Indicators of Cardiometabolic Function in Pregnancy and Long-Term Risk of COVID-19: Population-Based Cohort Study

Background: Pregnancy increases a woman’s susceptibility to severe COVID-19, especially those with metabolic dysfunction. It is unknown if markers of metabolic dysfunction commonly assessed around pregnancy are associated with COVID-19 illness after pregnancy. Aim: The aim of this study is to evaluate the indicators of metabolic dysfunction collected in pregnancy and the future risk of severe COVID-19 after pregnancy. Methods: This population-based cohort study was completed in all of Ontario, comprising 417,713 women aged 15-49 years with a hospital birth between April 2007 and March 2018. The main exposure was each 1-kg/m(2) higher body mass index (BMI), 1-mmol/L higher glucose concentration at the 50-g glucose challenge test, and one-week earlier gestational week at delivery. The main outcome was severe COVID-19 illness or death, from the start of the pandemic period on March 1, 2020, till December 31, 2021. Results: The adjusted hazard ratio (aHR) of COVID-19 illness increased per 1-kg/m(2) higher BMI (1.05, 95% CI 1.04-1.06), per 1-mmol/L higher serum glucose concentration (1.16, 95% CI 1.10-1.22), and for each one-week earlier gestational week at delivery (1.12, 95% CI 1.03-1.23). Relative to women with no dichotomized risk factors, the aHR for severe COVID-19 was 1.60 (95% CI 1.28-2.01) with one factor, 3.34 (95% CI 2.51-4.44) with two factors, and 4.52 (95% CI 2.11-9.67) with three factors. Conclusions: The number, and degree, of standard metabolic indicators measured around pregnancy predict the future risk of severe COVID-19 remotely after that pregnancy.