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Multicenter Study
. 2023 Feb 8;76(3):e51-e59.
doi: 10.1093/cid/ciac657.

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Testing and Detection During Peripartum Hospitalizations Among a Multicenter Cohort of Pregnant Persons: March 2020-February 2021

Miranda J Delahoy  1   2 , Flor Munoz  3 , De-Kun Li  4 , Carmen Sofia Arriola  1 , Nanette Lee Bond  3 , Michael Daugherty  1 , Jeannette Ferber  4 , Nickolas Ferguson  5 , Louise Hadden  5 , Jillian T Henderson  6 , Stephanie A Irving  6 , Mary Juergens  5 , Venkatesh Kancharla  3 , Mara Greenberg  7 , Roxana Odouli  4 , Gabriella Newes-Adeyi  5 , Erin G Nicholson  3 , Lawrence Reichle  5 , Momodou Sanyang  3 , Margaret Snead  1 , Fatimah S Dawood  1 , Allison L Naleway  6
Affiliations
Multicenter Study

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Testing and Detection During Peripartum Hospitalizations Among a Multicenter Cohort of Pregnant Persons: March 2020-February 2021

Miranda J Delahoy et al. Clin Infect Dis. .

Abstract

Background: Identifying severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections during peripartum hospitalizations is important to guide care, implement prevention measures, and understand infection burden.

Methods: This cross-sectional analysis used electronic health record data from hospitalizations during which pregnancies ended (peripartum hospitalizations) among a cohort of pregnant persons at 3 US integrated healthcare networks (sites 1-3). Maternal demographic, medical encounter, SARS-CoV-2 testing, and pregnancy and neonatal outcome information was extracted for persons with estimated delivery and pregnancy end dates during March 2020-February 2021 and ≥1 antenatal care record. Site-stratified multivariable logistic regression was used to identify factors associated with testing and compare pregnancy and neonatal outcomes among persons tested.

Results: Among 17 858 pregnant persons, 10 863 (60.8%) had peripartum SARS-CoV-2 testing; 222/10 683 (2.0%) had positive results. Testing prevalence varied by site and was lower during March-May 2020. Factors associated with higher peripartum SARS-CoV-2 testing odds were Asian race (adjusted odds ratio [aOR]: 1.36; 95% confidence interval [CI]: 1.03-1.79; referent: White) (site 1), Hispanic or Latino ethnicity (aOR: 1.33; 95% CI: 1.08-1.64) (site 2), peripartum Medicaid coverage (aOR: 1.33; 95% CI: 1.06-1.66) (site 1), and preterm hospitalization (aOR: 1.69; 95% CI: 1.19-2.39 [site 1]; aOR: 1.39; 95% CI: 1.03-1.88 [site 2]).

Conclusions: Findings highlight potential disparities in SARS-CoV-2 peripartum testing by demographic and pregnancy characteristics. Testing practice variations should be considered when interpreting studies relying on convenience samples of pregnant persons testing positive for SARS-CoV-2. Efforts to address testing differences between groups could improve equitable testing practices and care for pregnant persons with SARS-CoV-2 infections.

Keywords: COVID-19; SARS-CoV-2; SARS-CoV-2 testing; neonate; pregnancy.

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Conflict of interest statement

Potential conflicts of interest. A. L. N. received research funding from Pfizer and Vir Biotechnology for unrelated studies (paid to their institution). F. M. participates on data safety monitoring boards for Pfizer (includes a stipend for the author), Moderna (paid to author), Meissa (includes a stipend for the author), Virometix (unpaid participation), and the National Institutes of Health (unpaid participation) and reports grants or contracts from Pfizer (Pediatric COVID-19 Vaccine Study; payment to their institution), Gilead (Pediatric Remdesivir Study; payment to their institution), and the National Institutes of Health (COVID-19 vaccines in pregnant women and Acute Flacid Myelitis Natural History Study; payment to their institution) and royalties or licenses for Up to Date on various chapters and editing (paid to author). M. G. reports several internal grants from Kaiser Permanente Northern California Division of Research for research funding (paid to their institution). M. S. reports other financial or nonfinancial interests from the CDC as a government employee who performed co-authorship duties as part of regular employment. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

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