Reposted from University of Utah Health.

Nearly 1 in 10 people who get COVID while pregnant will go on to develop long COVID, a report published July 11 in Obstetrics & Gynecology has found.
 
“It was surprising to me that the prevalence was that high,” said Torri Metz, vice chair for research of obstetrics and gynecology at University of Utah Health, who co-led the nationwide study. “This is something that does continue to affect otherwise reasonably healthy and young populations.”

Intersecting risks

Prior research had shown that COVID affects pregnant people in uniquely risky ways. A COVID infection during pregnancy is more likely to lead to hospitalization or death, compared to an infection outside of pregnancy. COVID also increases the risk of pregnancy-related complications such as preterm birth or stillbirth. But until this study, the risk to pregnant people of developing long COVID was unknown.
 
The researchers enrolled more than 1,500 people who had been sick with COVID for the first time while pregnant and assessed self-reported long COVID symptoms at least six months after infection. As part of the National Institutes of Health RECOVER project, a massive collaboration to understand and treat long COVID, the large size of the study established solid associations and provided a picture of risk that was accurate for pregnant people across demographic groups.
 
The researchers found that 9.3% of people who contracted COVID during pregnancy went on to experience long-term symptoms. Some of the most common long COVID symptoms participants experienced were fatigue, gastrointestinal issues and feeling drained or exhausted by routine activities.

“This is a critical study as pregnancy and the postpartum period are one of the most vulnerable times in an individual’s life,” said David Goff, division director for the Division of Cardiovascular Sciences at the NIH’s National Heart, Lung, and Blood Institute. “By better understanding how individual characteristics interact with SARS-CoV-2 infection during pregnancy and lead to an increased risk of long COVID, this study yields important insights to potentially develop targeted interventions for this population.”

Because symptoms of long COVID can overlap with symptoms of pregnancy itself, Metz said, it’s especially important for obstetricians to be vigilant for them.

“I doubt most obstetric clinicians are as aware of long COVID as perhaps we should be,” Metz said. “But people are having these symptoms, and we need to make sure that we’re not forgetting that these could be long-term manifestations of their SARS-CoV-2 infection.”

To ensure that the reported long COVID symptoms weren’t arising from the pregnancy, the researchers did a secondary analysis that was restricted to people who reported symptoms more than 12 weeks after giving birth. The estimated risk of long COVID remained similar, confirming the initial findings.

While the rate of long COVID observed was surprisingly high, it could underestimate the actual risk of long COVID for pregnant people, Metz said. On average, people reported whether or not they had symptoms of long COVID 10 months after their initial infection, which means that the study could have missed people whose symptoms resolved earlier.

Several factors were associated with an increased risk of long COVID. People with anxiety or depression prior to their infection, as well as people with obesity, were more likely to experience lasting symptoms. 

Self-reported financial hardship was also associated with higher rates of long COVID, although the study could not determine whether financial difficulties were a cause or a consequence of extended symptoms.

Continued concern

Previous estimates of long COVID rates following infection in the general population range from 10% to more than 20%, putting the researchers’ results on the lower end of the risk spectrum. This could be because pregnant people’s immune systems tend to react less strongly to infection, Metz said. This puts pregnant people at higher risk of severe symptoms during the infection, but may put them at lower risk of long-term organ damage that can lead to persistent symptoms. Pregnant people tend to be overall younger and healthier than other populations, which could also contribute to the difference.
 
But the high prevalence of long COVID, including in pregnant populations, emphasizes that health practitioners should keep an eye out for its symptoms.

“We need to have this on our radar as we’re seeing patients,” Metz said. “It’s something we really don’t want to miss. And we want to get people referred to appropriate specialists who treat long COVID.”

Learn more about U of U Health’s Long COVID Clinic here.

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This research was published July 11 as “Post–Acute Sequelae of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) After Infection During Pregnancy” in Obstetrics and Gynecology. Funding came from the National Institutes of Health as part of the Researching COVID to Enhance Recovery (RECOVER) Research Initiative.
 
RECOVER brings together clinicians, scientists, caregivers, patients, and community members to understand, diagnose and treat long COVID. RECOVER has created one of the largest and most diverse groups of long COVID study participants in the world. In addition, RECOVER clinical trials are testing potential interventions across five symptom focus areas.

• Sophia Friesen Manager, Science Communications, University of Utah Health
  ‭(510) 495-7528‬ sophia.friesen@hsc.utah.edu