This is a preprint.

It has not yet been peer reviewed by a journal.

The National Library of Medicine is running a pilot to include preprints that result from research funded by NIH in PMC and PubMed.

[Preprint]. 2023 Apr 24:2023.04.24.23289025.

doi: 10.1101/2023.04.24.23289025.

Researching COVID to enhance recovery (RECOVER) pregnancy study: Rationale, objectives and design

Torri D Metz¹, Rebecca G Clifton², Richard Gallagher³, Rachel S Gross⁴, Leora I Horwitz⁵, Vanessa L Jacoby⁶, Susanne P Martin-Herz⁷, Myriam Peralta-Carcelen⁸, Harrison T Reeder⁹, Carmen J Beamon¹⁰, Marie-Abele Bind⁹, James Chan⁹, A Ann Chang¹¹, Lori B Chibnik⁹, Maged M Costantine¹², Megan L Fitzgerald⁵, Andrea S Foulkes⁹, Kelly S Gibson¹³, Nick Güthe⁵, Mounira Habli¹⁴, David N Hackney¹⁵, Matthew K Hoffman¹⁶, M Camille Hoffman¹⁷, Brenna L Hughes¹⁸, Stuart D Katz¹⁹, Victoria Laleau²⁰, Gail Mallett²¹, Hector Mendez-Figueroa²², Vanessa Monzon⁶, Anna Palatnik²³, Kristy T S Palomares²⁴, Samuel Parry²⁵, Myriam Peralta-Carcelen⁸, Christian M Pettker²⁶, Beth A Plunkett²⁷, Athena Poppas²⁸, Uma M Reddy²⁹, Dwight J Rouse³⁰, George R Saade³¹, Grecio J Sandoval³², Shannon M Schlater³³, Frank C Sciurba³⁴, Hyagriv N Simhan³⁵, Daniel W Skupski³⁶, Amber Sowles¹, Tanayott Thaweethai⁹, Gelise L Thomas³⁷, John M Thorp Jr³⁸, Alan T Tita³⁹, Steven J Weiner², Samantha Weigand⁴⁰, Lynn M Yee²¹, Valerie J Flaherman²⁰

Affiliations

¹ Department of Obstetrics and Gynecology, University of Utah Health Hospitals and Clinics, Salt Lake City, UT, USA.
² Biostatistics Center, The George Washington University, Washington, DC, USA.
³ Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY, USA.
⁴ Department of Pediatrics, New York University Grossman School of Medicine, New York, NY, USA.
⁵ Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA.
⁶ Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA.
⁷ Department of Pediatrics, Division of Developmental Medicine, University of California San Francisco, San Francisco, CA, San Francisco, CA, USA.
⁸ Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA.
⁹ Department of Biostatistics, Massachusetts General Hospital, Boston, MA, USA.
¹⁰ Department of Maternal Fetal Medicine, WakeMed Health and Hospitals, Raleigh, NC, USA.
¹¹ Women's Health Research Clinical Center, University of California San Francisco, San Francisco, CA, USA.
¹² Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
¹³ Department of Obstetrics and Gynecology, The MetroHealth System, Cleveland, OH, USA.
¹⁴ Division Maternal Fetal Medicine, Trihealth Good Samaritan Hospital Maternal Fetal Medicine, Cincinnati, OH, USA.
¹⁵ Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center: UH Cleveland Medical Center, Cleveland, OH, USA.
¹⁶ Department of Obstetrics and Gynecology, Christiana Care Health System, Newark, DE, USA.
¹⁷ Department of Obstetrics & Gynecology, University of Colorado School of Medicine, Aurora, CO, USA.
¹⁸ Department of Obstetrics and Gynecology, Duke University, Durham, NC, USA.
¹⁹ Department of Medicine, New York University School of Medicine, New York City, NY, USA.
²⁰ Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA.
²¹ Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
²² Department of Obstetrics, Gynecology and Reproductive Sciences, University of Texas McGovern Medical School: The University of Texas Health Science Center at Houston John P and Katherine G McGovern Medical School, Houston, TX, USA.
²³ Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, USA.
²⁴ Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Saint Peter's University Hospital, New Brunswick, NJ, USA.
²⁵ Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA, USA.
²⁶ Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA.
²⁷ Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL, USA.
²⁸ Division of Cardiology, Brown University Warren Alpert Medical School, PROVIDENCE, RI, USA.
²⁹ Department of Obstetrics and Gynecology, Columbia University, New York City, NY, USA.
³⁰ Department of Obstetrics and Gynecology, Brown University, Providence, RI, USA.
³¹ Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, TX, USA.
³² Biostatistics Center, The George Washington University, Rockville, MD, USA.
³³ Huntsman Cancer Institute, University of Utah Health, Salt Lake City, UT, USA.
³⁴ Department of Medicine, Division of Pulmonary Allergy and Critical Care Medicine, University of Pittsburgh, pittsburgh, PA, USA.
³⁵ Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
³⁶ Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, USA.
³⁷ Clinical and Translational Science Collaborative of Cleveland, Case Western Reserve University, Cleveland, Ohio, Cleveland, OH, USA.
³⁸ Department of Obstetrics and Gynecology, UNC: The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
³⁹ Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA.
⁴⁰ Department of Obstetrics and Gynecology, Wright State University Boonshoft School of Medicine, Dayton, OH, USA.

