The association of COVID-19 infection in pregnancy with preterm birth: A retrospective cohort study in California

Deborah Karasek, PhD, MPH; Rebecca J. Baer, MPH; Monica R. McLemore, PhD, MPH, RN, FAAN; April J. Bell, PhD, MPH; Bridgette E. Blebu, PhD, MPH; Joan A. Casey, PhD; Kimberly Coleman-Phox, MPH; Jean M. Costello; Jennifer N. Felder, PhD; Elena Flowers, PhD, RN; Jonathan D. Fuchs, MD, MPH; Anu Manchikanti Gomez, PhD, MSc; Kayla Karvonen, MD; Miriam Kuppermann, PhD, MPH; Liang Liang, PhD; Safyer McKenzie-Sampson, MSPH; Charles E. McCulloch, PhD; Scott P. Oltman, MS; Matthew S Pantell, MD, MS; Xianhua Piao, MD, PhD; Aric A. Prather, PhD; Rebecca J. Schmidt, PhD; Karen A. Scott, MD, MPH, FACOG; Solaire Spellen, MPH; Jodi D Stookey, PhD; Martha Tesfalul, MD; Larry Rand, MD; Laura L. Jelliffe-Pawlowski, PhD, MS

The Lancet Regional Health. Americas (Oct 2021)

The association of COVID-19 infection in pregnancy with preterm birth: A retrospective cohort study in California

Deborah Karasek, PhD, MPH,
Rebecca J. Baer, MPH,
Monica R. McLemore, PhD, MPH, RN, FAAN,
April J. Bell, PhD, MPH,
Bridgette E. Blebu, PhD, MPH,
Joan A. Casey, PhD,
Kimberly Coleman-Phox, MPH,
Jean M. Costello,
Jennifer N. Felder, PhD,
Elena Flowers, PhD, RN,
Jonathan D. Fuchs, MD, MPH,
Anu Manchikanti Gomez, PhD, MSc,
Kayla Karvonen, MD,
Miriam Kuppermann, PhD, MPH,
Liang Liang, PhD,
Safyer McKenzie-Sampson, MSPH,
Charles E. McCulloch, PhD,
Scott P. Oltman, MS,
Matthew S Pantell, MD, MS,
Xianhua Piao, MD, PhD,
Aric A. Prather, PhD,
Rebecca J. Schmidt, PhD,
Karen A. Scott, MD, MPH, FACOG,
Solaire Spellen, MPH,
Jodi D Stookey, PhD,
Martha Tesfalul, MD,
Larry Rand, MD,
Laura L. Jelliffe-Pawlowski, PhD, MS

