New study sheds light on racial and ethnic disparities in perinatal health during the COVID-19 pandemic period
- 3 min. read ▪ Published
A new UC Berkeley School of Public Health study, published in the journal Epidemiology, is the first to disentangle the effects of COVID-19 infections from the effects of the environmental and social stressors of the pandemic period on health for mothers and infants by race and ethnicity.
The results reveal how each of these two factors—infection and the pandemic—separately contributed to substantial racial and ethnic disparities in perinatal outcomes, particularly among Black and Asian birthing people.
Although prior research has examined how COVID-19 infection affects pregnancy—for example infection can modify immune and inflammatory responses, which can affect the function of the placenta and health outcomes for infants in the period just after birth—little research has separated the effects of infection on pregnancies from effects of the COVID-19 pandemic itself, which created substantial economic and social stressors and delayed access to health care.
UC Berkeley researchers analyzed California birth certificate and hospital data from 2019–2021, which included 849,401 singleton live birth deliveries before and during the COVID-19 pandemic. They compared health outcomes such as preterm birth, hypertensive disorders such as preeclampsia, and any other severe complications or illnesses during or after pregnancy and childbirth among three groups of pregnant people: those infected with SARS-CoV-2, the virus that causes COVID-19; those not infected during pandemic period; and those who gave birth before the pandemic.
“Even though we were focused on health disparities, both COVID-19 infection and the pandemic were associated with a higher risk of many adverse health outcomes for all racial and ethnic groups,” said lead author Emily Liu, PhD candidate in Epidemiology. “No populations were unaffected.”
The analysis found that although Hispanics, Native Hawaiians, and Pacific Islanders had the highest incidence of COVID-19 infection, Asian and Black pregnancies carried the greatest risk of negative health outcomes.
“I think what’s interesting is that the ways the health disparities played out across groups were very different,” said senior author Dr. Jennifer Ahern. “For Black and Asian populations, they didn’t have high burdens of infection, but when they experienced infections, it had way more severe effects.”
Black pregnant women had the largest increase in the risk of severe maternal complications when they had a COVID-19 infection, and the largest increase in hypertensive disorders of pregnancy when they experienced the pandemic period. This exacerbated the much higher burdens of negative health outcomes already experienced by Black pregnant people. The research cannot explain the reasons for stronger effects, but other work has found more negative financial and prenatal care effects of the pandemic on Black pregnant people, and these may contribute.
By contrast, Asian pregnant women were less likely to be recorded as having COVID-19 infections, but when infected, they faced particularly strong associations with negative outcomes such as preterm delivery, hypertensive disorders, and gestational diabetes.
The research cannot explain why Asian patients have worse outcomes, though social stressors such as the increase in anti-Asian sentiment during the COVID pandemic period could have had physical effects on those pregnant, in addition to potential delay in care seeking.
Overall, the highest proportion of those with COVID-19 infection was found among Hispanic pregnant women. This is consistent with other research that found Latinos were far more likely to live in a household with a high risk of exposure, and more likely to be employed as essential workers.
