Abstract
Background
Identifying SARS-CoV-2 infections during peripartum hospitalizations is important to guide care, implement prevention measures, and understand infection burden.
Methods
This cross-sectional analysis used electronic health record data from hospitalizations during which pregnancies ended (peripartum hospitalizations) among a cohort of pregnant persons at 3 U.S. integrated healthcare networks (Sites 1–3). Maternal demographic, medical encounter, SARS-CoV-2 testing, and pregnancy and neonatal outcome information was extracted for persons with estimated delivery and pregnancy end dates during March 2020–February 2021 and ≥1 prenatal care record. Site-stratified multivariable logistic regression was used to identify factors associated with testing and compare pregnancy and neonatal outcomes among persons tested.
Results
Among 17,858 pregnant persons, 10,863 (60.8%) had peripartum SARS-CoV-2 testing; 222/10,683 (2.0%) had positive results. Testing prevalence varied by site and was lower during March–May 2020. Factors associated with higher peripartum SARS-CoV-2 testing odds were Asian race (adjusted odds ratio [aOR]: 1.36; 95% CI: 1.03–1.79; referent: White) (Site 1), Hispanic or Latina ethnicity (aOR: 1.33; 95% CI: 1.08–1.64) (Site 2), peripartum Medicaid coverage (aOR: 1.33; 95% CI: 1.06–1.66) (Site 1), and preterm hospitalization (aOR: 1.69; 95% CI: 1.19–2.39 [Site 1]; aOR: 1.39; 95% CI: 1.03–1.88 [Site 2]).
Conclusions
Findings highlight potential disparities in SARS-CoV-2 peripartum testing by demographic and pregnancy characteristics. Testing practice variations should be considered when interpreting studies relying on convenience samples of pregnant persons testing positive for SARS-CoV-2. Efforts to address testing differences between groups could improve equitable testing practices and care for pregnant persons with SARS-CoV-2 infections.
Keywords: COVID-19, pregnancy, neonate, SARS-CoV-2, SARS-CoV-2 testing
Contributor Information
Miranda J Delahoy, COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Flor Munoz, Baylor College of Medicine, Houston, TX, USA.
De Kun Li, Kaiser Permanente Northern California, Oakland, CA, USA.
Carmen Sofia Arriola, COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Nanette Lee Bond, Baylor College of Medicine, Houston, TX, USA.
Michael Daugherty, COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Jeannette Ferber, Kaiser Permanente Northern California, Oakland, CA, USA.
Nickolas Ferguson, Abt Associates, Rockville, MD, USA.
Louise Hadden, Abt Associates, Rockville, MD, USA.
Jillian T Henderson, Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA.
Stephanie A Irving, Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA.
Mary Juergens, Abt Associates, Rockville, MD, USA.
Venkatesh Kancharla, Baylor College of Medicine, Houston, TX, USA.
Mara Greenberg, Department of Obstetrics and Gynecology, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA.
Roxana Odouli, Kaiser Permanente Northern California, Oakland, CA, USA.
Gabriella Newes-Adeyi, Abt Associates, Rockville, MD, USA.
Erin G Nicholson, Baylor College of Medicine, Houston, TX, USA.
Lawrence Reichle, Abt Associates, Rockville, MD, USA.
Momodou Sanyang, Baylor College of Medicine, Houston, TX, USA.
Margaret Snead, COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Fatimah S Dawood, COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Allison L Naleway, Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA.
Supplementary Material
Associated Data
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