(1180) Hypertensive disorders of pregnancy in pregnant patients following infection with COVID-19

Objective: To characterize rates of hypertensive disorders of pregnancy (HDP) in pregnant patients with COVID-19 infection according to variant genotype, disease severity and timing of HPD diagnosis in relationship to infection.

Study Design: Retrospective cohort of all patients diagnosed with COVID-19 at our institution and subsequently delivering at our center (3/2020–4/2022). We grouped patients by 1) variant genotype 2) NIH disease severity and 3) whether they were delivered at the time of acute COVID-19 diagnosis. The primary outcome was any HDP. Secondary outcomes included HDP subtypes and the time interval from COVID-19 diagnosis to HDP diagnosis. Outcomes were compared across these groups. Kaplan-Meier curves compared the timing of HDP diagnosis by disease severity and genotype (log-rank test).

Results: During the study period, 203 (38%) pre-delta, 138 (26%) delta and 189 (36%) omicron variant patients delivered at our center. 239 (45%) delivered during their acute COVID-19 infection. Overall rate of HDP was 36% in the entire cohort. Demographics, GA at delivery and medical/obstetrical comorbidities were similar across the 3 genotype groups. There was no difference in rates of HDP or its subtypes between variant genotype, disease severity, or timing of delivery in relationship to COVID-19 infection (Table). In univariate analysis, timing of HDP diagnosis was only significantly different by disease severity (not genotype p=0.07) with the mild/moderate group having the longest period from COVID infection to HDP diagnosis (p < 0.001). Survival analysis demonstrated longer time intervals to HDP diagnosis in mild/moderate disease and shorter intervals in asymptomatic or severe disease (p < 0.001), but demonstrated longer intervals to HDP pre-delta and shorter intervals for delta and omicron variants (p=0.008, Figure).

Conclusion: There are high rates of HDP (36%) in patients with COVID-19 infection, but HDP rates were similar by variant type, disease severity, and timing of illness. As timing of HDP varied across variants and disease severity, studies should investigate different pathophysiologic mechanisms.