COVID-19: No Serious Effects for Most Expectant Mothers, Their Infants

During the pandemic, pharmacists have fielded a lot of questions from nervous women expecting a child. Results from a new study can offer some comfort. It says 95% of mothers and 97% of babies have few adverse effects if the woman tests positive for COVID-19. Here is more information.

DALLAS – Most expectant mothers need not worry too much about COVID-19’s effect on them or their unborn children, according to a new study.

The report in JAMA Network Open advises that 95% of pregnant women testing positive for COVID-19 had not adverse outcomes, and the virus was transmitted to the fetus in just 3% of cases.

"Our findings are that approximately 5 percent of all delivered women with COVID-19 infection develop severe or critical illness. Five percent is a major concern when a pandemic is making its way through a population; however, it's lower than previous reports from the Centers for Disease Control and Prevention (CDC)," explained first author Emily Adhikari, MD, an obstetrician, gynecologist, at University of Texas Southwestern Medical Center. "Most women with asymptomatic or mild infection will be relieved to know that their babies are unlikely to be affected by the virus."

Researchers embarked on the study after previously published data suggested increased hospitalizations, placental abnormalities, and rare neonatal transmission among pregnant women with coronavirus disease 2019 (COVID-19).

The study team sought to evaluate adverse outcomes associated with SARS-CoV-2 infection in pregnancy, while also describing clinical management, disease progression, hospital admission, placental abnormalities, and neonatal outcomes.

The observational cohort study, conducted from March 19 through Aug. 22, 2020, focused on maternal and neonatal outcomes among delivered women with and without SARS-CoV-2 during pregnancy. All participants were at Parkland Health and Hospital System in Dallas, a high-volume prenatal clinic system and public maternity hospital with widespread access to SARS-CoV-2 testing in outpatient, emergency department, and inpatient settings.

Included were women who were tested for SARS-CoV-2 during pregnancy and delivered. During the study period, deliveries occurred for 3,374 pregnant women, mean age 27.6, who had been tested for SARS-CoV-2; 252 tested positive for SARS-CoV-2 and 3,122 tested negative. The cohort included 2,520 Hispanic (75%), 619 Black (18%), and 125 white (4%) women, with researchers pointing out no differences in age, parity, body mass index, or diabetes among women with or without SARS-CoV-2.

They note, however, that SARS-CoV-2 positivity was more common among Hispanic women (230 [91%] positive vs 2290 [73%] negative; difference, 17.9%; 95% CI, 12.3%-23.5%; P < .001).

Defined as the primary outcome was a composite of preterm birth, preeclampsia with severe features, or cesarean delivery for abnormal fetal heart rate among women delivered after 20 weeks of gestation. Also described were maternal illness severity, neonatal infection, and placental abnormalities. Researchers advise that, for placental analysis, the pathologist was blinded to illness severity.

Results indicate no difference in the composite primary outcome (52 women [21%] vs 684 women [23%]; relative risk, 0.94; 95% CI, 0.73-1.21; P = .64). Researchers report that early neonatal SARS-CoV-2 infection occurred in 6 of 188 tested infants (3%), primarily born to asymptomatic or mildly symptomatic women.

No placental pathologic differences by illness severity were determined, according to the authors, who add that maternal illness at initial presentation was asymptomatic or mild in 239 women (95%). Overall, 6 of the women (3%) developed severe or critical illness, and 14 (6%) were hospitalized for the indication of COVID-19, they add.

“In a large, single-institution cohort study, SARS-CoV-2 infection during pregnancy was not associated with adverse pregnancy outcomes,” researchers conclude. “Neonatal infection may be as high as 3% and may occur predominantly among asymptomatic or mildly symptomatic women. Placental abnormalities were not associated with disease severity, and hospitalization frequency was similar to rates among nonpregnant women.”

The authors suggest that further study will be required to understand whether maternal infection with COVID-19 has any effect on long-term maternal or infant health.

"Our goal is to develop evidence-based guidelines for the majority of pregnant women who are recovering at home," Adhikari added. "It's difficult to predict who will become severely ill, which is why prevention strategies such as hand-washing, masking, and social distancing are still extremely important."

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