Impact of the COVID-19 pandemic, SARS-CoV-2 infection and social determinants of health on pregnancy complications, birth outcomes and post-pregnancy maternal cardiovascular and mortality outcomes

PROJECT SUMMARY Nationally, South Carolina (SC) ranks among the worst for poor pregnancy outcomes and high maternal and infant mortality rates, with vast racial/ethnic disparities present. Infection with the novel SARS-CoV-2 during pregnancy has been associated with pregnancy complications and poor infant and maternal outcomes including mortality. Moreover, the effect of social determinants and inequities in healthcare received and health outcomes have been heightened by the COVID-19 pandemic caused by SARS-CoV-2. Cardiovascular risk factors during pregnancy (e.g., obesity, diabetes, and hypertension) and pregnancy complications such as pre-eclampsia are common, can result in morbidity and mortality for the mother and the baby, and are well-known risk factors for maternal cardiovascular and vascular disease short and long-term. Infection with SARS-CoV-2 during pregnancy has also been related to complications (e.g., intensive care unit (ICU) admission, invasive ventilation, myocardial infarction, embolism). Less information is available regarding the impact of the COVID-19 pandemic or specifically SARS-CoV-2 infection on maternal and infant morbidity and mortality. The objective of our study is to understand the impact of both the COVID-19 pandemic and infection with SARS-CoV-2 on the risk of maternal and infant morbidity and mortality including pregnancy complications (e.g., pre-eclampsia, ICU admissions, mechanical ventilation), adverse birth outcomes (e.g., preterm birth, small for gestational age), and maternal cardiovascular events (e.g., coronary heart disease, stroke, embolism) during and post-pregnancy. Data from statewide administrative datasets (e.g., hospitalizations, vital records, Medicaid, positive COVID-19 tests) will be linked to create a diverse, longitudinal cohort of women who gave birth between 2018-2021 with at least one year of follow-up through 2022. Approximately 45,000 live birth pregnancies take place in SC each year for a total of ~180,000 deliveries anticipated over the 4-year study period. As of June 1, 2021, 2600 pregnant women in SC were diagnosed with COVID-19. The proposed project aims to evaluate the impact of the COVID-19 pandemic (Aim 1) and the impact of SARS-CoV-2 infection (Aim 2) at the population level in SC on (1) pregnancy complications, adverse birth outcomes, maternal cardiovascular events, and maternal and infant mortality; (2) maternal one-year post pregnancy cardiovascular and mortality outcomes; and (3) to examine differences by race/ethnicity, social vulnerability, distance to main medical facility, and pre-pregnancy obesity and diabetes. This study will be among the first to evaluate the COVID-19 pandemic and SARS-CoV-2 infection during pregnancy in relation to maternal and infant morbidity and mortality in a population-based study. Determining the impact of the COVID-19 pandemic and SARS-CoV-2 infection on infant and maternal morbidity and mortality and the extent of social and racial-ethnic differences is critical to improving pregnancy outcomes and health disparities in the U.S. Findings are expected to inform clinical care of pregnant women and public health policy.