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Long COVID after SARS-CoV-2 during pregnancy in the United States

Author

Listed:
  • Chengxi Zang

    (Weill Cornell Medicine)

  • Daniel Guth

    (University of Rochester Medical Center)

  • Ann M. Bruno

    (University of Utah Health)

  • Zhenxing Xu

    (Weill Cornell Medicine)

  • Haoyang Li

    (Weill Cornell Medicine)

  • Nariman Ammar

    (Illinois State University
    Ochsner Clinic Foundation)

  • Robert Chew

    (RTI International)

  • Nick Guthe

    (NYU Grossman School of Medicine
    or Community Advocate Representative)

  • Emily Hadley

    (RTI International)

  • Rainu Kaushal

    (Weill Cornell Medicine)

  • Tanzy Love

    (Rochester)

  • Brenda M. McGrath

    (OCHIN Inc.)

  • Rena C. Patel

    (The University of Alabama at Birmingham)

  • Elizabeth C. Seibert

    (or Community Advocate Representative
    Arts and Sciences)

  • Yalini Senathirajah

    (University of Pittsburgh)

  • Sharad Kumar Singh

    (University of Rochester Medical Center)

  • Fei Wang

    (Weill Cornell Medicine)

  • Mark G. Weiner

    (Weill Cornell Medicine)

  • Kenneth J. Wilkins

    (National Institutes of Health)

  • Yiye Zhang

    (Weill Cornell Medicine)

  • Torri D. Metz

    (University of Utah Health)

  • Elaine Hill

    (University of Rochester Medical Center)

  • Thomas W. Carton

    (Louisiana Public Health Institute)

Abstract

Pregnancy alters immune responses and clinical manifestations of COVID-19, but its impact on Long COVID remains uncertain. This study investigated Long COVID risk in individuals with SARS-CoV-2 infection during pregnancy compared to reproductive-age females infected outside of pregnancy. A retrospective analysis of two U.S. databases, the National Patient-Centered Clinical Research Network (PCORnet) and the National COVID Cohort Collaborative (N3C), identified 29,975 pregnant individuals (aged 18–50) with SARS-CoV-2 infection in pregnancy from PCORnet and 42,176 from N3C between March 2020 and June 2023. At 180 days after infection, estimated Long COVID risks for those infected during pregnancy were 16.47 per 100 persons (95% CI, 16.00–16.95) in PCORnet using the PCORnet computational phenotype (CP) model and 4.37 per 100 persons (95% CI, 4.18–4.57) in N3C using the N3C CP model. Compared to matched non-pregnant individuals, the adjusted hazard ratios for Long COVID were 0.86 (95% CI, 0.83–0.90) in PCORnet and 0.70 (95% CI, 0.66–0.74) in N3C. The observed risk factors for Long COVID included Black race/ethnicity, advanced maternal age, first- and second-trimester infection, obesity, and comorbid conditions. While the findings suggest a high incidence of Long COVID among pregnant individuals, their risk was lower than that of matched non-pregnant females.

Suggested Citation

  • Chengxi Zang & Daniel Guth & Ann M. Bruno & Zhenxing Xu & Haoyang Li & Nariman Ammar & Robert Chew & Nick Guthe & Emily Hadley & Rainu Kaushal & Tanzy Love & Brenda M. McGrath & Rena C. Patel & Elizab, 2025. "Long COVID after SARS-CoV-2 during pregnancy in the United States," Nature Communications, Nature, vol. 16(1), pages 1-14, December.
    • Handle: RePEc:nat:natcom:v:16:y:2025:i:1:d:10.1038_s41467-025-57849-9
    DOI: 10.1038/s41467-025-57849-9
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    References listed on IDEAS

    as
    1. Ziyad Al-Aly & Yan Xie & Benjamin Bowe, 2021. "High-dimensional characterization of post-acute sequelae of COVID-19," Nature, Nature, vol. 594(7862), pages 259-264, June.
    2. Chengxi Zang & Hao Zhang & Jie Xu & Hansi Zhang & Sajjad Fouladvand & Shreyas Havaldar & Feixiong Cheng & Kun Chen & Yong Chen & Benjamin S. Glicksberg & Jin Chen & Jiang Bian & Fei Wang, 2023. "High-throughput target trial emulation for Alzheimer’s disease drug repurposing with real-world data," Nature Communications, Nature, vol. 14(1), pages 1-16, December.
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