Post–Acute Sequelae of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) After Infection During Pregnancy
Authors: Metz Torri D. , Reeder Harrison T. , Clifton Rebecca G. , Flaherman Valerie , Aragon Leyna V. , Baucom Leah Castro , Beamon Carmen J. , Braverman Alexis , Brown Jeanette , Cao Tingyi , Chang Ann , Costantine Maged M. , Dionne Jodie A. , Gibson Kelly S. , Gross Rachel S. , Guerreros Estefania , Habli Mounira , Hadlock Jennifer , Han Jenny , Hess Rachel , Hillier Leah , Hoffman M. Camille , Hoffman Matthew K. , Hughes Brenna L. , Jia Xiaolin , Kale Minal , Katz Stuart D. , Laleau Victoria , Mallett Gail , Mehari Alem , Mendez-Figueroa Hector , McComsey Grace A. , Monteiro Jonathan , Monzon Vanessa , Okumura Megumi J. , Pant Deepti , Pacheco Luis D. , Palatnik Anna , Palomares Kristy T.S. , Parry Samuel , Pettker Christian M. , Plunkett Beth A. , Poppas Athena , Ramsey Patrick , Reddy Uma M. , Rouse Dwight J. , Saade George R. , Sandoval Grecio J. , Sciurba Frank , Simhan Hyagriv N. , Skupski Daniel W. , Sowles Amber , Thorp John M. , Tita Alan T. N. , Wiegand Samantha , Weiner Steven J. , Yee Lynn M. , Horwitz Leora I. , Foulkes Andrea S. , Jacoby Vanessa ,   on behalf of the NIH Researching COVID to Enhance Recovery (RECOVER) Consortium*
Published: July 2024

OBJECTIVE:
To estimate the prevalence of post–acute sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (PASC) after infection with SARS-CoV-2 during pregnancy and to characterize associated risk factors.

METHODS:
In a multicenter cohort study (NIH RECOVER [Researching COVID to Enhance Recovery]-Pregnancy Cohort), individuals who were pregnant during their first SARS-CoV-2 infection were enrolled across the United States from December 2021 to September 2023, either within 30 days of their infection or at differential time points thereafter. The primary outcome was PASC, defined as score of 12 or higher based on symptoms and severity as previously published by the NIH RECOVER-Adult Cohort, at the first study visit at least 6 months after the participant's first SARS-CoV-2 infection. Risk factors for PASC were evaluated, including sociodemographic characteristics, clinical characteristics before SARS-CoV-2 infection (baseline comorbidities, trimester of infection, vaccination status), and acute infection severity (classified by need for oxygen therapy). Multivariable logistic regression models were fitted to estimate associations between these characteristics and presence of PASC.

RESULTS:
Of the 1,502 participants, 61.1% had their first SARS-CoV-2 infection on or after December 1, 2021 (ie, during Omicron variant dominance); 51.4% were fully vaccinated before infection; and 182 (12.1%) were enrolled within 30 days of their acute infection. The prevalence of PASC was 9.3% (95% CI, 7.9–10.9%) measured at a median of 10.3 months (interquartile range 6.1–21.5) after first infection. The most common symptoms among individuals with PASC were postexertional malaise (77.7%), fatigue (76.3%), and gastrointestinal symptoms (61.2%). In a multivariable model, the proportion PASC positive with vs without history of obesity (14.9% vs 7.5%, adjusted odds ratio [aOR] 1.65, 95% CI, 1.12–2.43), depression or anxiety disorder (14.4% vs 6.1%, aOR 2.64, 95% CI, 1.79–3.88) before first infection, economic hardship (self-reported difficulty covering expenses) (12.5% vs 6.9%, aOR 1.57, 95% CI, 1.05–2.34), and treatment with oxygen during acute SARS-CoV-2 infection (18.1% vs 8.7%, aOR 1.86, 95% CI, 1.00–3.44) were associated with increased prevalence of PASC.

CONCLUSION:
The prevalence of PASC at a median time of 10.3 months after SARS-CoV-2 infection during pregnancy was 9.3% in the NIH RECOVER-Pregnancy Cohort. The predominant symptoms were postexertional malaise, fatigue, and gastrointestinal symptoms. Several socioeconomic and clinical characteristics were associated with PASC after infection during pregnancy.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT05172024.