Long COVID in Pregnancy: Evaluating Risks and Outcomes
Evaluating the impact of Long COVID in pregnancy is essential for optimizing maternal and fetal care. Therefore, researchers investigated whether post-acute sequelae of SARS-CoV-2 infection influence perinatal health. In a prospective multicenter cohort from the RECOVER-Adult study, clinicians evaluated 603 pregnant participants with prior SARS-CoV-2 infection. Specifically, investigators categorized participants using the Long COVID Research Index to evaluate gestational risks.
Understanding Long COVID in Pregnancy and Study Design
The study analyzed participants enrolled between October 2021 and January 2024. Among the cohort, approximately 19.6% met the criteria for likely Long COVID before or during pregnancy. Furthermore, individuals in the likely Long COVID group frequently reported adverse social determinants of health. These participants faced challenges such as food insecurity, financial strain, and medical discrimination. Additionally, they demonstrated higher prepregnancy body mass index values compared to the indeterminate cohort. Consequently, researchers utilized propensity score matching to balance baseline differences accurately.
Key Findings on Preterm Birth and Complications
The primary outcome evaluated preterm birth occurring before 37 weeks of gestation. Overall, the primary average treatment effect analysis showed no significant association between likely Long COVID and preterm delivery. Secondary outcomes, including cesarean delivery, neonatal intensive care admission, and small-for-gestational-age birth weight, also showed no significant variance. However, sensitivity analyses among treated individuals revealed a notable pattern. Specifically, participants with likely Long COVID experienced a significantly higher risk of hypertensive disorders of pregnancy. In this subgroup, the adjusted outcome rate reached 39.0% compared to 25.9% in unexposed individuals.
Clinical Implications for Obstetric Care
These findings offer reassuring evidence regarding preterm birth rates in patients with lingering viral symptoms. Nevertheless, the elevated rate of hypertensive complications requires vigilant antenatal monitoring. Obstetricians should maintain high clinical suspicion for gestational hypertension and preeclampsia in women with chronic symptoms. Moreover, healthcare teams must address underlying social determinants of health during routine prenatal visits. Further prospective trials will help clarify the pathophysiological mechanisms linking viral persistence to vascular complications in pregnancy, which is a vital area covered in advanced fetal medicine training.
Frequently Asked Questions
Q1: Does Long COVID increase the risk of preterm birth?
No, primary analyses from the RECOVER study showed no significant association between Long COVID and preterm delivery before 37 weeks.
Q2: What complications were linked to Long COVID during pregnancy?
Sensitivity analyses revealed an increased risk of hypertensive disorders of pregnancy, such as gestational hypertension and preeclampsia.
Q3: How should clinicians monitor pregnant patients with prior Long COVID?
Clinicians should closely monitor maternal blood pressure, screen for preeclampsia symptoms, and evaluate social determinants of health throughout gestation, aligning with best practices taught in structured obstetric anesthesia and maternal care curriculums.
References
- Metz TD et al. Pregnancy Outcomes in Individuals With Long COVID. Obstet Gynecol. 2026 Aug 27. doi: 10.1097/AOG.0000000000006410. PMID: 42659593.
- Zang C et al. Post-acute sequelae of SARS-CoV-2 infection during pregnancy: A RECOVER study. Nat Commun. 2025;16(1):2845.
- Metz TD et al. Association of SARS-CoV-2 Infection With Serious Maternal Morbidity and Mortality. JAMA. 2022;327(8):748-759.
