Research Article

Is COVID-19 a Risk Factor for Hypertensive Disorders of Pregnancy?

Hannah Childs, Cayman Bickerstaff*, Teodora Stoikov, Hongyan Xu, Katherine Marino, Cynthia Li, Lina Nguye, Bailey Rodgers and Jennifer T Allen

Published: 11 September, 2023 | Volume 6 - Issue 3 | Pages: 120-125

Objective: This study aims to assess whether COVID-19 infection during pregnancy is a risk factor for hypertensive disorders of pregnancy, including gestational hypertension, preeclampsia, HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome, and eclampsia. 
Methods: A retrospective evaluation was conducted on obstetric patients who gave birth between March 2020 and December 2021 at Augusta University Medical Center, an academic urban referral center in Augusta, GA. The patients were categorized into two groups: those who were COVID-19 positive during pregnancy and those who were COVID-19 negative. The primary outcome was the development of a hypertensive disorder of pregnancy. Secondary outcomes included preterm delivery, mode of delivery, maternal death, maternal ICU admission, NICU admission, intrauterine fetal demise/stillbirth, fetal growth restriction, and prolonged hospital stay. The association between COVID-19 status and categorical outcomes was assessed using Chi-squared and Fisher’s exact tests. Mean differences between groups were evaluated using Student’s two-sample tests. Additionally, a multinomial multiple logistic regression was performed to assess whether COVID-19 is a risk factor for hypertensive disorders of pregnancy when adjusting for potential confounding effects. 
Results: Out of the 2760 charts reviewed, 2426 (87.9%) met the inclusion criteria. Of those 2426 patients, 203 were COVID-positive and 2223 were COVID-negative . There were no significant differences in patient sociodemographic information between the COVID-19 positive and negative groups. After adjusting for potential confounding effects, COVID-19 was determined to be a risk factor for combined hypertensive disorders of pregnancy (OR 1.93, 95% CI 1.39-2.66) and preeclampsia specifically (OR 2.01, 95% CI 1.38-2.88).
For the observed secondary outcomes, COVID-19 infection during pregnancy was associated with an increased risk of cesarean delivery (p = 0.046), maternal ICU admission (p = 0.008), and prolonged hospital stay (p < 0.001).
Conclusion: The findings of this study suggest that COVID-19 infection during pregnancy is linked to an increased risk of developing preeclampsia. COVID-19 was not a statistically significant risk factor for gestational hypertension when controlling for confounding effects. The study was unable to draw conclusions about more severe hypertensive conditions of pregnancy (HELLP, Eclampsia), likely due to their low prevalence in the study sample. COVID-19 was shown to be a risk factor for cesarean delivery, prolonged hospital stay, and maternal ICU admission in secondary outcome analysis. This research contributes to existing knowledge by examining the association between COVID-19 and hypertensive disorders of pregnancy during a period encompassing multiple strains of the COVID-19 virus.

Read Full Article HTML DOI: 10.29328/journal.cjog.1001139 Cite this Article Read Full Article PDF


