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NATIONAL HARBOR, Md. -- One in 10 people who were pregnant at their index COVID-19 infection developed long COVID, according to an analysis of a pregnancy cohort in the NIH's RECOVER Initiative.

In the final cohort of 1,502 women, 9.3% met criteria for post-acute sequelae of SARS-CoV-2 infection (PASC), and median time to the PASC-defining study visit was 10.3 months (interquartile range 6.1-21.5), reported Torri Metz, MD, MS, division chief for the department of maternal-fetal medicine at the University of Utah Health in Salt Lake City.

In general, 10% to 25% of adults develop long COVID after infection, Metz noted during her presentation at the Society for Maternal-Fetal Medicine annual meeting.

"This warrants more research to investigate the differences between pregnant and nonpregnant populations to determine if there's something unique about pregnancy that can give us insight into the pathophysiology of PASC," Metz said, adding that the team will be comparing the larger adult RECOVER population with the pregnancy cohort.

"We know that pregnant people are at higher risk of developing severe COVID-19, ICU admission, and death; thus, pregnant people have been disproportionately impacted by COVID-19," Metz said.

Amy Crockett, MD, MSPH, a maternal-fetal medicine physician at Prisma Health in Greenville, South Carolina, told MedPage Today that COVID has been linked to many serious problems for pregnant people and babies, such as increased risk of stillbirth and more severe cases of COVID.

"It's good news to see for pregnant women that they're less likely to develop the symptoms of long COVID than patients that are not pregnant," Crockett said.

The most common symptoms in this study were post-exertional malaise, fatigue, gastrointestinal symptoms, dizziness, and brain fog, the researchers reported.

Of the patients with PASC, 57% had difficulty covering expenses (adjusted OR 1.57, 95% CI 1.05-2.34), 38% had obesity (aOR 1.65, 95% CI 1.12-2.43), 59% had depression or anxiety (aOR 2.64, 95% CI 1.79-3.88), and 12% needed oxygen for acute infection (aOR 1.86, 95% CI 1.00-3.44).

In unadjusted models, infection pre-Omicron, not being fully vaccinated, higher discrimination index scores, and medical comorbidities were associated with long COVID, but this was not the case after adjustment.

In total, 1,502 of the original group of 14,636 participants from the RECOVER-pregnancy cohort were included. Those who had no study visit with the PASC symptom survey 6 months or more from the index infection were excluded. Participants were enrolled from December 2021 through September 2023. There were 26 in-person sites, and data from other locations were captured remotely through the University of California San Francisco.

Metz and team examined sociodemographic factors, such as insurance status and enrollment, self-reported difficulty paying bills, and discrimination measured using the Everyday Discrimination Scale. They also assessed pre-existing clinical characteristics, such as vaccination status and medical comorbidities including tobacco use, obesity, hypertension, and depression or anxiety disorder, as well as the severity of the SARS-CoV-2 infection, especially the need for oxygen, the trimester in which infection occurred, and the date it occurred as proxy for COVID variant.

Every 3 months following initial COVID infection, participants completed surveys on PASC symptoms and severity. RECOVER developed a PASC scoring system based on presence and severity of symptoms on a scale from 0 to 34. If a participant scored 12 or higher, they were considered to have long COVID.

Among these patients, 48% had their index infection during their third trimester and 61% were during Omicron's dominance; 51% were fully vaccinated ≥2 weeks before index infection. In addition, 24% reported obesity in the year prior to infection, and 29% had medical comorbidities.

Metz noted that it's possible that the PASC algorithm missed some people with long COVID and that some long COVID symptoms overlap with pregnancy and postpartum symptoms. Additionally, nirmatrelvir/ritonavir (Paxlovid) wasn't used frequently enough to analyze its effects.

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