Affiliations

Deborah Karasek, PhD, MPH: Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco 490 Illinois Street, Flr 9 Box 2930, San Francisco, CA 94143, USA; California Preterm Birth Initiative, University of California, San Francisco, 490 Illinois Street, Flr 9 Box 2930, San Francisco, CA 94143, USA; Corresponding author:
Rebecca J. Baer, MPH: California Preterm Birth Initiative, University of California, San Francisco, 490 Illinois Street, Flr 9 Box 2930, San Francisco, CA 94143, USA; Department of Pediatrics, University of California San Diego, 9500 Gilman Drive, La Jolla, California 92093, USA
Monica R. McLemore, PhD, MPH, RN, FAAN: Department of Family Health Care Nursing, 2 Koret Way, San Francisco CA 94143, USA
April J. Bell, PhD, MPH: Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco 490 Illinois Street, Flr 9 Box 2930, San Francisco, CA 94143, USA; California Preterm Birth Initiative, University of California, San Francisco, 490 Illinois Street, Flr 9 Box 2930, San Francisco, CA 94143, USA
Bridgette E. Blebu, PhD, MPH: Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco 490 Illinois Street, Flr 9 Box 2930, San Francisco, CA 94143, USA; California Preterm Birth Initiative, University of California, San Francisco, 490 Illinois Street, Flr 9 Box 2930, San Francisco, CA 94143, USA
Joan A. Casey, PhD: Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, 722 West 168th St. NY, NY 10032, USA
Kimberly Coleman-Phox, MPH: Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco 490 Illinois Street, Flr 9 Box 2930, San Francisco, CA 94143, USA; California Preterm Birth Initiative, University of California, San Francisco, 490 Illinois Street, Flr 9 Box 2930, San Francisco, CA 94143, USA
Jean M. Costello: California Preterm Birth Initiative, University of California, San Francisco, 490 Illinois Street, Flr 9 Box 2930, San Francisco, CA 94143, USA; Department of Biological and Medical Informatics, University of California San Francisco, 550 16th Street, Flr 3, San Francisco, CA, 94158, USA
Jennifer N. Felder, PhD: Osher Center for Integrative Medicine, University of California, San Francisco, 1545 Divisadero St, San Francisco, CA 94115, USA; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 3333 California Street, San Francisco CA 94118, USA
Elena Flowers, PhD, RN: Department of Physiological Nursing, University of California, San Francisco, Koret Way, San Francisco, CA 94143, USA
Jonathan D. Fuchs, MD, MPH: California Preterm Birth Initiative, University of California, San Francisco, 490 Illinois Street, Flr 9 Box 2930, San Francisco, CA 94143, USA; Center for Learning & Innovation, San Francisco Department of Public Health 25 Van Ness, Suite 500, San Francisco, CA, 94102, USA
Anu Manchikanti Gomez, PhD, MSc: School of Social Welfare, Sexual Health and Reproductive Equity Program, University of California, Berkeley, 110 Haviland Hall MC 7400, Berkeley, CA 94720-7400, USA
Kayla Karvonen, MD: Department of Pediatrics, University of California San Francisco, 550 16th Street, Box 0110, San Francisco, CA 94143, USA
Miriam Kuppermann, PhD, MPH: Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco 490 Illinois Street, Flr 9 Box 2930, San Francisco, CA 94143, USA; California Preterm Birth Initiative, University of California, San Francisco, 490 Illinois Street, Flr 9 Box 2930, San Francisco, CA 94143, USA
Liang Liang, PhD: Department of Genetics, Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305, USA
Safyer McKenzie-Sampson, MSPH: Department of Epidemiology and Biostatistics, University of California, San Francisco, 550 16th Street, Flr 3, San Francisco, CA, 94158, USA
Charles E. McCulloch, PhD: Department of Epidemiology and Biostatistics, University of California, San Francisco, 550 16th Street, Flr 3, San Francisco, CA, 94158, USA
Scott P. Oltman, MS: California Preterm Birth Initiative, University of California, San Francisco, 490 Illinois Street, Flr 9 Box 2930, San Francisco, CA 94143, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, 550 16th Street, Flr 3, San Francisco, CA, 94158, USA
Matthew S Pantell, MD, MS: California Preterm Birth Initiative, University of California, San Francisco, 490 Illinois Street, Flr 9 Box 2930, San Francisco, CA 94143, USA; School of Social Welfare, Sexual Health and Reproductive Equity Program, University of California, Berkeley, 110 Haviland Hall MC 7400, Berkeley, CA 94720-7400, USA
Xianhua Piao, MD, PhD: Newborn Brain Research Institute, Department of Pediatrics, Weill Institute for Neuroscience, University of California San Francisco, 1651 4th St, San Francisco, CA 94158, USA
Aric A. Prather, PhD: Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 3333 California Street, San Francisco CA 94118, USA
Rebecca J. Schmidt, PhD: Department of Public Health Sciences and MIND Institute, School of Medicine, and Perinatal Origins of Disparities Center; University of California Davis, 123 Med Sci 1C, One Shields Ave, Davis, California 95616, USA
Karen A. Scott, MD, MPH, FACOG: Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco 490 Illinois Street, Flr 9 Box 2930, San Francisco, CA 94143, USA; California Preterm Birth Initiative, University of California, San Francisco, 490 Illinois Street, Flr 9 Box 2930, San Francisco, CA 94143, USA; Department of Humanities and Social Sciences, University of California, San Francisco, 490 Illinois Street, Flr 7, San Francisco, CA 94143, USA
Solaire Spellen, MPH: Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco 490 Illinois Street, Flr 9 Box 2930, San Francisco, CA 94143, USA; California Preterm Birth Initiative, University of California, San Francisco, 490 Illinois Street, Flr 9 Box 2930, San Francisco, CA 94143, USA
Jodi D Stookey, PhD: Maternal, Child & Adolescent Health, San Francisco Department of Public Health, 30 Van Ness Avenue, Suite 260B, San Francisco, CA, USA
Martha Tesfalul, MD: Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco 490 Illinois Street, Flr 9 Box 2930, San Francisco, CA 94143, USA; California Preterm Birth Initiative, University of California, San Francisco, 490 Illinois Street, Flr 9 Box 2930, San Francisco, CA 94143, USA
Larry Rand, MD: Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco 490 Illinois Street, Flr 9 Box 2930, San Francisco, CA 94143, USA; California Preterm Birth Initiative, University of California, San Francisco, 490 Illinois Street, Flr 9 Box 2930, San Francisco, CA 94143, USA
Laura L. Jelliffe-Pawlowski, PhD, MS: California Preterm Birth Initiative, University of California, San Francisco, 490 Illinois Street, Flr 9 Box 2930, San Francisco, CA 94143, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, 550 16th Street, Flr 3, San Francisco, CA, 94158, USA

