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.