Women’s Health
SARS-CoV-2 Infection and Asthma Exacerbations Among Pregnant Women with Asthma in South Carolina, 2020-2021 Aisha* Aisha Alkandari Alkandari Alkandari Alkandari Alkandari 1 Epidemiology PhD candidate, University of South Carolina, Columbia, Department of Epidemiology and Biostatistics, Columbia, SC, USA. 2 Mission Scholar, Kuwait University, Department of Community Medicine & Behavioral Sciences, Kuwait, KU.
Background: The association between SARS-CoV-2 infection during pregnancy and asthma exacerbations among pregnant women with asthma is unclear. We evaluated this association and examined heterogeneity by race/ethnicity and residence.
Methods: We conducted a cohort study of 6,005 pregnancies (5,876 women) using the South Carolina COVID-19 Cohort Pregnancy Database (March 2020-December 2021). Asthma exacerbation was defined as an emergency department visit, intensive care unit admission, or inpatient hospitalization with an ICD-10 asthma diagnosis during pregnancy. We fit a trimester piecewise Cox model with race/ethnicity-specific baseline hazards, adjusting for maternal age, modified obstetric comorbidity index, education, pre-pregnancy body mass index, insurance, and calendar time, using a natural cubic spline to capture COVID-19 pandemic changes. Robust standard errors were used to account for multiple pregnancies per woman.
Results: Overall, 1,818 (30.3%) experienced asthma exacerbation. SARS-CoV-2 infection was not associated with asthma exacerbation overall (adjusted hazard ratio [aHR] 1.19, 95% CI 0.91-1.55), but the association varied by trimester (p=0.042). First trimester infection was associated with higher risk (aHR 2.57, 95% CI 1.09-6.05) compared with no infection, with no associations in later trimesters. Race/ethnicity modified the association (p=0.065). Within-group trimester-specific aHRs were higher in trimester 1 for White (aHR 3.28,95% CI 1.37-7.84) and Hispanic pregnancies (aHR 5.38,95% CI 1.83-15.84) and in trimester 2 for Hispanic pregnancies (aHR 2.91,95% CI 1.12-7.54), compared with uninfected in the same trimester and group.
Conclusion: Among pregnancies with asthma, SARS-CoV-2 infection early in gestation was associated with increased hazard of asthma exacerbation, with evidence of heterogeneity by race/ethnicity. Results may inform risk assessment during respiratory virus surges and point to early gestation as a key vulnerable window.