The association of COVID-19 infection in pregnancy with preterm birth: A retrospective cohort study in California (2025)

Karasek, D., Baer, R. J., McLemore, M. R., Bell, A. J., Blebu, B. E., Casey, J. A., Coleman-Phox, K., Costello, J. M., Felder, J. N., Flowers, E., Fuchs, J. D., Gomez, A. M., Karvonen, K., Kuppermann, M., Liang, L., McKenzie-Sampson, S., McCulloch, C. E., Oltman, S. P., Pantell, M. S., ... Jelliffe-Pawlowski, L. L. (2021). The association of COVID-19 infection in pregnancy with preterm birth: A retrospective cohort study in California. The Lancet Regional Health - Americas, 2, Article 100027. https://doi.org/10.1016/j.lana.2021.100027

The association of COVID-19 infection in pregnancy with preterm birth: A retrospective cohort study in California. / Karasek, Deborah; Baer, Rebecca J.; McLemore, Monica R. et al.
In: The Lancet Regional Health - Americas, Vol. 2, 100027, 10.2021.

Research output: Contribution to journal › Article › peer-review

Karasek, D, Baer, RJ, McLemore, MR, Bell, AJ, Blebu, BE, Casey, JA, Coleman-Phox, K, Costello, JM, Felder, JN, Flowers, E, Fuchs, JD, Gomez, AM, Karvonen, K, Kuppermann, M, Liang, L, McKenzie-Sampson, S, McCulloch, CE, Oltman, SP, Pantell, MS, Piao, X, Prather, AA, Schmidt, RJ, Scott, KA, Spellen, S, Stookey, JD, Tesfalul, M, Rand, L & Jelliffe-Pawlowski, LL 2021, 'The association of COVID-19 infection in pregnancy with preterm birth: A retrospective cohort study in California', The Lancet Regional Health - Americas, vol. 2, 100027. https://doi.org/10.1016/j.lana.2021.100027

Karasek D, Baer RJ, McLemore MR, Bell AJ, Blebu BE, Casey JA et al. The association of COVID-19 infection in pregnancy with preterm birth: A retrospective cohort study in California. The Lancet Regional Health - Americas. 2021 Oct;2:100027. doi: 10.1016/j.lana.2021.100027

Karasek, Deborah ; Baer, Rebecca J. ; McLemore, Monica R. et al. / The association of COVID-19 infection in pregnancy with preterm birth : A retrospective cohort study in California. In: The Lancet Regional Health - Americas. 2021 ; Vol. 2.

@article{6c69593398cf49269983217f3c8b1479,

title = "The association of COVID-19 infection in pregnancy with preterm birth: A retrospective cohort study in California",

abstract = "Introduction: Our understanding of the association between coronavirus disease 19 (COVID-19) and preterm or early term birth among racially and ethnically diverse populations and people with chronic medical conditions is limited. Methods: We determined the association between COVID-19 and preterm (PTB) birth among live births documented by California Vital Statistics birth certificates between July 2020 and January 2021 (n=240,147). We used best obstetric estimate of gestational age to classify births as very preterm (VPTB, <32 weeks), PTB (< 37 weeks), early term (37 and 38 weeks), and term (39-44 weeks), as each confer independent risks to infant health and development. Separately, we calculated the joint effects of COVID-19 diagnosis, hypertension, diabetes, and obesity on PTB and VPTB. Findings: COVID-19 diagnoses on birth certificates increased for all racial/ethnic groups between July 2020 and January 2021 and were highest for American Indian/Alaska Native (12.9%), Native Hawaiian/Pacific Islander (11.4%), and Latinx (10.3%) birthing people. COVID-19 diagnosis was associated with an increased risk of VPTB (aRR 1.6, 95% CI [1.4, 1.9]), PTB (aRR 1.4, 95% CI [1.3, 1.4]), and early term birth (aRR 1.1, 95% CI [1.1, 1.2]). There was no effect modification of the overall association by race/ethnicity or insurance status. COVID-19 diagnosis was associated with elevated risk of PTB in people with hypertension, diabetes, and/or obesity. Interpretation: In a large population-based study, COVID-19 diagnosis increased the risk of VPTB, PTB, and early term birth, particularly among people with medical comorbidities. Considering increased circulation of COVID-19 variants, preventative measures, including vaccination, should be prioritized for birthing persons. Funding: UCSF-Kaiser Department of Research Building Interdisciplinary Research Careers in Women's Health Program (BIRCWH) National Institute of Child Health and Human Development (NICHD) and the Office of Research on Women's Health (ORWH) [K12 HD052163] and the California Preterm Birth Initiative, funded by Marc and Lynn Benioff.",

