Socioeconomic Status and Race Impact Maternal Morbidity Among Women Testing Positive for COVID-19

The purpose of this study is to investigate the relationship between maternal morbidity, socioeconomic status (SES), and race/ethnicity among pregnant women testing positive for COVID-19 prior to delivery. We conducted a retrospective chart review of patients who tested positive for COVID-19 prior to delivery and received obstetric care between March-December 2020. All variables abstracted for the review were collected as part of standard clinical procedure. Patient zip codes were used as a proxy for SES. ICD-10 codes for key gestational diagnoses were used to evaluate maternal morbidity. For data analysis, patients were grouped into three successive levels based on median household income extracted from zip codes. Within these levels, patients were further grouped by race (White and Other races/ethnicities [Black, Hispanic, Multiracial, or Asian]). We compared rates of maternal morbidity between these levels and secondarily analyzed rates among White and Other race/ethnicity patients. Patients with unknown race and/or zip codes were excluded from analysis. We analyzed data from 129 patients who tested positive for COVID-19. The majority of patients with the highest median income (L3) were White (86.4%), while the majority of patients with the lowest median income (L1) were other races/ethnicities (68.3%; among these 92.9% Black, 7.1% Hispanic). Rates of gestational hypertension decreased as median household income increased. In the lowest income levels (L1, L2), Other race/ethnicity patients were overrepresented among those with gestational hypertension and low birth weight (LBW). In the highest income level (L3), Other race/ethnicity patients were overrepresented among those with gestational diabetes and preterm birth (Table 1). We found that among pregnant patients testing positive for COVID-19, lower SES was associated with higher rates of gestational hypertension. Other race/ethnicity patients with lower incomes had higher rates of hypertension during pregnancy and LBW upon delivery. Among higher income patients, other race/ethnicity patients had higher rates of gestational diabetes and preterm birth.