Abstract
Objective: Though previous studies have assessed both COVID-19 outcomes in pregnancy and racial disparities among non-pregnant patients with COVID-19, few have specifically investigated racial disparities among pregnant patients with COVID-19. The objective of this study is to explore the potential association between race and disparate COVID-19 risk in pregnancy.
Study Design: A retrospective cohort analysis was performed using data collected as part of the COVID-19 in Pregnancy and The Newborn: State of Michigan Collaborative, an established database of pregnant patients admitted to 14 institutions in Southern Michigan. Cases were defined as patients with a positive SARS-CoV-2 test result. Controls, those who had no symptoms of COVID-19 prior to universal screening or a negative PCR test, were matched to cases on the same unit within 30 days of each case. For this analysis, the independent variable was race, with maternal age, body mass index (BMI), chronic hypertension, diabetes, asthma, substance use, and smoking included as a potential covariates- in a robust Poisson regression model, and COVID-19 status (COVID or non-COVID) used as the primary dependent variable. In addition, symptomatology (an aggregate of eighteen symptoms) and disease severity (mild/moderate/severe) were compared between non-Hispanic Black and non-Hispanic White patients using the same statistical method.
Results: Of 1,131 non-Hispanic gravidas, 42.9% (n=485) self-identified as Black. These patients were at two-fold greater risk for COVID-19 compared with their non-Hispanic White counterparts [35.9% vs. 18.3%, RR=1.96(1.6-2.4)]. After adjusting for the risk factors mentioned, only obesity and diabetes independently contributed, in addition to race (aRR 1.96[1.57-2.35]). There was no difference between non-Hispanic Black and White groups with COVID-19 in either symptomatology or severity of disease presentation.
Conclusions: There is disparity in the risk of COVID-19 during pregnancy between non-Hispanic Black and non-Hispanic white patients. This disparity is not explained by a range of covariate risk factors. Thus, other kinds of determinants, such as social determinants of health, will need to be examined to fully understand this disparity. In addition to increased susceptibility to infection, our analysis will further delve into examining disparities in treatment and outcome within our sample.