{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,2]],"date-time":"2025-08-02T18:33:01Z","timestamp":1754159581250,"version":"3.41.2"},"reference-count":30,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,6,30]],"date-time":"2025-06-30T00:00:00Z","timestamp":1751241600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pregnancy"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>To examine the association between pre\u2010pregnancy and gestational COVID\u201019 infection by trimester with adverse pregnancy and infant outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective cohort study was conducted to evaluate singleton live births and fetal deaths among pregnant women in South Carolina (SC) from January 2020 through December 2022. Birth certificate and COVID\u201019 diagnosis data obtained from the SC Department of Health and Environmental Control were linked to inpatient hospital discharge and emergency department records and Medicaid eligibility files from the SC Revenue and Fiscal Affairs Office. Log\u2010binomial and modified Poisson models were used in matched and unmatched analyses to estimate risk ratios (RRs) for maternal and infant outcomes associated with COVID\u201019 infection pre\u2010pregnancy, during the first\/second trimester, and during the third trimester.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 145,028 pregnancies, first infection with COVID\u201019 occurred for 7.5% before pregnancy, 5.5% during the first\/second trimester, and 3.4% during the third trimester. In matched analyses following adjustment for sociodemographic, clinical, and behavioral factors, COVID\u201019 infection pre\u2010pregnancy increased the risk for hypertensive disorders of pregnancy (HDP) (RR\u00a0=\u00a01.07, 95% CI: 1.03\u20131.14), preeclampsia\/eclampsia (RR\u00a0=\u00a01.09, 95% CI: 1.01\u20131.17), and cesarean delivery (RR\u00a0=\u00a01.06, 95% CI: 1.00\u20131.11). COVID\u201019 infection during the first\/second trimester increased the risk for preeclampsia\/eclampsia (RR\u00a0=\u00a01.10, 95% CI: 1.00\u20131.20) as well as placental abruption (RR\u00a0=\u00a01.15, 95% CI: 1.01\u20131.30) and severe maternal morbidity (SMM) with (RR\u00a0=\u00a01.60, 95% CI: 1.32\u20131.93) and without transfusion (RR\u00a0=\u00a01.91, 95% CI: 1.52\u20132.40) after full adjustment. COVID\u201019 during the third trimester increased the risk for preeclampsia\/eclampsia (RR\u00a0=\u00a01.15, 95% CI: 1.02\u20131.29), placenta abruption (RR\u00a0=\u00a01.38, 95% CI: 1.15\u20131.66), postpartum hemorrhage (RR\u00a0=\u00a01.24, 95% CI: 1.02\u20131.51), and SMM with (RR\u00a0=\u00a02.07, 95% CI: 1.65\u20132.59) and without transfusion (RR\u00a0=\u00a02.56, 95% CI: 1.98\u20133.35) after full adjustment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This study demonstrated that COVID\u201019 infection during pregnancy and more notably before pregnancy was significantly associated with multiple adverse pregnancy events, after controlling for pertinent sociodemographic, clinical, and behavioral factors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Keypoints<\/jats:title><jats:p><jats:list list-type=\"bullet\">\n<jats:list-item><jats:p>While prior studies have examined potential risks associated with COVID\u201019 infection during pregnancy, our study is one of the first to investigate potential risks associated with COVID\u201019 prior to pregnancy. We report significantly increased risk of hypertensive disorders of pregnancy (HDP), specifically preeclampsia\/eclampsia, among pregnant women who had COVID\u201019 infection prior to pregnancy compared to those without COVID\u201019 in a statewide matched analyses after adjustment for covariates.<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>COVID\u201019 infection during the first or second trimester was associated with increased risk for preeclampsia\/eclampsia, placental abruption, and severe maternal morbidity (SMM) relative to those with no history of COVID\u201019.<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>COVID\u201019 infection during the third trimester was associated with increased risk of preeclampsia\/eclampsia, placental abruption, postpartum hemorrhage, and SMM (both including and excluding transfusion).<\/jats:p><\/jats:list-item>\n<\/jats:list><\/jats:p><\/jats:sec>","DOI":"10.1002\/pmf2.70051","type":"journal-article","created":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T00:54:31Z","timestamp":1751331271000},"source":"Crossref","is-referenced-by-count":0,"title":["Adverse pregnancy and infant outcomes by COVID\u201019 infection status before and during pregnancy"],"prefix":"10.1002","volume":"1","author":[{"given":"Kelly J.","family":"Hunt","sequence":"first","affiliation":[{"name":"Department of Public Health Sciences Medical University of South Carolina Charleston South Carolina USA"},{"name":"Ralph H. Johnson Department of Veterans Affairs Medical Center Health Equity and Rural Outreach Innovation Center Charleston South Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chun\u2010Che","family":"Wen","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences Medical University of South Carolina Charleston South Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kalyan J.","family":"Chundru","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences Medical University of South Carolina Charleston South Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julio","family":"Mateus","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynecology Maternal\u2010Fetal Medicine Division Atrium Health Charlotte North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hermes","family":"Florez","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences Medical University of South Carolina Charleston South Carolina USA"},{"name":"Ralph H. Johnson Department of Veterans Affairs Medical Center Health Equity and Rural Outreach Innovation Center Charleston South Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey E.","family":"Korte","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences Medical University of South Carolina Charleston South Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian","family":"Neelon","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences Medical University of South Carolina Charleston South Carolina USA"},{"name":"Ralph H. Johnson Department of Veterans Affairs Medical Center Health Equity and Rural Outreach Innovation Center Charleston South Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dulaney A.","family":"Wilson","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences Medical University of South Carolina Charleston South Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Pearce","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences Medical University of South Carolina Charleston South Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mallory H.","family":"Alkis","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynecology Maternal\u2010Fetal Medicine Division Medical University of South Carolina Charleston South Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah","family":"Simpson","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences Medical University of South Carolina Charleston South Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erin","family":"Alsbrook","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences Medical University of South Carolina Charleston South Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Veronica","family":"Spates","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences Medical University of South Carolina Charleston South Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angela M.","family":"Malek","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences Medical University of South Carolina Charleston South Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,6,30]]},"reference":[{"volume-title":"COVID Data Tracker: U.S. Department of Health and Human Services CDC","year":"2024","author":"Centers for Disease Control and 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