Objective
It is well known that the inflammatory response plays a significant role in the pathogenesis of hypertensive disease of pregnancy (HDP). As such, it is likely that the acute inflammatory state of the COVID-19 infection may incite or exacerbate HDP. Our objective was to evaluate differences in the rates of new HDP and disease severity in COVID-19 positive (COVID+) versus COVID-19 negative (COVID-) patients.
Study Design
This was a retrospective chart review of all patients who had pre-admission COVID-19 nasal polymerase chain reaction (PCR) testing at a single institution between March-June 2020. The exposure was COVID+ versus COVID- result on admission testing and the primary outcome was overall rates of HDP including gestational hypertension (gHTN), pre-eclampsia (PEC) without severe features, and PEC with severe features. A secondary analysis was performed evaluating the subgroup of patients with HDP to determine whether disease severity differed by COVID-19 testing status. Patients with a history of chronic hypertension and multiple gestations were excluded. Secondary outcomes included selected markers of hypertensive disease severity.
Results
Our primary analysis included 1,715 patients who had COVID-19 nasal PCR testing, 1,548 who tested COVID- and 167 who tested COVID+. Overall rates of gHTN (9.0 vs 3.6%, P<0.001) and PEC without severe features (3.6 vs. 1.3%, P = 0.034) were significantly higher in COVID+ patients. Rates of PEC with severe features did not differ significantly between the two groups (5.4 vs 3.6%, P=0.12, Table 1). Our secondary analysis included 161 women with a diagnosis of HDP, 30 of which were COVID+ and 131 of which were COVID-. The gestational age at time of COVID-19 testing did not differ between the two groups. COVID+ and COVID- patients did not differ significantly on variables assessing hypertensive disease severity (Table 2).
Conclusion
Patients who were COVID+ had significantly higher rates of gHTN and PEC without severe features compared to COVID- patients. Severity of HDP did not differ between COVID+ and COVID- patients.
