Objective This study aimed to estimate the prevalence of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) among pregnant patients at the time of delivery in a rural Midwest tertiary care hospital and to examine demographics, clinical factors, and maternal and neonatal outcomes associated with SARS-CoV-2 infection during pregnancy. Study Design This prospective cohort study included all delivering patients between May 1 and September 22, 2020 at the University of Iowa Hospitals and Clinics. Plasma SARS-CoV-2 antibody testing was performed. SARS-CoV-2 viral reverse-transcription polymerase chain reaction (RT-PCR) results and maternal and neonatal outcomes were collected from the electronic medical record. Data were analyzed using univariate statistical methods with clustering for multiple births. Results In total, 1,000 patients delivered between May 1 and September 22, 2020. Fifty-eight (5.8%) were SARS-CoV-2 antibody positive. Twenty-three also tested viral positive during pregnancy. Three of 1,000 (0.3%) were viral positive on admission but antibody negative. The median age was 30 years (interquartile range [IQR]: 26–33 years) and body mass index was 31.75 kg/m2 (IQR 27.7–37.5 kg/m2). The cesarean delivery rate was 34.0%. The study population was primarily white (71.6%); however, 41.0% of SARS-CoV-2 infected patients identified as Black, 18.0% as Hispanic/Latino, 3.3% as Native Hawaiian/Pacific Islander, and only 27.9% as White (p < 0.0001). SARS-CoV-2 infection was more likely in patients without private insurance (p = 0.0243). Adverse maternal and/or neonatal outcomes were not more likely in patients with evidence of infection during pregnancy. Two SARS-CoV-2 infected patients were admitted to the intensive care unit. There were no maternal deaths during the study period. Conclusion In this largely rural Midwest population, 6.1% of delivering patients had evidence of past or current SARS-CoV-2 infection. Rates of SARS-CoV-2 during pregnancy were higher among racial and ethnic minorities and patients without private insurance. The SARS-CoV-2 infected patients and their neonates were not found to be at increased risk for adverse outcomes. Key Points

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Aim: To compare prevalence and disease severity of Severe Acute Respiratory Syndrome Coronavirus 2 (COVID-19) among multiparous and nulliparous pregnant patients at a rural Midwest tertiary care hospital; parity used as a surrogate for having additional children, assessing if exposure to other coronaviruses is protective for COVID-19. Methods: Retrospective cohort study included all patients who delivered at the University of Iowa between May 1, 2020 and September 22, 2020. Reverse transcriptase polymerase chain reaction and plasma antibody testing for COVID-19 were performed on women at the time of delivery. Demographics and outcome information were obtained from the electronic medical record. Adjusted odds ratio estimates for COVID-19 risk factors were obtained through the generalized linear modeling framework. Results: In 1,001 delivering patients, 6.2% tested positive for COVID-19 by either viral or antibody tests. Comparing infection rates by parity strata revealed no significant distinctions, with 5.4% of nulliparous women and 6.7% of multiparous women positive by either test (p=0.41). Odds of COVID-19 infection decreased by 6.2% for each year of maternal age (p=0.02). Conclusion: No significant associations were found between parity and prevalence or severity of COVID-19 infection in this population. Increasing maternal age and decreased COVID-19 frequency demonstrated a significant association.

Objective: To determine if ABO blood group, age, body mass index (BMI), or symptomatic COVID-19 infection are associated with COVID-19 antibody response in unvaccinated COVID-19 antibody positive pregnant women at time of delivery. Methods: At the time of delivery, 2,499 consecutive pregnant women were tested for ABO blood group and antibodies to both the spike protein and nucleocapsid protein of the COVID-19 virus. The DiaSorin assay was used for antibody to spike protein analysis and the Roche assay for antibody to nucleocapsid protein. Gamma regression models with a log link were used to compare antibody signals, with blood group, age, and BMI as the predictors. Results: 260 (10.4%) of 2,499 women who had not been vaccinated for COVID-19, were positive for both spike and nucleocapsid protein antibodies to COVID-19. The mean signal for COVID-19 nucleocapsid antibody was significantly lower for blood group AB (p=0.028) compared with blood group O. A relationship between blood group and presence of symptomatic COVID-19 was detected (p = 0.028), with asymptomatic individuals having blood group B at a higher rate than the symptomatic individuals do. No other significant pairwise differences between blood groups were detected. There was no significant difference in signal level of antibodies to COVID-19 spike protein between any of the blood groups. Mean signals for antibodies to spike and nucleocapsid proteins were significantly higher in older women (p=0.001 for spike protein antibody and p=0.002 for nucleocapsid antibody). Significantly higher signal levels of antibody to spike and nucleocapsid proteins were found in women with class 2/3 obesity (p=0.022 and p=0.003, respectively). Conclusions: Pregnant women of AB blood group had lower antibody signal to nucleocapsid protein compared to the O blood group, and women of older age and greater BMI had higher antibody signal to COVID-19 spike and nucleocapsid proteins. There was a significant association between women with blood group B and asymptomatic infections.