Coronavirus Disease 2019 (COVID-19) And The Risk of Hypertensive Disorders of Pregnancy: A Retrospective Cohort Study

Purpose: To evaluate the association of hypertensive disorders of pregnancy with SARs-CoV-2 infection in pregnant women. Methods: : We conducted a retrospective cohort study of all pregnant patients with positive SARs-CoV-2 molecular test at four participating hospitals located in a large metropolitan city and who delivered between February 1 st and November 24 th , 2020. Patients who tested positive during their pregnancy and delivered (index cases) were compared to the three subsequent deliveries of patients who tested negative (controls) at the same institution. We evaluated the impact of COVID-19 on the development of hypertensive disorders of pregnancy. Results: : A total of 280 patients were included in the study: 70 patients who tested positive for Coronavirus Disease-2019 and 210 matched controls. Compared with pregnancies negative for SARS-CoV-2 infection, COVID-19 was associated with an increased risk of developing a hypertensive disorders of pregnancy (OR 3.68, 95% CI 1.67 -8.10). Overall rates of preeclampsia with severe features were significantly higher in patients with a COVID-19 diagnosis (18.6% vs 7.1%, p=0.006). Of COVID-19 positive patients, an early SARS-CoV-2 infection (prior to 32 week’s gestation) conferred a higher risk of hypertensive disorders in pregnancy (OR=6.29, CI 1.64-24.07; p=0.007). There was no difference in route of delivery, preterm birth, intrauterine growth restriction, intrauterine fetal demise, or pregnancy and fetal outcomes. Conclusion: COVID-19 is a risk factor for hypertensive disorders of pregnancy. Tweetable Abstract Patients who test positive for COVID-19 during their pregnancy are at increased risk of developing a hypertensive disorder of pregnancy compared to pregnant patients who test negative for COVID-19. Earlier SARs-CoV-2 infection results in increased risk of developing a hypertensive disorder. Furthermore, even patients who are asymptomatic but positive for SARs-CoV-2 during their pregnancy have a higher risk of developing a hypertensive disorder of pregnancy.