Post-Viral Fatigue Following SARS-CoV-2 Infection during Pregnancy: A Longitudinal Comparative Study

Background: Several studies have reported post-COVID-19 fatigue in the general population, but none explored post-COVID-19 fatigue among pregnant women. The objectives of this study were to determine the prevalence over time, duration and risk factors of post-viral fatigue among pregnant women infected with SARS-CoV-2. Methods: Longitudinal comparative study involving 588 pregnant women with SARS-CoV-2 investigation during pregnancy or at delivery in Sao Paulo, Brazil. Three groups were investigated: G1 (N=259) women with COVID-19 (symptomatic SARS-CoV-2 infection) identified during pregnancy; G2 (N=131) women with positive SARS-CoV-2 serology determined at delivery; G3 (N=198) women with negative SARS-CoV-2 serology at delivery. Questionnaires investigating fatigue were applied at 6 weeks, 3 and 6 months after SARS-CoV-2 identification for G1; and at delivery, 6 weeks, 3 and 6 months after delivery for all groups. The prevalence of fatigue, fatigue most of the time, and significant fatigue were determined at all timepoints. Cox regression analysis was used to estimate hazard ratios (HR) and 95% confidence intervals (CI) to evaluate the risk of remaining with fatigue over time in G1 women.Results: Prevalence of overall fatigue in G1 women at 6 weeks, 3 and 6 months were 40.6%, 33.6% and 27.8%, respectively. The cumulative risk of remaining with fatigue increased over time according to the severity of disease, with HR of 1.69 (95%CI: 0.89-3.20) and 2.43 (95%CI: 1.49-3.95) for women with moderate and severe symptoms, respectively. In multivariate analysis, the independent risk factors of fatigue in G1 women were cough and myalgia. At and after delivery the prevalence of fatigue was significantly higher in G1 women compared to G2 and G3 women at all time points. Conclusions: The prevalence of post-viral fatigue is higher in pregnant women acquiring SARS-CoV-2 during pregnancy, and the risk and duration of fatigue increase with severity of infection.