The COVID-19 pandemic has had a major impact on patients and healthcare systems worldwide. Current data suggest that pregnant people infected with SARS-CoV-2 appear to be at increased risk for developing pregnancy complications in addition to severe sequelae of COVID-19; yet there remains insufficient data to draw conclusions, and subsequently guide management.

Increased rates of preterm delivery (PTD), low birth weight, and increased hospital admission rates were of these outcomes associated with COVID-19 infection [1], [2], [3], [4], [5], [6], [7], [8], [9], [10]. The timing of infection, mode of delivery, comorbidities, reinfection rate, as well as the type of SARS-CoV-2 variant are additional factors hypothesized to play a role in these maternal and neonatal outcomes [1], [3], [4], [5], [6], [10]. Increased cases of gestational hypertension and preeclampsia are maternal outcomes associated with COVID-19 infection during pregnancy, yet conflicting data has been reported concerning the role of additional factors in this association, including preexisting conditions, risk factors, or pathophysiological interactions [11], [12]. Due to the small number of sample sizes and overall number of studies concerning the investigation of factors, such findings associated with COVID-19 infection during pregnancy remain open for further investigation.

Associations between COVID-19 infection during pregnancy and certain neonatal outcomes remain to be questioned due to the lack of consistent data. Differences in NICU admission rates, although found to occur in association with COVID-19 infection during pregnancy, are thought to be contributable to required neonatal isolation following delivery rather than independent complications caused by infection [13]. There also exists conflicting data on the relationship between COVID-19 infection and stillbirth rates, and studies investigating possible factors behind these varied associations have yet to be conducted [14], [15], [16]. Reported rates of fetal growth restriction (FGR) during the pandemic vary amongst studies, all reporting either a reduction, increase, or no change in number of infants with FGR in association with COVID-19 infection [17], [18].

The purpose of this retrospective, cohort study is to investigate the rates of adverse maternal and neonatal outcomes in association with COVID-19 diagnoses during pregnancy using the HCA national database. The adverse maternal and neonatal outcomes at the focus of our study include PTD, gestational hypertension and preeclampsia, FGR, NICU admission, and intrauterine fetal demise (IUFD) and placental abnormalities.