Perinatal & Pediatric
Racial and ethnic differences in COVID-19 infection and the pandemic period on perinatal health in California Emily Liu* Emily Liu Shelley Jung Kara Rudolph Jennifer Ahern
Few studies have examined differences in the effects of COVID-19 infection and the pandemic period on perinatal outcomes by race and ethnicity. Race and ethnicity are social constructs, shaped by structural forces, that have relevance for health through the embodiment of social experiences. We linked individual hospital and birth records in California from 2019 and 2020 to examine preterm birth, pregnancy-associated hypertension, severe maternal morbidity, and gestational diabetes by race and ethnicity. Our analysis estimated (1) the effect of COVID-19 infection alone by comparing infected births to uninfected births in 2020 and (2) the effect of the pandemic period alone by comparing uninfected births in 2020 to births in 2019. We used targeted maximum likelihood estimation to estimate “average effect of treatment on the treated” risk differences (RD) adjusted for community- and individual-level confounders. When examining COVID-19 infection, we observed differences in risk of all outcomes by racial and ethnic group (Figure 1A). For example, COVID-19 infection was associated with excess burden of preterm birth for Asian (RD [95% Confidence Interval (CI)] = 4.4% [0.9, 7.8]), Hispanic (RD [95% CI] = 4.0% [1.6, 6.3]), and White (RD [95% CI] = 2.5% [1.6, 3.4]) pregnancies, but no differences were observed among Black pregnancies. Generally, for all racial and ethnic groups, the pandemic period had a very small protective effect on preterm birth, but increased risk of the other outcomes examined, except for severe maternal morbidity among White pregnancies (Figure 1B). Next steps include examining differences in pre-pregnancy health, characteristics of those infected, and mechanisms of effect that may explain the findings.
