Hypertensive disorders of pregnancy in pregnant patients following infection with COVID-19

To characterize rates of hypertensive disorders of pregnancy (HDP) in pregnant patients with COVID-19 infection according to variant genotype, disease severity and timing of HPD diagnosis in relationship to infection. Retrospective cohort of all patients diagnosed with COVID-19 at our institution and subsequently delivering at our center (3/2020–4/2022). We grouped patients by 1) variant genotype 2) NIH disease severity and 3) whether they were delivered at the time of acute COVID-19 diagnosis. The primary outcome was any HDP. Secondary outcomes included HDP subtypes and the time interval from COVID-19 diagnosis to HDP diagnosis. Outcomes were compared across these groups. Kaplan-Meier curves compared the timing of HDP diagnosis by disease severity and genotype (log-rank test). During the study period, 203 (38%) pre-delta, 138 (26%) delta and 189 (36%) omicron variant patients delivered at our center. 239 (45%) delivered during their acute COVID-19 infection. Overall rate of HDP was 36% in the entire cohort. Demographics, GA at delivery and medical/obstetrical comorbidities were similar across the 3 genotype groups. There was no difference in rates of HDP or its subtypes between variant genotype, disease severity, or timing of delivery in relationship to COVID-19 infection (Table). In univariate analysis, timing of HDP diagnosis was only significantly different by disease severity (not genotype p=0.07) with the mild/moderate group having the longest period from COVID infection to HDP diagnosis (p < 0.001). Survival analysis demonstrated longer time intervals to HDP diagnosis in mild/moderate disease and shorter intervals in asymptomatic or severe disease (p< 0.001), but demonstrated longer intervals to HDP pre-delta and shorter intervals for delta and omicron variants (p=0.008, Figure). There are high rates of HDP (36%) in patients with COVID-19 infection, but HDP rates were similar by variant type, disease severity, and timing of illness. As timing of HDP varied across variants and disease severity, studies should investigate different pathophysiologic mechanisms.View Large Image Figure ViewerDownload Hi-res image Download (PPT)