Second trimester COVID-19 linked to increased preeclampsia risk


New ACOG 2024 data suggest SARS-CoV-2 in the early stages of pregnancy can lead to a higher likelihood of preeclampsia, as well as more severe disease.

Second trimester COVID-19 linked to increased preeclampsia risk

Patients infected with SARS-CoV-2 in the early months of pregnancy are at an approximate 50% greater risk of developing preeclampsia, according to new findings presented at the American College of Obstetrics & Gynecology (ACOG) 2024 Annual Clinical & Scientific Meeting in San Francisco, CA, this weekend.

A team of US-based investigators, led by Heidi K. Leftwich, DO, of the University of Massachusetts Chan Medical School, presented findings from a cohort analysis showing women who test positive for COVID-19 in their second trimester are significantly more likely to develop preeclampsia those non-infected during pregnancy. The data may help to inform preventive health discussions with women planning pregnancy, as well as help to elucidate the overall health effect of SARS-CoV-2 on pregnant women.

Leftwich and colleagues conducted their retrospective cohort analysis including patients receiving prenatal care at a single academic hospital between January 2019 – December 2022. They sought a primary outcome of rate and severity of preeclampsia, as well as secondary outcomes including characteristic of placental pathology. Prior research has indicated an association between COVID-19 and preeclampsia risk, which investigators have connected to mechanisms including the once-pandemic virus’ effect on trophoblast function and the arterial wall, as well the exacerbated inflammatory response of pregnant women to the virus, among other interactions.

“With COVID-19 becoming more endemic, trimester-specific infection risks are important to study,” Leftwich and colleagues wrote. “Here, we examine the effect of SARS-CoV-2 positivity by trimester on development of preeclampsia.”

The team’s analysis included 6174 patients who met inclusion criteria; approximately 10% (n = 649) tested positive for SARS-CoV-2 during their pregnancy. Among those patients, SARS-CoV-2 infection occurred most frequently in the second trimester (40.8%), followed by the third (39.8%) and first (19.4%).

Investigators observed greater preeclampsia rates in pregnant women infected in the first (19.2%) and second (18.2%) trimesters, compared to women not infected during their pregnancy (11.7%; P = .001). The rate of preeclampsia was actually slightly lower among women infected in their third trimester (11.2%).

With adjustment for confounding factors, Leftwich and colleagues reported that women who tested positive for SARS-CoV-2 were 48% more likely to develop preeclampsia than those not infected by the virus (95% CI, 1.04 – 2.11; P = .005). The severity of preeclampsia was increased with SARS-CoV-2 infection in any trimester of pregnancy versus no infection (P = .008); however, the association was only significantly greater among women infected in the first trimester (odds ratio [OR], 6.55; 95% CI, 1.95 – 22.55; P = .003).

The team also observed a 63% increased risk of meconium-stained placenta in pregnant women who were infected during their second trimester (95% CI, 1.01 – 2.61; P = .044). Investigators concluded that patients infected with SARS-CoV-2 in either the first or second trimester reported higher rates of preeclampsia and more severe disease thereof. They noted the finding is consistent with the timing of preeclampsia pathogenesis in pregnant women.

“This finding helps clarify conflicting studies versus the risk of preeclampsia with SARS-CoV-2 infection in that this risk may be trimester specific and can help aid in our counseling and proposed future research,” investigators concluded.


  1. Leftwich HK, Hillman M, Khan L, Patel J, et al. Trimester-Specific SARS-CoV-2 Infection and the Association With Preeclampsia. Poster presented at: American College of Obstetrics & Gynecology 2024 Annual Clinical & Scientific Meeting. San Francisco, CA. May 17 – 19, 2024.
  2. González-Vanegas O, Martinez-Perez O. SARS-CoV-2 Infection and Preeclampsia-How an Infection Can Help Us to Know More about an Obstetric Condition. Viruses. 2023;15(7):1564. Published 2023 Jul 17. doi:10.3390/v15071564
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