Abstract
INTRODUCTION: Many physiological, immune, and respiratory adaptations occur during pregnancy. Data have emerged that COVID-19 infection affects placental function, raising concerns about obstetric morbidity. It is not currently known how timing of COVID-19 infection affects pregnancy. We hypothesize that maternal and neonatal outcomes are different if COVID-19 infection occurs in different trimesters of pregnancy. METHODS: This IRB-approved retrospective cohort study was conducted at a single center from March 2020 to June 2022. Pregnant patients with a positive COVID-19 infection more than 10 days before delivery (COVID-recovered) were identified and grouped by trimester of infection. Demographics and maternal infection, obstetric, and neonatal outcomes were collected. Wilcoxon rank-sum and Fisher’s exact tests were used to compare continuous and categorical data, respectively. To account for multiple comparisons, a significant P value was set at .01. RESULTS: Two hundred ninety-eight COVID-recovered pregnant patients were identified. Of those, 48 (16%) were infected in the first trimester, 123 (41%) in the second trimester, and 127 (43%) in the third trimester. There were no significant demographic differences between the study groups. Vaccination status was similar. Hospital admission rate and the need for oxygen therapy while infected were significantly higher in patients with second- or third-trimester infection (18% and 20% versus 2% and 13% and 14% versus 0%, respectively). Rates of preterm birth (PTB) less than 37 weeks (33% versus 19% and 12%, P=.006) and extreme PTB (19% versus 5%, P<.001) were higher in the first-trimester infection group. Infants born to mothers infected in the second trimester had more neonatal sepsis workups (22% versus 12% and 7%, P=.008). Other maternal, obstetric, and neonatal outcomes were similar between groups. CONCLUSION: First-trimester COVID-recovered patients were more likely to have preterm birth despite having lower rates of hospital admission and oxygen supplementation while infected than patients who recovered from a second- or third-trimester infection.
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