keywords = "COVID-19, Pregnancy, Preterm Birth, Racial/Ethnic Inequities",

author = "Deborah Karasek and Baer, {Rebecca J.} and McLemore, {Monica R.} and Bell, {April J.} and Blebu, {Bridgette E.} and Casey, {Joan A.} and Kimberly Coleman-Phox and Costello, {Jean M.} and Felder, {Jennifer N.} and Elena Flowers and Fuchs, {Jonathan D.} and Gomez, {Anu Manchikanti} and Kayla Karvonen and Miriam Kuppermann and Liang Liang and Safyer McKenzie-Sampson and McCulloch, {Charles E.} and Oltman, {Scott P.} and Pantell, {Matthew S.} and Xianhua Piao and Prather, {Aric A.} and Schmidt, {Rebecca J.} and Scott, {Karen A.} and Solaire Spellen and Stookey, {Jodi D.} and Martha Tesfalul and Larry Rand and Jelliffe-Pawlowski, {Laura L.}",

note = "Publisher Copyright: {\textcopyright} 2021",

year = "2021",

month = oct,

doi = "10.1016/j.lana.2021.100027",

language = "English (US)",

volume = "2",

journal = "The Lancet Regional Health - Americas",

issn = "2667-193X",

publisher = "Elsevier Ltd",

}

TY - JOUR

T1 - The association of COVID-19 infection in pregnancy with preterm birth

T2 - A retrospective cohort study in California

AU - Karasek, Deborah

AU - Baer, Rebecca J.

AU - McLemore, Monica R.

AU - Bell, April J.

AU - Blebu, Bridgette E.

AU - Casey, Joan A.

AU - Coleman-Phox, Kimberly

AU - Costello, Jean M.

AU - Felder, Jennifer N.

AU - Flowers, Elena

AU - Fuchs, Jonathan D.

AU - Gomez, Anu Manchikanti

AU - Karvonen, Kayla

AU - Kuppermann, Miriam

AU - Liang, Liang

AU - McKenzie-Sampson, Safyer

AU - McCulloch, Charles E.

AU - Oltman, Scott P.

AU - Pantell, Matthew S.

AU - Piao, Xianhua

AU - Prather, Aric A.

AU - Schmidt, Rebecca J.

AU - Scott, Karen A.

AU - Spellen, Solaire

AU - Stookey, Jodi D.

AU - Tesfalul, Martha

AU - Rand, Larry

AU - Jelliffe-Pawlowski, Laura L.

