Post-Acute Sequelae of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) After Infection During Pregnancy

Torri D. Metz, University of Utah Health, Salt Lake City, Utah; Massachusetts General Hospital, Boston, Massachusetts; George Washington University and Howard University, Washington, DC; University of California San Francisco, San Francisco, and Stanford University, Palo Alto, California; University of New Mexico, Albuquerque, New Mexico; RECOVER Patient, Caregiver, or Community Advocate Representative, NYU Grossman School of Medicine, Mount Sinai Medical Center, and Columbia University, New York, and NewYork-Presbyterian Queens, Queens, New York; WakeMed Health and Hospitals, Raleigh, Duke University, Durham, and University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; University of Illinois Chicago and Northwestern University, Chicago, and NorthShore University Health System, Evanston, Illinois; The Ohio State University, Columbus, Case Western Reserve University, Cleveland, TriHealth Good Samaritan Hospital, Cincinnati, and Wright State University Boonshoft School of Medicine, Dayton, Ohio; University of Alabama at Birmingham, Birmingham, Alabama; University of Washington and Institute for Systems Biology, Seattle, Washington; Emory University, Atlanta, Georgia; University of Arizona, Phoenix, Arizona; University of Colorado School of Medicine, Aurora, Colorado; Christiana Care Health System, Newark, Delaware; University of Texas at Houston, Houston, University of Texas Medical Branch, Galveston, and University of Texas Health Sciences Center San Antonio, San Antonio, Texas; Medical College of Wisconsin, Milwaukee, Wisconsin; Saint Peter's University Hospital, New Brunswick, New Jersey; University of Pennsylvania, Philadelphia, and University of Pittsburgh, Pittsburgh, Pennsylvania; Yale School of Medicine, New Haven, Connecticut; and Brown University, Providence, Rhode Island.
Harrison T. Reeder
Rebecca G. Clifton
Valerie Flaherman
Leyna V. Aragon
Leah Castro Baucom
Carmen J. Beamon
Alexis Braverman
Jeanette Brown
Tingyi Cao
Ann Chang
Maged M. Costantine
Jodie A. Dionne
Kelly S. Gibson
Rachel S. Gross
Estefania Guerreros
Mounira Habli
Jennifer Hadlock
Jenny Han
Rachel Hess
Leah Hillier
M Camille Hoffman
Matthew K. Hoffman
Brenna L. Hughes
Xiaolin Jia
Minal Kale
Stuart D. Katz
Victoria Laleau
Gail Mallett
Alem Mehari
Hector Mendez-Figueroa
Grace A. McComsey

Document Type

Journal Article

Publication Date

9-1-2024

Journal

Obstetrics and gynecology

Volume

144

Issue

3

DOI

10.1097/AOG.0000000000005670

Abstract

OBJECTIVE: To estimate the prevalence of post-acute sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (PASC) after infection with SARS-CoV-2 during pregnancy and to characterize associated risk factors. METHODS: In a multicenter cohort study (NIH RECOVER [Researching COVID to Enhance Recovery]-Pregnancy Cohort), individuals who were pregnant during their first SARS-CoV-2 infection were enrolled across the United States from December 2021 to September 2023, either within 30 days of their infection or at differential time points thereafter. The primary outcome was PASC , defined as score of 12 or higher based on symptoms and severity as previously published by the NIH RECOVER-Adult Cohort, at the first study visit at least 6 months after the participant's first SARS-CoV-2 infection. Risk factors for PASC were evaluated, including sociodemographic characteristics, clinical characteristics before SARS-CoV-2 infection (baseline comorbidities, trimester of infection, vaccination status), and acute infection severity (classified by need for oxygen therapy). Multivariable logistic regression models were fitted to estimate associations between these characteristics and presence of PASC. RESULTS: Of the 1,502 participants, 61.1% had their first SARS-CoV-2 infection on or after December 1, 2021 (ie, during Omicron variant dominance); 51.4% were fully vaccinated before infection; and 182 (12.1%) were enrolled within 30 days of their acute infection. The prevalence of PASC was 9.3% (95% CI, 7.9-10.9%) measured at a median of 10.3 months (interquartile range 6.1-21.5) after first infection. The most common symptoms among individuals with PASC were postexertional malaise (77.7%), fatigue (76.3%), and gastrointestinal symptoms (61.2%). In a multivariable model, the proportion PASC positive with vs without history of obesity (14.9% vs 7.5%, adjusted odds ratio [aOR] 1.65, 95% CI, 1.12-2.43), depression or anxiety disorder (14.4% vs 6.1%, aOR 2.64, 95% CI, 1.79-3.88) before first infection, economic hardship (self-reported difficulty covering expenses) (12.5% vs 6.9%, aOR 1.57, 95% CI, 1.05-2.34), and treatment with oxygen during acute SARS-CoV-2 infection (18.1% vs 8.7%, aOR 1.86, 95% CI, 1.00-3.44) were associated with increased prevalence of PASC. CONCLUSION: The prevalence of PASC at a median time of 10.3 months after SARS-CoV-2 infection during pregnancy was 9.3% in the NIH RECOVER-Pregnancy Cohort. The predominant symptoms were postexertional malaise, fatigue, and gastrointestinal symptoms. Several socioeconomic and clinical characteristics were associated with PASC after infection during pregnancy. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov , NCT05172024.

Department

Epidemiology

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