COVID-19 infection history as a risk factor for early pregnancy loss: results from the electronic health record-based Southeast Texas COVID and Pregnancy Cohort Study
Abstract Background The effects of SARS-CoV-2 infection before or during pregnancy on pregnancy outcomes are still largely unknown. We hypothesized that COVID-19 in early pregnancy is a risk factor for adverse pregnancy outcomes, particularly miscarriage. Methods We examined the relationship between...
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2025-05-01
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| Online Access: | https://doi.org/10.1186/s12916-025-04094-y |
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| author | Micaela N. Sandoval Michelle R. Klawans MacKinsey A. Bach Jennifer Mikhail Edward A. Graviss Tru Cao Jacqueline G. Parchem Junaid Husain Eric Boerwinkle |
| author_facet | Micaela N. Sandoval Michelle R. Klawans MacKinsey A. Bach Jennifer Mikhail Edward A. Graviss Tru Cao Jacqueline G. Parchem Junaid Husain Eric Boerwinkle |
| author_sort | Micaela N. Sandoval |
| collection | DOAJ |
| description | Abstract Background The effects of SARS-CoV-2 infection before or during pregnancy on pregnancy outcomes are still largely unknown. We hypothesized that COVID-19 in early pregnancy is a risk factor for adverse pregnancy outcomes, particularly miscarriage. Methods We examined the relationship between COVID-19 and adverse pregnancy outcomes, including spontaneous abortion, ectopic pregnancy, and preterm delivery in a large, retrospective, electronic health record (EHR)-based cohort, from 2019 to 2023. Generalized estimating equation modeling was performed to identify risk factors for adverse pregnancy outcomes. Study exposures included COVID-19 before pregnancy, COVID-19 during pregnancy, age, race/ethnicity, comorbidity burden, and neighborhood-level social vulnerability. Results In the Southeast Texas Pregnancy and COVID Cohort (26,783 pregnancy episodes), the risk of miscarriage among pregnancy episodes with a miscarriage, livebirth, or delivery outcome was 6.3% (1514/ 24,119). In multivariable modeling, history of both mild and moderate to severe COVID-19 before pregnancy were associated with miscarriage (adjusted odds ratio (aOR) 2.48, confidence interval (CI) 2.21–2.78 and aOR 2.81, CI 1.8–4.38, respectively). Additionally, in the same model, both mild and moderate to severe COVID-19 in the first trimester were associated with miscarriage (aOR 2.31, CI 1.96–2.72 and aOR 2.45, CI 1.12–5.35, respectively). Conclusions COVID-19 both prior to and during pregnancy was identified as a risk factor for spontaneous abortion in this study sample. These findings highlight the importance of COVID-19 vaccination and post-COVID management for pregnant people and those planning a pregnancy. |
| format | Article |
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| institution | Kabale University |
| issn | 1741-7015 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medicine |
| spelling | doaj-art-ffccce52fab54c0bae9cbb15c752a2392025-08-20T03:53:12ZengBMCBMC Medicine1741-70152025-05-0123111410.1186/s12916-025-04094-yCOVID-19 infection history as a risk factor for early pregnancy loss: results from the electronic health record-based Southeast Texas COVID and Pregnancy Cohort StudyMicaela N. Sandoval0Michelle R. Klawans1MacKinsey A. Bach2Jennifer Mikhail3Edward A. Graviss4Tru Cao5Jacqueline G. Parchem6Junaid Husain7Eric Boerwinkle8Department of Epidemiology, University of Texas Health Science Center at Houston School of Public HealthDepartment of Epidemiology, University of Texas Health Science Center at Houston School of Public HealthDepartment of Epidemiology, University of Texas Health Science Center at Houston School of Public HealthHealthconnect TexasHouston Methodist Research InstituteDepartment of Biostatistics and Data Science, University of Texas Health Science Center at Houston School of Public HealthDepartment of Obstetrics, Gynecology & Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at HoustonHealthconnect TexasDepartment of Epidemiology, University of Texas Health Science Center at Houston School of Public HealthAbstract Background The effects of SARS-CoV-2 infection before or during pregnancy on pregnancy outcomes are still largely unknown. We hypothesized that COVID-19 in early pregnancy is a risk factor for adverse pregnancy outcomes, particularly miscarriage. Methods We examined the relationship between COVID-19 and adverse pregnancy outcomes, including spontaneous abortion, ectopic pregnancy, and preterm delivery in a large, retrospective, electronic health record (EHR)-based cohort, from 2019 to 2023. Generalized estimating equation modeling was performed to identify risk factors for adverse pregnancy outcomes. Study exposures included COVID-19 before pregnancy, COVID-19 during pregnancy, age, race/ethnicity, comorbidity burden, and neighborhood-level social vulnerability. Results In the Southeast Texas Pregnancy and COVID Cohort (26,783 pregnancy episodes), the risk of miscarriage among pregnancy episodes with a miscarriage, livebirth, or delivery outcome was 6.3% (1514/ 24,119). In multivariable modeling, history of both mild and moderate to severe COVID-19 before pregnancy were associated with miscarriage (adjusted odds ratio (aOR) 2.48, confidence interval (CI) 2.21–2.78 and aOR 2.81, CI 1.8–4.38, respectively). Additionally, in the same model, both mild and moderate to severe COVID-19 in the first trimester were associated with miscarriage (aOR 2.31, CI 1.96–2.72 and aOR 2.45, CI 1.12–5.35, respectively). Conclusions COVID-19 both prior to and during pregnancy was identified as a risk factor for spontaneous abortion in this study sample. These findings highlight the importance of COVID-19 vaccination and post-COVID management for pregnant people and those planning a pregnancy.https://doi.org/10.1186/s12916-025-04094-yCOVID-19PregnancyMiscarriageInfectious diseaseEpidemiologyElectronic health records |
| spellingShingle | Micaela N. Sandoval Michelle R. Klawans MacKinsey A. Bach Jennifer Mikhail Edward A. Graviss Tru Cao Jacqueline G. Parchem Junaid Husain Eric Boerwinkle COVID-19 infection history as a risk factor for early pregnancy loss: results from the electronic health record-based Southeast Texas COVID and Pregnancy Cohort Study BMC Medicine COVID-19 Pregnancy Miscarriage Infectious disease Epidemiology Electronic health records |
| title | COVID-19 infection history as a risk factor for early pregnancy loss: results from the electronic health record-based Southeast Texas COVID and Pregnancy Cohort Study |
| title_full | COVID-19 infection history as a risk factor for early pregnancy loss: results from the electronic health record-based Southeast Texas COVID and Pregnancy Cohort Study |
| title_fullStr | COVID-19 infection history as a risk factor for early pregnancy loss: results from the electronic health record-based Southeast Texas COVID and Pregnancy Cohort Study |
| title_full_unstemmed | COVID-19 infection history as a risk factor for early pregnancy loss: results from the electronic health record-based Southeast Texas COVID and Pregnancy Cohort Study |
| title_short | COVID-19 infection history as a risk factor for early pregnancy loss: results from the electronic health record-based Southeast Texas COVID and Pregnancy Cohort Study |
| title_sort | covid 19 infection history as a risk factor for early pregnancy loss results from the electronic health record based southeast texas covid and pregnancy cohort study |
| topic | COVID-19 Pregnancy Miscarriage Infectious disease Epidemiology Electronic health records |
| url | https://doi.org/10.1186/s12916-025-04094-y |
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