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Association between acquiring SARS-CoV-2 during pregnancy and post-acute sequelae of SARS-CoV-2 infection, 2024, Bruno et al.

Discussion in 'Long Covid research' started by SNT Gatchaman, May 29, 2024.

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  1. SNT Gatchaman

    SNT Gatchaman Senior Member (Voting Rights)

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    Association between acquiring SARS-CoV-2 during pregnancy and post-acute sequelae of SARS-CoV-2 infection: RECOVER electronic health record cohort analysis
    Ann M. Bruno; Chengxi Zang; Zhengxing Xu; Fei Wang; Mark G. Weiner; Nick Guthe; Megan Fitzgerald; Rainu Kaushal; Thomas W. Carton; Torri D. Metz

    BACKGROUND
    Little is known about post-acute sequelae of SARS-CoV-2 infection (PASC) after acquiring SARS-CoV-2 infection during pregnancy. We aimed to evaluate the association between acquiring SARS-CoV-2 during pregnancy compared with acquiring SARS-CoV-2 outside of pregnancy and the development of PASC.

    METHODS
    This retrospective cohort study from the Researching COVID to Enhance Recovery (RECOVER) Initiative Patient-Centred Clinical Research Network (PCORnet) used electronic health record (EHR) data from 19 U.S. health systems. Females aged 18–49 years with lab-confirmed SARS-CoV-2 infection from March 2020 through June 2022 were included. Validated algorithms were used to identify pregnancies with a delivery at >20 weeks' gestation. The primary outcome was PASC, as previously defined by computable phenotype in the adult non-pregnant PCORnet EHR dataset, identified 30–180 days post-SARS-CoV-2 infection. Secondary outcomes were the 24 component diagnoses contributing to the PASC phenotype definition. Univariable comparisons were made for baseline characteristics between individuals with SARS-CoV-2 infection acquired during pregnancy compared with outside of pregnancy. Using inverse probability of treatment weighting to adjust for baseline differences, the association between SARS-CoV-2 infection acquired during pregnancy and the selected outcomes was modelled. The incident risk is reported as the adjusted hazard ratio (aHR) with 95% confidence intervals.

    FINDINGS
    In total, 83,915 females with SARS-CoV-2 infection acquired outside of pregnancy and 5397 females with SARS-CoV-2 infection acquired during pregnancy were included in analysis. Non-pregnant females with SARS-CoV-2 infection were more likely to be older and have comorbid health conditions. SARS-CoV-2 infection acquired in pregnancy as compared with acquired outside of pregnancy was associated with a lower incidence of PASC (25.5% vs 33.9%; aHR 0.85, 95% CI 0.80–0.91). SARS-CoV-2 infection acquired in pregnant females was associated with increased risk for some PASC component diagnoses including abnormal heartbeat (aHR 1.67, 95% CI 1.43–1.94), abdominal pain (aHR 1.34, 95% CI 1.16–1.55), and thromboembolism (aHR 1.88, 95% CI 1.17–3.04), but decreased risk for other diagnoses including malaise (aHR 0.35, 95% CI 0.27–0.47), pharyngitis (aHR 0.36, 95% CI 0.26–0.48) and cognitive problems (aHR 0.39, 95% CI 0.27–0.56).

    INTERPRETATION
    SARS-CoV-2 infection acquired during pregnancy was associated with lower risk of development of PASC at 30–180 days after incident SARS-CoV-2 infection in this nationally representative sample. These findings may be used to counsel pregnant and pregnant capable individuals, and direct future prospective study.

    FUNDING
    National Institutes of Health (NIH) Other Transaction Agreement (OTA) OT2HL16184.


    Link | PDF (Lancet: eClinicalMedicine) [Open Access]
     
    SNT Gatchaman, May 29, 2024
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    Peter Trewhitt, Trish, Midnattsol and 2 others like this.
  2. Subtropical Island

    Subtropical Island Senior Member (Voting Rights)

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    “Non-pregnant females with SARS-CoV-2 infection were more likely to be older and have comorbid health conditions. ”
    Hang on, did they not adjust for age and comorbidities? I can get why they might report the basic data that way but what about reporting the adjusted figures too? The sample size isn’t so tiny it would be obviously not statistically viable is it? (If it were the whole, sample would be skewed? I think?)
     
    Subtropical Island, May 29, 2024
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  3. Hutan

    Hutan Moderator Staff Member

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    What an interesting question. The decreased risk of post-infection malaise and cognitive problems is very marked.

    As far as I can see, PASC is defined as any of these that were not present prior to Covid-19:
    So, there's quite a lot there that we wouldn't necessarily associate with ME/CFS.

    Yeah. They do seem to have done an analysis with what they call 'propensity score matched' participants from the non-pregnant group. They say that findings were stable,
    but actually the charts in Appendix 3 in the Supplementary Information suggest that using a better matched comparison cohort substantially increased the risk reduction from pregnancy. That is, in a better matched comparison, being pregnant reduced the risk of getting "PASC" even more.

    If this is a real finding, then it seems like a substantial clue, probably pointing towards immunological risk factors. But, this paper is a bit opaque, I think a lot of things that were done have not been explained well. And the definition of PASC makes everything a bit questionable. On the plus side, pregnancy seemed to be protective even against 'malaise and fatigue' so there may be something here.
     
    Hutan, May 29, 2024
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  4. Midnattsol

    Midnattsol Moderator Staff Member

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    My PEM threshold was quite a lot higher during pregnancy, and still is two months after giving birth. I don't feel a lot of either malaise or fatigue (I don't even feel sleep deprived, even though maybe I should. I sleep so well the hours I do sleep it's amazing. Note: I can get up to five hours of continuous sleep, I know that is a luxury not all infant parents enjoy)

    Is pregnancy protective, or is it perhaps masking symptoms the women would otherwise have?
     
    Midnattsol, May 29, 2024
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  5. Hutan

    Hutan Moderator Staff Member

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    That's a good point, new mothers may put fatigue down to poor sleep, and so not say that they have unexplained fatigue, or think of it as a disease symptom.
     
    Hutan, May 29, 2024
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  6. Midnattsol

    Midnattsol Moderator Staff Member

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    I think this will also be true for cognitive impairment. In Norwegian we have the term "ammetåke" which translates to "breastfeeding fog", a spin on the Norwegian word for brain fog. I have not had this explained to me as just a symptom of poor sleep, although that could of course be an explanation for it, but something I should be prepared for regardless. Funny how easy it is that should I lose my cognitive abilities now I would most likely be believed, but when I struggled with cognitive impairment in the beginning of my ME I was not seen as a reliable narrator.
     
    Midnattsol, May 29, 2024
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  7. Peter Trewhitt

    Peter Trewhitt Senior Member (Voting Rights)

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    In English often ‘baby brain’ is used.
     
    Peter Trewhitt, May 29, 2024
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  8. Midnattsol

    Midnattsol Moderator Staff Member

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    Thank you! I hadn't heard "breastfeeding fog" anywhere but I was sure there was something. I have heard pregnancy brain, so maybe I should have made the leap to baby brain ;)
     
    Midnattsol, May 29, 2024
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  9. SNT Gatchaman

    SNT Gatchaman Senior Member (Voting Rights)

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    My medical colleagues experiencing this called it "lactation brain".
     
    SNT Gatchaman, May 29, 2024
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