Journal volume & issue: Vol. 2
p. 100027

Abstract

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Introduction: Our understanding of the association between coronavirus disease 19 (COVID-19) and preterm or early term birth among racially and ethnically diverse populations and people with chronic medical conditions is limited.Methods: We determined the association between COVID-19 and preterm (PTB) birth among live births documented by California Vital Statistics birth certificates between July 2020 and January 2021 (n=240,147). We used best obstetric estimate of gestational age to classify births as very preterm (VPTB, <32 weeks), PTB (< 37 weeks), early term (37 and 38 weeks), and term (39-44 weeks), as each confer independent risks to infant health and development. Separately, we calculated the joint effects of COVID-19 diagnosis, hypertension, diabetes, and obesity on PTB and VPTB.Findings: COVID-19 diagnoses on birth certificates increased for all racial/ethnic groups between July 2020 and January 2021 and were highest for American Indian/Alaska Native (12.9%), Native Hawaiian/Pacific Islander (11.4%), and Latinx (10.3%) birthing people. COVID-19 diagnosis was associated with an increased risk of VPTB (aRR 1.6, 95% CI [1.4, 1.9]), PTB (aRR 1.4, 95% CI [1.3, 1.4]), and early term birth (aRR 1.1, 95% CI [1.1, 1.2]). There was no effect modification of the overall association by race/ethnicity or insurance status. COVID-19 diagnosis was associated with elevated risk of PTB in people with hypertension, diabetes, and/or obesity.Interpretation: In a large population-based study, COVID-19 diagnosis increased the risk of VPTB, PTB, and early term birth, particularly among people with medical comorbidities. Considering increased circulation of COVID-19 variants, preventative measures, including vaccination, should be prioritized for birthing persons.Funding: UCSF-Kaiser Department of Research Building Interdisciplinary Research Careers in Women's Health Program (BIRCWH) National Institute of Child Health and Human Development (NICHD) and the Office of Research on Women's Health (ORWH) [K12 HD052163] and the California Preterm Birth Initiative, funded by Marc and Lynn Benioff.

Published in The Lancet Regional Health. Americas

ISSN: 2667-193X (Online)
Publisher: Elsevier
Country of publisher: United Kingdom
LCC subjects: Medicine: Public aspects of medicine
Website: https://www.thelancet.com/journals/lanam/home

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