remains unclear. METHODS: We conducted a retrospective cohort study using linked birth records and hospitalization claims from the New Jersey Integrated Population Health Data Project (2017–2021; N=62,924). Hypertensive disorders of pregnancy and cvSMM were identified via ICD-10 codes. Latent class analysis generated risk profiles based on HDP status and cardiometabolic comorbidities. Firth’s logistic regression estimated adjusted odds ratios (aORs) for cvSMM from delivery through 42 days postpartum, adjusting for COVID-19 infection, pandemic period, race, and other confounders. RESULTS: Three risk profiles emerged: 1) low comorbidity, no HDP (91.35% of total sample), 2) moderate metabolic burden, no HDP (4.50%), and 3) high cardiometabolic risk with HDP (4.15%). Compared with profile 1, profile 2 (aOR 1.81; 95% CI, 1.13–2.77) and profile 3 (aOR 2.35; 95% CI, 1.50–3.53) had higher odds of cvSMM. Black racial identity independently predicted cvSMM (aOR 1.77; 95% CI, 1.24–2.54). COVID-19 infection and the pandemic period were not associated with cvSMM. CONCLUSIONS/IMPLICATIONS: Patients with HDP and significant underlying cardiometabolic burden faced over twice the odds of cvSMM compared with healthy patients. In this cohort, acute cardiovascular risk during the COVID-19 pandemic was driven primarily by preexisting cardiometabolic burden. Incorporating this stratification into peripartum care could guide targeted monitoring and timely intervention to reduce cardiovascular complications.
Pande et al. (2026) studied this question.