Long COVID after SARS-CoV-2 during pregnancy in the United States
Zang, C; Guth, D; Bruno, AM; et al., Nature Communications
Published
April 2025
Journal
Nature Communications
Abstract
Pregnancy alters immune responses and clinical manifestations of COVID-19, but its impact on Long COVID remains uncertain. This study investigated Long COVID risk in individuals with SARS-CoV-2 infection during pregnancy compared to reproductive-age females infected outside of pregnancy. A retrospective analysis of two U.S. databases, the National Patient-Centered Clinical Research Network (PCORnet) and the National COVID Cohort Collaborative (N3C), identified 29,975 pregnant individuals (aged 18-50) with SARS-CoV-2 infection in pregnancy from PCORnet and 42,176 from N3C between March 2020 and June 2023. At 180 days after infection, estimated Long COVID risks for those infected during pregnancy were 16.47 per 100 persons (95% CI, 16.00-16.95) in PCORnet using the PCORnet computational phenotype (CP) model and 4.37 per 100 persons (95% CI, 4.18-4.57) in N3C using the N3C CP model. Compared to matched non-pregnant individuals, the adjusted hazard ratios for Long COVID were 0.86 (95% CI, 0.83-0.90) in PCORnet and 0.70 (95% CI, 0.66-0.74) in N3C. The observed risk factors for Long COVID included Black race/ethnicity, advanced maternal age, first- and second-trimester infection, obesity, and comorbid conditions. While the findings suggest a high incidence of Long COVID among pregnant individuals, their risk was lower than that of matched non-pregnant females.
Authors
Chengxi Zang, Daniel Guth, Ann M Bruno, Zhenxing Xu, Haoyang Li, Nariman Ammar, Robert Chew, Nick Guthe, Emily Hadley, Rainu Kaushal, Tanzy Love, Brenda M McGrath, Rena C Patel, Elizabeth C Seibert, Yalini Senathirajah, Sharad Kumar Singh, Fei Wang, Mark G Weiner, Kenneth J Wilkins, Yiye Zhang, Torri D Metz, Elaine Hill, Thomas W Carton, RECOVER PCORnet EHR Consortia, RECOVER N3C EHR Consortia, RECOVER Pregnancy Consortia
Keywords
Humans; Female; Pregnancy; COVID-19/epidemiology/virology/complications; Adult; United States/epidemiology; Pregnancy Complications, Infectious/epidemiology/virology; SARS-CoV-2/isolation & purification; Retrospective Studies; Adolescent; Young Adult; Middle Aged; Risk Factors
Short Summary
This RECOVER study looked at whether pregnancy made it more or less likely to get Long COVID. Researchers compared the electronic health records (EHRs) of pregnant women who had COVID-19 during pregnancy to those of non-pregnant women of the same age who also had COVID-19. They found that even though many pregnant women got Long COVID, they were less likely to get it than non-pregnant women their age who had COVID-19. But, certain risk factors increased the chances of Long COVID among pregnant women. These included identifying as Black, being age 35 or older, having COVID-19 earlier in pregnancy, being overweight, and having other health conditions. This study shows that even though many pregnant women have Long COVID, they are less likely to get it than women who are not pregnant.