While not much was clear on how the COVID-19 infection affected pregnant women and unborn children at the beginning of the pandemic, more recent studies have been able to shed light on a number of risk factors and outcomes connected to both.
The need for more studies on maternal health during the pandemic
A study published in Science Immunology in July 2020 showed that pregnant women are four times more likely to get COVID-19 than the general population, while another one by the Centres for Disease Control and Prevention (CDC) indicated that pregnant women are more likely to get severe COVID-19.
This study also said that pregnant women are at a higher risk of being hospitalised or admitted to the intensive care unit (ICU) and may have a greater need for oxygen support than non-pregnant women.
Yet another study published in BMJ in September 2020 reiterated these findings and further stated that pregnant women with COVID-19 infection experienced higher levels of maternal stress and were more likely to experience premature labour and birth.
The findings of these studies, and other ongoing ones, are likely to help healthcare professionals provide better care to pregnant women, reduce their risk of mortality and ensure better outcomes for both mother and child.
A new study published in the Journal of Perinatal Medicine, which is also the largest study yet on pregnant women with confirmed COVID-19 infection, goes even further in providing more information regarding this issue.
The impact of COVID-19 on unborn children
This new study was a secondary analysis of the World Association of Perinatal Medicine (WAPM) study, which was based on a multinational patient cohort including pregnant women with lab-confirmed COVID-19, diagnosed between February 2020 and April 2020.
The data was collected from 73 centres located in 22 different countries, including the US, Spain, Italy, Germany, Brazil, Argentina and Turkey. The new study tracked the course of 388 of these COVID-19 positive pregnant women.
Of this group of women, 8 percent were diagnosed with COVID-19 infection during their first trimester, 22.2 percent were diagnosed in the second trimester and 69.8 percent were diagnosed in the third trimester. The most common symptom experienced by these women was a cough, followed by fever and shortness of breath. The study found that 11.1 percent of the women were admitted to the ICU, and 6.4 percent needed intubation. There were three cases of maternal deaths, which suggests a maternal mortality rate of 0.8 percent.
Risk factors associated with adverse fetal outcomes
All the women who completed their pregnancies went through an evaluation for potential risk factors for unborn children and adverse fetal outcomes. There were six cases of miscarriages, six with intrauterine devices (which increases the risk of preterm birth, lower birth weight, etc), and five of neonatal deaths.
These 17 cases were the only ones that had adverse fetal outcomes and that too linked with premature birth instead of congenital anomalies or arterial defects. Of the remaining cases, only one newborn tested COVID-19 positive, who remained asymptomatic and was found to be COVID-19 negative 14 days after birth – thus indicating that vertical transmission of the infection from mother to newborn is still rare.
The researchers behind this study found that the lower your gestational age at the time of COVID-19 diagnosis, the higher the risk of adverse fetal outcomes. Newborns with lower birth weight or those born to women with first-time pregnancies, who smoked during pregnancy or had preexisting health conditions also had a higher risk of adverse fetal outcomes.
Newborns of mothers who needed oxygen support due to COVID-19 infection were also at a significantly higher risk of having adverse fetal outcomes.
Therefore, this study indicates that gestational age at the time of COVID-19 diagnosis, low birth weight of newborn and maternal requirement of ventilatory support are the factors associated with adverse fetal outcomes. Healthcare professionals can take these factors into account while creating a treatment plan for pregnant women with COVID-19.
Perhaps the most positive outcome of this study is the fact that pharmacological treatments with drugs like heparin, azithromycin, hydroxychloroquine or antiviral drugs had no adverse effects on unborn children – thereby clearing these drugs for the treatment of pregnant women with COVID-19.
For more information, read our article on COVID-19 and pregnancy.
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