COVID-19 infection; Pregnancy; Gestational hypertension; Preeclampsia


  1. The Society for Maternal-Fetal Medicine. Management of COVID Positive Pregnant Patients. https://www.smfm.org/covidclinical  
  2. Wang CL, Liu YY, Wu CH, Wang CY, Wang CH, Long CY. Impact of COVID-19 on Pregnancy. Int J Med Sci. 2021 Jan 1;18(3):763-767. doi: 10.7150/ijms.49923. PMID: 33437211; PMCID: PMC7797535.
  3. The Society for Maternal-Fetal Medicine. What MFMs need to know. https://www.smfm.org/covidclinical  
  4. Novel coronavirus 2019 (COVID-19). ACOG Practice Advisory. https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2020/03/novel-coronavirus-2019  
  5. Karrar SA, Hong PL. Preeclampsia. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023. https://www.ncbi.nlm.nih.gov/books/NBK570611/   
  6. Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222. Obstet Gynecol. 2020 Jun;135(6):e237-e260. doi: 10.1097/AOG.0000000000003891. PMID: 32443079.
  7. Villar J, Ariff S, Gunier RB, Thiruvengadam R, Rauch S, Kholin A, Roggero P, Prefumo F, do Vale MS, Cardona-Perez JA, Maiz N, Cetin I, Savasi V, Deruelle P, Easter SR, Sichitiu J, Soto Conti CP, Ernawati E, Mhatre M, Teji JS, Liu B, Capelli C, Oberto M, Salazar L, Gravett MG, Cavoretto PI, Nachinab VB, Galadanci H, Oros D, Ayede AI, Sentilhes L, Bako B, Savorani M, Cena H, García-May PK, Etuk S, Casale R, Abd-Elsalam S, Ikenoue S, Aminu MB, Vecciarelli C, Duro EA, Usman MA, John-Akinola Y, Nieto R, Ferrazi E, Bhutta ZA, Langer A, Kennedy SH, Papageorghiou AT. Maternal and Neonatal Morbidity and Mortality Among Pregnant Women With and Without COVID-19 Infection: The INTERCOVID Multinational Cohort Study. JAMA Pediatr. 2021 Aug 1;175(8):817-826. doi: 10.1001/jamapediatrics.2021.1050. Erratum in: JAMA Pediatr. 2022 Jan 1;176(1):104. PMID: 33885740; PMCID: PMC8063132.
  8. Papageorghiou AT, Deruelle P, Gunier RB, Rauch S, García-May PK, Mhatre M, Usman MA, Abd-Elsalam S, Etuk S, Simmons LE, Napolitano R, Deantoni S, Liu B, Prefumo F, Savasi V, do Vale MS, Baafi E, Zainab G, Nieto R, Maiz N, Aminu MB, Cardona-Perez JA, Craik R, Winsey A, Tavchioska G, Bako B, Oros D, Rego A, Benski AC, Hassan-Hanga F, Savorani M, Giuliani F, Sentilhes L, Risso M, Takahashi K, Vecchiarelli C, Ikenoue S, Thiruvengadam R, Soto Conti CP, Ferrazzi E, Cetin I, Nachinab VB, Ernawati E, Duro EA, Kholin A, Firlit ML, Easter SR, Sichitiu J, Bowale A, Casale R, Cerbo RM, Cavoretto PI, Eskenazi B, Thornton JG, Bhutta ZA, Kennedy SH, Villar J. Preeclampsia and COVID-19: results from the INTERCOVID prospective longitudinal study. Am J Obstet Gynecol. 2021 Sep;225(3):289.e1-289.e17. doi: 10.1016/j.ajog.2021.05.014. Epub 2021 Jun 26. PMID: 34187688; PMCID: PMC8233533.
  9. Hill J, Patrick HS, Ananth CV, O'Brien D, Spernal S, Horgan R, Brandt JS, Schwebel M, Miller RC, Straker MJ, Graebe RA, Rosen T. Obstetrical outcomes and follow-up for patients with asymptomatic COVID-19 at delivery: a multicenter prospective cohort study. Am J Obstet Gynecol MFM. 2021 Nov;3(6):100454. doi: 10.1016/j.ajogmf.2021.100454. Epub 2021 Aug 8. PMID: 34375750; PMCID: PMC8349406.
  10. Narang K, Enninga EAL, Gunaratne MDSK, Ibirogba ER, Trad ATA, Elrefaei A, Theiler RN, Ruano R, Szymanski LM, Chakraborty R, Garovic VD. SARS-CoV-2 Infection and COVID-19 During Pregnancy: A Multidisciplinary Review. Mayo Clin Proc. 2020 Aug;95(8):1750-1765. doi: 10.1016/j.mayocp.2020.05.011. Epub 2020 May 30. PMID: 32753148; PMCID: PMC7260486.
  11. Jayaram A, Buhimschi IA, Aldasoqi H, Hartwig J, Owens T, Elam GL, Buhimschi CS. Who said differentiating preeclampsia from COVID-19 infection was easy? Pregnancy Hypertens. 2021 Dec;26:8-10. doi: 10.1016/j.preghy.2021.07.248. Epub 2021 Jul 24. PMID: 34392167; PMCID: PMC8302825.
  12. Østergaard L. SARS CoV-2 related microvascular damage and symptoms during and after COVID-19: Consequences of capillary transit-time changes, tissue hypoxia and inflammation. Physiol Rep. 2021 Feb;9(3):e14726. doi: 10.14814/phy2.14726. PMID: 33523608; PMCID: PMC7849453.
  13. Delta Variant. Baptist Health. 2023. https://www.baptisthealth.com/connect-learn/covid19/covid19-resources/covid-19-variants/delta-variant#:~:text=Has%20the%20Delta%20Variant%20Reached,the%20U.S.%20in%20March%202021.

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