COVID-19 tied to hypertensive disorders of pregnancy, not placental pathology

Key takeaways:

• Hypertensive disorders of pregnancy risk was 72.4% higher for women with vs. without COVID-19 in pregnancy.
• COVID-19 in pregnancy was not associated with placental pathology.

SAN FRANCISCO — COVID-19 infection during pregnancy was associated with increased risk for hypertensive disorders of pregnancy, but not with placental pathology, according to data presented at the ACOG Annual Clinical & Scientific Meeting.

“We know that COVID-19 is associated with increased risk of hypertensive disorders of pregnancy and that, historically, hypertensive disorders of pregnancy are associated with abnormalities on placental histology,” Tamara Siblini, MD, a third-year resident in the department of obstetrics and gynecology at Ascension St. John Hospital in Detroit, told Healio. “So, we were looking at the association between placental histology and COVID-19 to see if that was a linking factor.”

Siblini and colleagues conducted a retrospective cohort study with data from 177 women who tested positive for COVID-19 during pregnancy and 470 women who tested negative. Researchers compared placentas of women from both groups to assess associations between COVID-19 infection during pregnancy and placental pathology.

Overall, those positive for COVID-19 had a higher likelihood of recreational drug use during pregnancy (6.8% vs. 2.9%; P = .04), and Black women were more likely to test positive for COVID-19 compared with white women (57.1% vs. 36.7%; P = .01).

More than one-quarter (28.6%) of women who tested positive for COVID-19 were diagnosed with hypertensive disorders of pregnancy compared with 15.1% of women who tested negative. Risk for hypertensive disorders of pregnancy was 72.4% higher for women who tested positive for COVID-19 during pregnancy compared with those who tested negative (OR = 1.72; 95% CI, 1.09-2.73; P = .02).

Researchers observed no significant differences in placental pathology between women who tested positive vs. negative for COVID-19 during pregnancy. Women with infarcts on placental pathology had a 2.5-fold higher likelihood of being diagnosed with hypertensive disorders of pregnancy compared with women without (OR = 2.5; 95% CI, 1.3-4.82; P = .007).

Women with hypertensive disorders of pregnancy had significantly increased risk for infarcts compared with women without (14.9% vs. 6.8%; P =.003).

“This really tells us that COVID-19 doesn’t exert its role of increasing the risk of hypertensive disorders of pregnancy through placental infection and inflammation,” Siblini said. “Rather, it may exert its role through systemic inflammation, cytokine storm or dysregulation of the renin-angiotensin-aldosterone system.”