COVID-19 Infection in Second Trimester Raises Risk of Preeclampsia: Daily Dose

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Patient Care brings primary care clinicians a lot of medical news every day—it’s easy to miss an important study. The Daily Dose provides a concise summary of one of the website's leading stories you may not have seen.

This week, we reported on findings from a study presented at the American College of Obstetrics & Gynecology (ACOG) 2024 Annual Clinical & Scientific Meeting in San Francisco, CA, May 17-19, 2024.

The study

To examine the effect of COVID-19 infection by trimester on the development of preeclampsia, researchers conducted a retrospective cohort study including patients receiving prenatal care at a single academic hospital between January 2019 and December 2022. The primary outcome was the rate and severity of preeclampsia and secondary outcomes included specific characteristics of placental pathology.

The analysis included 6174 patients who met inclusion criteria; approximately 10% (n = 649) tested positive for SARS-CoV-2 during their pregnancy. Among those patients, SARS-CoV-2 infection occurred most frequently in the second trimester (40.8%), followed by the third (39.8%) and first (19.4%).

The findings

Investigators observed greater preeclampsia rates in pregnant women infected in the first (19.2%) and second (18.2%) trimesters, compared to women not infected during their pregnancy (11.7%; P = .001). The rate of preeclampsia was actually slightly lower among women infected in their third trimester (11.2%).

Following adjustment for potential confounding variables, researchers reported that women who tested positive for SARS-CoV-2 were 48% more likely to develop preeclampsia than those not infected by the virus (95% CI, 1.04 – 2.11; P = .005). The severity of preeclampsia was increased with SARS-CoV-2 infection in any trimester of pregnancy versus no infection (P = .008); however, the association was only significantly greater among women infected in the first trimester (odds ratio [OR], 6.55; 95% CI, 1.95 – 22.55; P = .003).

Authors' comment

"This finding helps clarify conflicting studies versus the risk of preeclampsia with SARS-CoV-2 infection in that this risk may be trimester specific and can help aid in our counseling and proposed future research."

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