Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2024 Sep 1;144(3):411-420.
doi: 10.1097/AOG.0000000000005670. Epub 2024 Jul 11.

Post-Acute Sequelae of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) After Infection During Pregnancy

Torri D Metz  1 , Harrison T Reeder, Rebecca G Clifton, Valerie Flaherman, Leyna V Aragon, Leah Castro Baucom, Carmen J Beamon, Alexis Braverman, Jeanette Brown, Tingyi Cao, Ann Chang, Maged M Costantine, Jodie A Dionne, Kelly S Gibson, Rachel S Gross, Estefania Guerreros, Mounira Habli, Jennifer Hadlock, Jenny Han, Rachel Hess, Leah Hillier, M Camille Hoffman, Matthew K Hoffman, Brenna L Hughes, Xiaolin Jia, Minal Kale, Stuart D Katz, Victoria Laleau, Gail Mallett, Alem Mehari, Hector Mendez-Figueroa, Grace A McComsey, Jonathan Monteiro, Vanessa Monzon, Megumi J Okumura, Deepti Pant, Luis D Pacheco, Anna Palatnik, Kristy T S Palomares, Samuel Parry, Christian M Pettker, Beth A Plunkett, Athena Poppas, Patrick Ramsey, Uma M Reddy, Dwight J Rouse, George R Saade, Grecio J Sandoval, Frank Sciurba, Hyagriv N Simhan, Daniel W Skupski, Amber Sowles, John M Thorp Jr, Alan T N Tita, Samantha Wiegand, Steven J Weiner, Lynn M Yee, Leora I Horwitz, Andrea S Foulkes, Vanessa Jacoby; NIH Researching COVID to Enhance Recovery (RECOVER) Consortium*
Affiliations
Multicenter Study

Post-Acute Sequelae of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) After Infection During Pregnancy

Torri D Metz et al. Obstet Gynecol. .

Abstract

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.

PubMed Disclaimer

Conflict of interest statement

Financial Disclosure Torri D. Metz is the site PI for a Pfizer study of Paxlovid in pregnancy and was the site PI for a Pfizer study of COVID-19 vaccination in pregnancy. She has received UpToDate royalties for two topics on trial of labor after cesarean. Carmen J. Beamon disclosed receiving payments from Wellcare of North Carolina. Ann Chang's institution received payment from New York University for her efforts on this study. Kelly S. Gibson disclosed that her institution received funding from the NICHD, NHLBI, and Materna. Rachel Hess received payment from Astellas Pharmaceuticals. M. Camile Hoffman disclosed her institution received payment for her expert testimony for one medicolegal trial from Wheeler, Trigg, and Associates (a defense attorneys firm). Her institution also received payment for a disease state presentation on postpartum depression and zuranolone from SAGE/Biogen. Brenna L. Hughes disclosed receiving payments from UpToDate and Moderna. Stuart Katz disclosed payments for providing expert testimony for Venable LLP. Jennifer Hadlock has received funding (paid to institution) for retrospective studies of COVID-19 from Pfizer, Novartis, Janssen, and Gilead. Grace A. McComsey served as an advisor for Gilead and ViiVGlaxoSmithKline. Patrick Ramsey disclosed receiving royalties from UpToDate. His institution was paid by the Texas Collaborative for Healthy Mothers and Babies (TCHMB)—Texas PQC for part of his efforts. Daniel W. Skupski reports receiving payments from Organon, Inc and Cooper Surgical. Alan T.N. Tita disclosed money paid to his institution from Pfizer for his efforts in this study. Andrea Foulkes disclosed receiving past payments from Round Table, Inc. The other authors did not report any potential conflicts of interest.

