Cardiovascular complications as a consequence of coronavirus infection in pregnant women managed in ambulatory settings

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Background SARS-CoV-2 has been linked to cardiovascular complications in the general population. However, data regarding cardiovascular outcomes among pregnant women remain limited, particularly in community-based ambulatory populations, as most previous studies focused primarily on hospitalized or critically ill patients. In this retrospective population-based matched cohort study, we evaluated whether COVID-19 infection during pregnancy is associated with an increased incidence of cardiovascular complications among pregnant women managed predominantly in outpatient settings. Methods We conducted a retrospective population-based matched cohort study using electronic health record data from pregnant women between 2020 and 2025. Women with COVID-19 during pregnancy were matched 1:1 to women without documented COVID-19 during pregnancy according to demographic, obstetric, and clinical characteristics. The final analytical cohort included 4,068 women in each group. Cardiovascular outcomes during pregnancy and within a year since last menstrual period were assessed. Baseline demographic and obstetric characteristics were comparable between the COVID-19 and control groups. No significant differences were observed between the groups in the incidence of major cardiovascular complications, either when analyzed individually or as a composite endpoint (0.15% vs. 0.15%; OR 1.00, 95% CI 0.27–3.74). Specifically, there were no significant differences in the occurrence of atrial fibrillation/flutter, congestive heart failure, cardiomyopathy, myocarditis, pulmonary embolism, or deep venous thrombosis. In contrast, cough and backache were significantly more frequent among women with COVID-19 than among matched controls (6.88% vs. 4.87%; OR 1.45, 95% CI 1.19–1.75; 13.8% vs. 11.8%; OR 1.20, 95% CI 1.05–1.37; p = 0.007 respectively). Conclusions Our findings suggest that among pregnant women in ambulatory community settings, COVID-19 infection is not associated with an increased risk of major cardiovascular complications.