A look at the possible link between COVID-19 and pregnancy
Thursday, May 21, 2020
According to the United Nations Children’s Fund, approximately 116 million babies are expected to be born during the COVID-19 pandemic. These births will occur up to 40 weeks after COVID-19 was recognized as a pandemic on March 11, 2020.
Although there are no current data proving that COVID-19 affects pregnant women more than non-pregnant women, those who are pregnant are at a greater risk of contracting respiratory viruses, including pneumonia, which is a concern because lung capacity is already diminished during pregnancy.
Some pregnant women have become ill and some have died during the pandemic. In a cohort study, researchers at the University of Oxford collected data, using the UK Obstetric Surveillance System, from 427 pregnant women with COVID-19 admitted to hospitals in the United Kingdom. Of these, three have died with the virus, and nine remain in critical care.
The researchers noted that most of the hospitalized women in this cohort were in the late second or third trimester of pregnancy, suggesting the importance of social distancing during later pregnancy. Most were 35 years of age and older, overweight, or obese, had pre-existing medical problems, such as hypertension and diabetes, and were from black and ethnic minority backgrounds. Of the 247 women (58%) gave birth or had a pregnancy loss; 180 (73%) gave birth at term. Forty (9%) hospitalized women required respiratory support. It should be noted that this study has not yet been peer-reviewed.
A review of 18 articles that reported data from 108 pregnancies between December 8, 2019, and April 1, 2020, described women presenting in the third trimester with fever (68%) and coughing (34%). Lymphocytopenia (59%) with elevated C-reactive protein (70%) was observed. This cohort study suggested that the virus may affect birth; 91% of the women were delivered by cesarean section. There was one neonatal death and one intrauterine death; there were no maternal deaths.
Based on limited data to date, intrauterine transmission of COVID-19 from infected pregnant women to their fetuses has not been observed. In a small study of infants born to mothers infected with COVID-19, none of the infants tested positive for COVID-19. The virus was not detected in the amniotic fluid or placenta. However, a report of 33 infants born to mothers with COVID-19 pneumonia showed that three newborns tested positive for the virus two days after birth, despite precautions to prevent infection.
In another study of six infants who were born to mothers with mild symptoms of COVID-19, the newborns had no symptoms of COVID-19 and tested negative. There was evidence that some of the infants' immune systems responded to COVID-19 before birth. Further research is needed to determine the impact of the virus on babies during pregnancy and after birth.
As information emerges from the babies born during the pandemic, the American Academy of Pediatrics recommends special care for the newborns born to women with confirmed or suspected COVID-19. Although difficult, this care might include temporarily separating the mother and the newborn to decrease the risk of infecting the baby, monitoring the baby for signs of infection, and, if possible, testing the newborn for COVID-19.
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