Impact of COVID-19 on Pregnancy Outcomes across Trimesters in the United States

Background: Evidence on trimester-specific risks of COVID-19 in pregnancy remains limited. Using the US National Inpatient Sample (NIS) 2020, we examined trimester-specific outcomes among hospitalized pregnant women with COVID-19. Results: Among 3,447,771 pregnant women identified, those with COVID-19 had higher in-hospital mortality in the third trimester than those without COVID-19. Mechanical ventilation, acute kidney injury (AKI), renal replacement therapy, and perinatal complications (preeclampsia, HELLP syndrome, preterm birth) were significantly elevated across trimesters in COVID-19 patients. COVID-19 was more prevalent among low-income, Hispanic pregnant women. Conclusions: COVID-19 during pregnancy is associated with increased maternal mortality and complications, particularly in the third trimester, and substantial racial/socioeconomic disparities. Equitable healthcare strategies are needed to mitigate adverse maternal and fetal outcomes.

Shiza Virk, Karthik Gan, Adeel Nasrullah, Aaisha Shah, Zohaa Faiz, Umair Khan, David Bradley Jackson, Anam Javed, Asif Farooq, Briana Disilvio, Tariq Cheema, Abu Baker Sheikh