N1 - Publisher Copyright:© 2021

PY - 2021/10

Y1 - 2021/10

N2 - Introduction: Our understanding of the association between coronavirus disease 19 (COVID-19) and preterm or early term birth among racially and ethnically diverse populations and people with chronic medical conditions is limited. Methods: We determined the association between COVID-19 and preterm (PTB) birth among live births documented by California Vital Statistics birth certificates between July 2020 and January 2021 (n=240,147). We used best obstetric estimate of gestational age to classify births as very preterm (VPTB, <32 weeks), PTB (< 37 weeks), early term (37 and 38 weeks), and term (39-44 weeks), as each confer independent risks to infant health and development. Separately, we calculated the joint effects of COVID-19 diagnosis, hypertension, diabetes, and obesity on PTB and VPTB. Findings: COVID-19 diagnoses on birth certificates increased for all racial/ethnic groups between July 2020 and January 2021 and were highest for American Indian/Alaska Native (12.9%), Native Hawaiian/Pacific Islander (11.4%), and Latinx (10.3%) birthing people. COVID-19 diagnosis was associated with an increased risk of VPTB (aRR 1.6, 95% CI [1.4, 1.9]), PTB (aRR 1.4, 95% CI [1.3, 1.4]), and early term birth (aRR 1.1, 95% CI [1.1, 1.2]). There was no effect modification of the overall association by race/ethnicity or insurance status. COVID-19 diagnosis was associated with elevated risk of PTB in people with hypertension, diabetes, and/or obesity. Interpretation: In a large population-based study, COVID-19 diagnosis increased the risk of VPTB, PTB, and early term birth, particularly among people with medical comorbidities. Considering increased circulation of COVID-19 variants, preventative measures, including vaccination, should be prioritized for birthing persons. Funding: UCSF-Kaiser Department of Research Building Interdisciplinary Research Careers in Women's Health Program (BIRCWH) National Institute of Child Health and Human Development (NICHD) and the Office of Research on Women's Health (ORWH) [K12 HD052163] and the California Preterm Birth Initiative, funded by Marc and Lynn Benioff.

AB - Introduction: Our understanding of the association between coronavirus disease 19 (COVID-19) and preterm or early term birth among racially and ethnically diverse populations and people with chronic medical conditions is limited. Methods: We determined the association between COVID-19 and preterm (PTB) birth among live births documented by California Vital Statistics birth certificates between July 2020 and January 2021 (n=240,147). We used best obstetric estimate of gestational age to classify births as very preterm (VPTB, <32 weeks), PTB (< 37 weeks), early term (37 and 38 weeks), and term (39-44 weeks), as each confer independent risks to infant health and development. Separately, we calculated the joint effects of COVID-19 diagnosis, hypertension, diabetes, and obesity on PTB and VPTB. Findings: COVID-19 diagnoses on birth certificates increased for all racial/ethnic groups between July 2020 and January 2021 and were highest for American Indian/Alaska Native (12.9%), Native Hawaiian/Pacific Islander (11.4%), and Latinx (10.3%) birthing people. COVID-19 diagnosis was associated with an increased risk of VPTB (aRR 1.6, 95% CI [1.4, 1.9]), PTB (aRR 1.4, 95% CI [1.3, 1.4]), and early term birth (aRR 1.1, 95% CI [1.1, 1.2]). There was no effect modification of the overall association by race/ethnicity or insurance status. COVID-19 diagnosis was associated with elevated risk of PTB in people with hypertension, diabetes, and/or obesity. Interpretation: In a large population-based study, COVID-19 diagnosis increased the risk of VPTB, PTB, and early term birth, particularly among people with medical comorbidities. Considering increased circulation of COVID-19 variants, preventative measures, including vaccination, should be prioritized for birthing persons. Funding: UCSF-Kaiser Department of Research Building Interdisciplinary Research Careers in Women's Health Program (BIRCWH) National Institute of Child Health and Human Development (NICHD) and the Office of Research on Women's Health (ORWH) [K12 HD052163] and the California Preterm Birth Initiative, funded by Marc and Lynn Benioff.

KW - COVID-19

KW - Pregnancy

KW - Preterm Birth

KW - Racial/Ethnic Inequities

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U2 - 10.1016/j.lana.2021.100027

DO - 10.1016/j.lana.2021.100027

M3 - Article

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SN - 2667-193X

VL - 2

JO - The Lancet Regional Health - Americas

JF - The Lancet Regional Health - Americas

M1 - 100027

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