OBJECTIVE: This study of pregnant people with obesity examined two aims in testing the hypothesis that the COVID-19 pandemic widened racial disparity in maternal health in high-risk pregnancies
it compared by race both (1) gestational weight gain (GWG) patterns and (2) patterns of preexisting conditions and adverse pregnancy outcomes. METHODS: This retrospective chart review included birth certificate and delivery records from a large women's specialty hospital in Louisiana between 2018 and 2022. Differences in preexisting conditions, GWG, and adverse pregnancy outcomes were explored across early-, peak-, and late-pandemic periods using log-linear regression and robust Poisson models. RESULTS: Among 7431 deliveries (54% Black), Black pregnant people had higher rates of preexisting type 2 diabetes and chronic hypertension but lower rates of gestational diabetes and preeclampsia compared to White pregnant people across all periods. Black individuals had higher prepregnancy weight and lower GWG compared to White individuals across all periods. GWG differences were not significant in peak- and late-pandemic periods. CONCLUSIONS: Black individuals with obesity started pregnancy with higher weight and more preexisting conditions but had lower GWG compared to White individuals. Exacerbated disparities in preexisting conditions demonstrate higher health risks for Black individuals during pregnancy.