A 2021 January publication1 discusses pregnancy during the Covid-19 Pandemic in greater detail. There are many unknowns for pregnant women during the pandemic. Clinical experience of pregnancies complicated with infection by other coronaviruses e.g., Severe Acute Respiratory Syndrome and Middle Eastern Respiratory Syndrome, has led to pregnant woman being considered potentially vulnerable to severe COVID-19 infection. Physiological changes during pregnancy have a significant impact on the immune system, respiratory system, cardiovascular function, and coagulation.2 These may have positive or negative effects on COVID-19 disease progression.3 The impact of SARS-CoV-2 in pregnancy remains to be determined, and a concerted, global effort is required to determine the effects on implantation, fetal growth and development, labor, and neonatal health. Asymptomatic infection presents a further challenge regarding service provision, prevention, and management.
From the current evidence base, it is difficult to draw absolute conclusions on whether pregnant women are at increased risk of severe consequences of COVID-19. Most women will experience mild or asymptomatic disease with no lasting consequences4; however, some centers have seen increased rates of ICU admission, and the need for mechanical ventilation in pregnant women. The lack of detailed data makes identification of risk factors, and the definitive comparison of pregnant and nonpregnant cohorts impossible. The lack of universal COVID-19 testing means that it is likely that the majority of cases go undetected. Vertical transmission is probable, but it appears rare, and in the majority of neonates, it has minimal impact. However, once more, this is impossible to fully assess until neonatal testing is routine. There are a number of unknowns, in particular, whether COVID-19 is an independent risk factor for preterm birth, whether infection during pregnancy is likely to lead to long-term adverse effects in offspring, and whether this effect is dependent on gestational age at infection.
The review published in the journal Physiology Reviews1, further summarizes the research findings:
- The risk factors for severe COVID-19 are similar in pregnancy to the general population.
- Vertical transmission is plausible, but mechanisms are uncertain. Severe neonatal disease appears to be rare.
- Antenatal corticosteroid use for threatened preterm birth is likely to be safe for the mother, and corticosteroid use for severe maternal disease may be beneficial.
- Mothers with COVID-19 should be encouraged to breastfeed if they are able but should wear personal protective equipment to do so.
- Asymptomatic COVID-19 in pregnancy appears to be common but is of uncertain clinical significance.
Source:
1 Wastnedge EAN, Reynolds RM, van Boeckel SR, et al. Pregnancy and COVID-19. Physiol Rev. 2021; 101(1): 303–18.
2 Abdoli A, Falahi S, Kenarkoohi A, et al. The COVID-19 pandemic, psychological stress during pregnancy, and risk of neurodevelopmental disorders in offspring: a neglected consequence. J PsychosomObstetGynaecol 2020;41:247–48.doi:10.1080/0167482X.2020.1761321.
3 Baud D, Greub G, Favre G, et al. Second-trimester miscarriage in a pregnant woman with SARS-CoV-2 infection. JAMA 2020;323:2198–2200. doi:10.1001/jama.2020.7233.
4 Breslin N, Baptiste C, Gyamfi-Bannerman C, et al. Coronavirus disease 2019 infection among asymptomatic and symptomatic pregnant women: two weeks of confirmed presentations to an affiliated pair of New York City hospitals. Am J ObstetGynecolMFM 2 2020:100118. doi:10.1016/j.ajogmf.2020.100118.