PMID: 37162923
PMCID: PMC10168506
DOI: 10.1101/2023.04.24.23289025

Researching COVID to enhance recovery (RECOVER) pregnancy study: Rationale, objectives and design

Torri D Metz et al. medRxiv. 2023.

[Preprint]. 2023 Apr 24:2023.04.24.23289025.

doi: 10.1101/2023.04.24.23289025.

Authors

Affiliations

¹ Department of Obstetrics and Gynecology, University of Utah Health Hospitals and Clinics, Salt Lake City, UT, USA.
² Biostatistics Center, The George Washington University, Washington, DC, USA.
³ Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY, USA.
⁴ Department of Pediatrics, New York University Grossman School of Medicine, New York, NY, USA.
⁵ Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA.
⁶ Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA.
⁷ Department of Pediatrics, Division of Developmental Medicine, University of California San Francisco, San Francisco, CA, San Francisco, CA, USA.
⁸ Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA.
⁹ Department of Biostatistics, Massachusetts General Hospital, Boston, MA, USA.
¹⁰ Department of Maternal Fetal Medicine, WakeMed Health and Hospitals, Raleigh, NC, USA.
¹¹ Women's Health Research Clinical Center, University of California San Francisco, San Francisco, CA, USA.
¹² Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
¹³ Department of Obstetrics and Gynecology, The MetroHealth System, Cleveland, OH, USA.
¹⁴ Division Maternal Fetal Medicine, Trihealth Good Samaritan Hospital Maternal Fetal Medicine, Cincinnati, OH, USA.
¹⁵ Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center: UH Cleveland Medical Center, Cleveland, OH, USA.
¹⁶ Department of Obstetrics and Gynecology, Christiana Care Health System, Newark, DE, USA.
¹⁷ Department of Obstetrics & Gynecology, University of Colorado School of Medicine, Aurora, CO, USA.
¹⁸ Department of Obstetrics and Gynecology, Duke University, Durham, NC, USA.
¹⁹ Department of Medicine, New York University School of Medicine, New York City, NY, USA.
²⁰ Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA.
²¹ Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
²² Department of Obstetrics, Gynecology and Reproductive Sciences, University of Texas McGovern Medical School: The University of Texas Health Science Center at Houston John P and Katherine G McGovern Medical School, Houston, TX, USA.
²³ Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, USA.
²⁴ Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Saint Peter's University Hospital, New Brunswick, NJ, USA.
²⁵ Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA, USA.
²⁶ Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA.
²⁷ Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL, USA.
²⁸ Division of Cardiology, Brown University Warren Alpert Medical School, PROVIDENCE, RI, USA.
²⁹ Department of Obstetrics and Gynecology, Columbia University, New York City, NY, USA.
³⁰ Department of Obstetrics and Gynecology, Brown University, Providence, RI, USA.
³¹ Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, TX, USA.
³² Biostatistics Center, The George Washington University, Rockville, MD, USA.
³³ Huntsman Cancer Institute, University of Utah Health, Salt Lake City, UT, USA.
³⁴ Department of Medicine, Division of Pulmonary Allergy and Critical Care Medicine, University of Pittsburgh, pittsburgh, PA, USA.
³⁵ Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
³⁶ Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, USA.
³⁷ Clinical and Translational Science Collaborative of Cleveland, Case Western Reserve University, Cleveland, Ohio, Cleveland, OH, USA.
³⁸ Department of Obstetrics and Gynecology, UNC: The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
³⁹ Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA.
⁴⁰ Department of Obstetrics and Gynecology, Wright State University Boonshoft School of Medicine, Dayton, OH, USA.

PMID: 37162923
PMCID: PMC10168506
DOI: 10.1101/2023.04.24.23289025

Abstract

Importance: Pregnancy induces unique physiologic changes to the immune response and hormonal changes leading to plausible differences in the risk of developing post-acute sequelae of SARS-CoV-2 (PASC), or Long COVID. Exposure to SARS-CoV-2 during pregnancy may also have long-term ramifications for exposed offspring, and it is critical to evaluate the health outcomes of exposed children. The National Institutes of Health (NIH) Researching COVID to Enhance Recovery (RECOVER) Multi-site Observational Study of PASC aims to evaluate the long-term sequelae of SARS-CoV-2 infection in various populations. RECOVER- Pregnancy was designed specifically to address long-term outcomes in maternal-child dyads.

