COVID-19 in Pregnancy: Maternal, Neonatal, and Racial Disparities in a Local Cohort

Background COVID-19 during pregnancy has been linked to adverse maternal and neonatal outcomes. However, data describing these outcomes by trimester and within specific local populations remain limited. The influence of COVID-19 on racial disparities in pregnancy outcomes is also not well understood. Accordingly, we investigated trimester-specific maternal and neonatal outcomes, as well as racial disparities, in pregnancies complicated by COVID-19 in Rockford, Illinois. Objective To describe maternal and neonatal outcomes among women diagnosed with COVID-19 during pregnancy at Mercyhealth Javon Bea Hospital in Rockford, Illinois, and to compare outcomes by trimester of infection, race, and with county-level data. Methods We conducted a retrospective chart review of obstetric patients diagnosed with COVID-19 during pregnancy who delivered between January 1, 2019, and October 28, 2022. Maternal and neonatal outcomes were assessed by trimester of infection and race and compared with 2021 Winnebago County outcomes. Chi-square tests, Fisher's exact tests, and logistic regression were applied with 95% confidence intervals. Results Among 198 women diagnosed with COVID-19 (201 newborns), 15 (7.6%) were diagnosed in the first trimester, 73 (36.9%) in the second, and 110 (55.6%) in the third. Third-trimester infection was associated with pneumonia (13/110, 11.8%; p=0.024). First-trimester infection showed higher odds of preterm birth (7/17, 41.2%; OR=3.83, 95% CI 1.28-11.45) and low birth weight (4/17, 23.5%; OR=11.24, 95% CI 3.04-41.55). No maternal deaths were observed within the study period. Compared with 2021 Winnebago County data, our cohort had higher rates of gestational diabetes (16.2% vs. 10.8%; p=0.02) and ICU admission (1.5% vs. 0.3%; p=0.01). Other outcomes, including cesarean delivery, overall preterm birth, NICU admission, and low birth weight, were similar. Conclusion This single-center cohort suggests that trimester of infection may be associated with different maternal and neonatal outcomes, with pneumonia more common after third-trimester infection and preterm birth and low birth weight more frequent after first-trimester infection.