Background: Risk factors for SARS-CoV2 infection in pregnancy remain poorly understood. Understanding populations at heightened risk of acquisition is essential to more effectively target outreach and prevention efforts. Objective: To compare sociodemographic and clinical characteristics of pregnant women with and without SARS-CoV2 infection and, among those with SARS-CoV2, to compare characteristics of those who reported COVID-19 symptoms and those who were asymptomatic at diagnosis. Study Design: This retrospective cohort study includes pregnant women who delivered or intended to deliver at Northwestern Memorial Hospital after initiation of a universal testing protocol on admission (April 8, 2020 - May 31, 2020). Women were dichotomized by whether they tested positive for SARS-CoV2. Among women who tested positive, women were further dichotomized by whether they endorsed symptoms of COVID-19. Bivariable analysis, and non-parametric tests of trend were used for analyses. Logistic regression was used to control for potential confounders as well as to examine effect modification between race and ethnicity and any other identified risk factors. Results: During the study period, 1,418 women met inclusion criteria, of whom 101 (7.1%) tested positive for SARS-CoV2. Of the 101 women who tested positive, 77 (76.2%) were symptomatic at the time of diagnosis. Compared to women who tested negative for SARS-CoV2, women who tested positive were younger and were more likely to have public insurance, to identify as Black/African-American or Latina, to be unmarried, to be obese, have pre-existing pulmonary disease, and have living children. An increasing number of living children was associated with an increasing risk of SARS-CoV2 infection and this finding persisted after controlling for potential confounders. There was no effect modification between race or ethnicity and having living children with regard to the risk of infection. There were no significant differences identified between women who were symptomatic and asymptomatic. Conclusion: Many risk factors for SARS-CoV2 infection in pregnancy are similar to the social and structural determinants of health that have been reported in the general population. The observed association between SARS-CoV2 infection and having children raises the possibility of children themselves as vectors of viral spread or behavior patterns of parents as mediators of acquisition.
Risk Factors for SARS-CoV2 Infection in Pregnant Women