Strengths and Limitations
Strengths of our study include the high rate (>99%) rate
of SARS-CoV-2 testing on admission, with a large study population of
over 1,000 patients included in a four-week time period. Furthermore,
manual chart review of all patients allowed for robust examination of
detailed demographic and clinical data. With 32 cases of infection in
our sample, it was not possible to perform extensive multivariable
adjustments, particularly given that a number of factors associated with
infection may be correlated, but an understanding of the factors
associated with infection remains relevant to recognizing which patients
may be at risk for SARS-CoV-2 infection. Moreover, the linear
relationship of risk of infection with each additional associated factor
suggests that the factors are not all correlated and that there is
additive risk with each added factor. In this study, we equate a
negative test with the lack of infection, but while the sensitivity of
the test is high, it may be imperfect. However, in the context of an
overall low prevalence of infection, false negatives are unlikely to
substantially bias the associations with risk factors reported. Finally,
the frequencies of SARS-CoV-2 infection in pregnant patients and factors
associated with infection may not be fully generalizable to the general
population, given physiologic changes specific to pregnancy and
potential variations in behavior of pregnant women compared to the
general population, particularly in the weeks leading up to delivery.
Nonetheless, our findings remain important in risk stratifying
parturients at risk for SARS-CoV-2 infection throughout pregnancy and at
the time of labor and delivery and in directing counseling and
prevention efforts.