Methods: RECOVER-Pregnancy cohort is a combined prospective and retrospective cohort that proposes to enroll 2,300 individuals with a pregnancy during the COVID-19 pandemic and their offspring exposed and unexposed in utero, including single and multiple gestations. Enrollment will occur both in person at 27 sites through the Eunice Kennedy Shriver National Institutes of Health Maternal-Fetal Medicine Units Network and remotely through national recruitment by the study team at the University of California San Francisco (UCSF). Adults with and without SARS-CoV-2 infection during pregnancy are eligible for enrollment in the pregnancy cohort and will follow the protocol for RECOVER-Adult including validated screening tools, laboratory analyses and symptom questionnaires followed by more in-depth phenotyping of PASC on a subset of the overall cohort. Offspring exposed and unexposed in utero to SARS-CoV-2 maternal infection will undergo screening tests for neurodevelopment and other health outcomes at 12, 18, 24, 36 and 48 months of age. Blood specimens will be collected at 24 months of age for SARS-CoV-2 antibody testing, storage and anticipated later analyses proposed by RECOVER and other investigators.

Discussion: RECOVER-Pregnancy will address whether having SARS-CoV-2 during pregnancy modifies the risk factors, prevalence, and phenotype of PASC. The pregnancy cohort will also establish whether there are increased risks of adverse long-term outcomes among children exposed in utero.

Registration: NCT05172024.

PubMed Disclaimer

Conflict of interest statement

Dr. Metz reports personal fees from Pfizer for her role as a medical consultant for a SARS-CoV-2 vaccination in pregnancy study, grants from Pfizer for role as a site PI for SARS-CoV-2 vaccination in pregnancy study, grants from Pfizer for role as a site PI for RSV vaccination in pregnancy study, and grants from Gestvision for role as a site PI for a preeclampsia study outside the submitted work. Dr. Horwitz reported serving as a member of the National Academy of Medicine Committee on the Long-Term Health Effects Stemming from COVID-19 and Implications for the Social Security Administration. Dr. Costantine reported receiving grant support for work not related to this paper from Baxter International and Siemens Healthcare and personal consulting fees not related to this paper from Progenity and Siemens Healthcare.

The other authors state that they have nothing to disclose.

Figures

**Figure 1.**
Study procedures for RECOVER-Adult

**Figure 2.**
Schematic representation of planned enrollment for RECOVER-Pregnancy including pregnant individuals (both with and without SARS-CoV-2 during pregnancy) and the pediatric in utero exposure cohort. Acute infection is infection within the last 30 days and post-acute infection is infection during pregnancy, but at a time that was more than 30 days from the date of enrollment.

**Figure 3.**
Study assessment schedule for children enrolled in RECOVER-Pregnancy or the in utero exposure cohort of RECOVER

See this image and copyright information in PMC

References

1. Ballering AV, van Zon SKR, Hartman TCO, Rosmalen JGM. Persistence of somatic symptoms after COVID-19 in the Netherlands: an observational cohort study. Lancet 2022; 400: 452–61. - PMC - PubMed
1. Carfi A, Bernabei R, Landi F. Persistent symptoms in patients after acute COVID-19. JAMA 2020; 324(6): 603–05. - PMC - PubMed
1. Bull-Otterson L. Post-COVID conditions among adult COVID-19 survivors aged 18-64 and ≥ 65 years old – United States, March 2020-November 2021. MMWR 2021; 71:713.
1. Davis HE, McCorkell L, Vogel JM, Topol EJ. Long COVID: major findings, mechanisms and recommendations. Nat Reviews Microbiology 2023; 21: 133–146. - PMC - PubMed
1. Afshar Y, Gaw SL, Flaherman VJ, et al. Clinical presentation of coronavirus disease 2019 (COVID-19) in pregnant and recently pregnant people. Obstet Gynecol 2020; 136(6):1117–25. - PMC - PubMed

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

This is a preprint.

Researching COVID to enhance recovery (RECOVER) pregnancy study: Rationale, objectives and design

Affiliations

Researching COVID to enhance recovery (RECOVER) pregnancy study: Rationale, objectives and design

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

Associated data

Grants and funding

LinkOut - more resources

Full Text Sources

Medical

Miscellaneous