Similar articles

  • Development of a Definition of Postacute Sequelae of SARS-CoV-2 Infection.
    Thaweethai T, Jolley SE, Karlson EW, Levitan EB, Levy B, McComsey GA, McCorkell L, Nadkarni GN, Parthasarathy S, Singh U, Walker TA, Selvaggi CA, Shinnick DJ, Schulte CCM, Atchley-Challenner R, Alba GA, Alicic R, Altman N, Anglin K, Argueta U, Ashktorab H, Baslet G, Bassett IV, Bateman L, Bedi B, Bhattacharyya S, Bind MA, Blomkalns AL, Bonilla H, Brim H, Bush PA, Castro M, Chan J, Charney AW, Chen P, Chibnik LB, Chu HY, Clifton RG, Costantine MM, Cribbs SK, Davila Nieves SI, Deeks SG, Duven A, Emery IF, Erdmann N, Erlandson KM, Ernst KC, Farah-Abraham R, Farner CE, Feuerriegel EM, Fleurimont J, Fonseca V, Franko N, Gainer V, Gander JC, Gardner EM, Geng LN, Gibson KS, Go M, Goldman JD, Grebe H, Greenway FL, Habli M, Hafner J, Han JE, Hanson KA, Heath J, Hernandez C, Hess R, Hodder SL, Hoffman MK, Hoover SE, Huang B, Hughes BL, Jagannathan P, John J, Jordan MR, Katz SD, Kaufman ES, Kelly JD, Kelly SW, Kemp MM, Kirwan JP, Klein JD, Knox KS, Krishnan JA, Kumar A, Laiyemo AO, Lambert AA, Lanca M, Lee-Iannotti JK, Logarbo BP, Longo MT, Luciano CA, Lutrick K, Maley JH, Mallett G, Marathe JG, Marconi V, Marshall GD, Martin CF, Matusov Y, Mehari A, Mendez-Figueroa H, Mermelstein R, Metz TD… See abstract for full author list ➔ Thaweethai T, et al. JAMA. 2023 Jun 13;329(22):1934-1946. doi: 10.1001/jama.2023.8823. JAMA. 2023. PMID: 37278994 Free PMC article.
  • Researching COVID to Enhance Recovery (RECOVER) adult study protocol: Rationale, objectives, and design.
    Horwitz LI, Thaweethai T, Brosnahan SB, Cicek MS, Fitzgerald ML, Goldman JD, Hess R, Hodder SL, Jacoby VL, Jordan MR, Krishnan JA, Laiyemo AO, Metz TD, Nichols L, Patzer RE, Sekar A, Singer NG, Stiles LE, Taylor BS, Ahmed S, Algren HA, Anglin K, Aponte-Soto L, Ashktorab H, Bassett IV, Bedi B, Bhadelia N, Bime C, Bind MC, Black LJ, Blomkalns AL, Brim H, Castro M, Chan J, Charney AW, Chen BK, Chen LQ, Chen P, Chestek D, Chibnik LB, Chow DC, Chu HY, Clifton RG, Collins S, Costantine MM, Cribbs SK, Deeks SG, Dickinson JD, Donohue SE, Durstenfeld MS, Emery IF, Erlandson KM, Facelli JC, Farah-Abraham R, Finn AV, Fischer MS, Flaherman VJ, Fleurimont J, Fonseca V, Gallagher EJ, Gander JC, Gennaro ML, Gibson KS, Go M, Goodman SN, Granger JP, Greenway FL, Hafner JW, Han JE, Harkins MS, Hauser KSP, Heath JR, Hernandez CR, Ho O, Hoffman MK, Hoover SE, Horowitz CR, Hsu H, Hsue PY, Hughes BL, Jagannathan P, James JA, John J, Jolley S, Judd SE, Juskowich JJ, Kanjilal DG, Karlson EW, Katz SD, Kelly JD, Kelly SW, Kim AY, Kirwan JP, Knox KS, Kumar A, Lamendola-Essel MF, Lanca M, Lee-Lannotti JK, Lefebvre RC, Levy BD, Lin JY, Logarbo BP Jr, Logue JK, Longo MT, Luciano CA, Lutrick K, Malakooti SK, Ma… See abstract for full author list ➔ Horwitz LI, et al. PLoS One. 2023 Jun 23;18(6):e0286297. doi: 10.1371/journal.pone.0286297. eCollection 2023. PLoS One. 2023. PMID: 37352211 Free PMC article.
  • Risk factors associated with post-acute sequelae of SARS-CoV-2: an N3C and NIH RECOVER study.
    Hill EL, Mehta HB, Sharma S, Mane K, Singh SK, Xie C, Cathey E, Loomba J, Russell S, Spratt H, DeWitt PE, Ammar N, Madlock-Brown C, Brown D, McMurry JA, Chute CG, Haendel MA, Moffitt R, Pfaff ER, Bennett TD; N3C Consortium; and the RECOVER Consortium. Hill EL, et al. BMC Public Health. 2023 Oct 25;23(1):2103. doi: 10.1186/s12889-023-16916-w. BMC Public Health. 2023. PMID: 37880596 Free PMC article.
  • Neurological post-acute sequelae of SARS-CoV-2 infection.
    Takao M, Ohira M. Takao M, et al. Psychiatry Clin Neurosci. 2023 Feb;77(2):72-83. doi: 10.1111/pcn.13481. Epub 2022 Oct 17. Psychiatry Clin Neurosci. 2023. PMID: 36148558 Free PMC article. Review.
  • The Neurological Manifestations of Post-Acute Sequelae of SARS-CoV-2 infection.
    Moghimi N, Di Napoli M, Biller J, Siegler JE, Shekhar R, McCullough LD, Harkins MS, Hong E, Alaouieh DA, Mansueto G, Divani AA. Moghimi N, et al. Curr Neurol Neurosci Rep. 2021 Jun 28;21(9):44. doi: 10.1007/s11910-021-01130-1. Curr Neurol Neurosci Rep. 2021. PMID: 34181102 Free PMC article. Review.
See all similar articles

Cited by

References

    1. Chinn J, Sedighim S, Kirby KA, et al. Characteristics and outcomes of women with COVID-19 giving birth in U.S. academic centers during the COVID-19 pandemic. JAMA Netw Open 2021; 4(8):e2120456. DOI: 10.1001/jamanetworkopen.2021.20456 - DOI - PMC - PubMed
    1. Metz TD, Clifton RG, Hughes BL, et al. Association of SARS-CoV-2 infection with serious maternal morbidity and mortality from obstetric complications. JAMA 2022; 327(8):748–59. DOI: 10.1001/jama.2022.1190. - DOI - PMC - PubMed
    1. Simon E, Gouyon JB, Cottenet J, et al. Impact of SARS-CoV-2 infection on risk of prematurity, birthweight and obstetric complications: A multivariate analysis from a nationwide, population-based retrospective cohort study. BJOG 2022; 129(7):1084–94. DOI: 10.1111/1471-0528.17135 - DOI - PMC - PubMed
    1. Desisto CL, Wallace B, Simeone RM, et al. Risk for stillbirth among women with and without COVID-19 at delivery hospitalization – United States, March 2020-September 2021. MMWR Morb Mortal Wkly Rep 2021; 70(47):1640–45. . DOI: 10.15585/mmwr.mm7047e1. - DOI - PMC - PubMed
    1. Metz TD, Clifton RG, Hughes BL, et al. Disease severity and perinatal outcomes of pregnant patients with coronavirus disease 2019 (COVID-19). Obstet Gynecol 2021; 137(4):571–80. DOI: 10.1097/AOG.0000000000004339. - DOI - PMC - PubMed

Publication types

Associated data