R3 Seminar Recap: Long COVID after SARS-CoV-2 during pregnancy

Observational study findings

Dr. Flaherman (University of California, San Francisco) emphasized the importance of understanding how the body responds to a SARS-CoV-2 infection during pregnancy. She shared that approximately 4 million pregnancies occur in the U.S. each year—and previous RECOVER research has found that between 10% and 26% of adults develop Long COVID after a SARS-CoV-2 infection. Given these data, it is especially important to examine the relationship between pregnancy and Long COVID. Dr. Flaherman discussed how RECOVER research including pregnant women might help develop Long COVID treatments for both pregnant women and other people.

Dr. Metz (University of Utah) presented research findings that showed about 1 in 10 pregnant women developed Long COVID symptoms at least 6 months after infection. She shared that the rate of Long COVID among women who had a SARS-CoV-2 infection during pregnancy may be 10% to 25% lower than in nonpregnant adults. These findings are based on data from participants in RECOVER’s observational study of pregnant women, which includes a large group of women from different backgrounds and walks of life who had COVID-19 while pregnant.

This study also identified several symptoms that pregnant women are likely to experience while having Long COVID, with the most common symptoms being fatigue, brain fog, dizziness, gastrointestinal problems, and post-exertional malaise (symptoms that get worse after physical, mental, or emotional activity).

Dr. Metz also highlighted specific characteristics found in pregnant women that were associated with a higher chance of developing Long COVID. Study participants who were more likely to develop Long COVID included pregnant women who:

• Had difficulty covering expenses or paying bills.
• Had depression or anxiety at the beginning of the study.
• Self-reported obesity before a SARS-CoV-2 infection.
• Required oxygen to help with COVID-19 symptoms.

EHR study findings

Dr. Zang (Cornell University) shared findings from analyses of EHR data from two national research networks: the National Patient-Centered Clinical Research Network (PCORnet) and the National COVID Cohort Collaborative (N3C). These studies compared women who were pregnant while having a SARS-CoV-2 infection with women who had similar characteristics but were not pregnant at the time of infection.

In datasets from both research networks included in the study, women who were pregnant while having a SARS-CoV-2 infection had a lower chance of developing Long COVID compared to women who were not pregnant during a SARS-CoV-2 infection. 

• PCORnet data revealed that the chance of developing Long COVID was about 17 cases per 100 people for pregnant women, compared to almost 19 cases per 100 people for nonpregnant peers.
• N3C data showed an even lower risk, at about 4 cases per 100 people for pregnant women, compared to about 6 per 100 people for nonpregnant peers.

Similar to the research shared by Dr. Metz, these EHR study findings identified several risk factors that might affect a pregnant woman’s chance of developing Long COVID. These risk factors included: 

• Race – Women who identified as Black were more likely to develop Long COVID.
• Age – Women who were 35 years or older during pregnancy were more likely to develop Long COVID.
• Trimester – Women who had a SARS-CoV-2 infection during the first or second trimester of pregnancy were more likely to develop Long COVID than those who had a SARS-CoV-2 infection later in pregnancy.
• COVID-19 variant – Women who had a SARS-CoV-2 infection during the Delta or Omicron waves were more likely to develop Long COVID.
• Body mass index (BMI) – Women with obesity were more likely to develop Long COVID.
• Pre-existing health conditions – Women with conditions such as diabetes, high blood pressure, asthma, or other chronic illnesses were more likely to develop Long COVID. 

Following both presentations, Dr. Flaherman led a discussion and noted that, “Studying Long COVID [in pregnant women] presents unique opportunities and also has unique challenges.”

Past studies researching Long COVID and pregnancy were smaller in size due to these challenges, which include: 

• Difficulty recruiting enough study participants.
• Difficulty telling the difference between pregnancy, postpartum, and Long COVID symptoms.
• Not being able to safely complete all tests required for a study on pregnant women.

To find recordings and transcripts of more R3 seminars, visit the RECOVER YouTube channel and the R3 webpage.