More Severe COVID-19 Can Have Ill Effects on Expectant Mothers Fetuses

For eight months or more of the pandemic, pharmacists have been fielding questions from worried expectant mothers. Now, a new matched case-control study provides some answers about how COVID-19 affects pregnancy outcomes. Find out how researchers determined that women with mild cases have little reason for concern, but that severe novel coronavirus infection can be dangerous for both the mother and the fetus. Here is more information.

NEW BRUNSWICK, NJ – While mild cases of COVID-19 appear to have little ill-effect on the health of pregnant women and their unborn infants, those with severe or critical COVID-19 and their unborn infants face increased risks before and after delivery.

The study published in the American Journal of Obstetrics and Gynecology reports that pregnant women with mild cases of coronavirus disease 2019 had similar outcomes compared to those of similar age or circumstance who were uninfected.

“We know that women are more susceptible to some viral respiratory infections during pregnancy but needed to understand how the severity of this novel coronavirus might affect maternal and neonatal health,” said lead author Justin Brandt, an assistant professor of obstetrics and gynecology in the Division of Maternal-Fetal Medicine at Rutgers Robert Wood Johnson Medical School. “A major advantage of our study was the matched case-control design that allowed comparisons of pregnant women with COVID-19 to uninfected pregnant controls,” he said.

The study suggests that coronavirus disease 2019 might be associated with adverse maternal and neonatal outcomes in pregnancy but decried the lack of controlled data to quantify the magnitude of these risks or to characterize the epidemiology and risk factors.

Researchers sought to quantify the associations of COVID-19 with adverse maternal and neonatal outcomes in pregnancy, while documenting the epidemiology and risk factors.

To do that, they performed a matched case-control study of pregnant patients with confirmed coronavirus disease 2019 cases who delivered between 16 and 41 weeks gestation from March 11 to June 11, 2020. The research involved 61 confirmed coronavirus disease 2019 cases – 54 with mild disease, 6 with severe disease and 1 with critical disease.

More than 60% of the women with a mild case of COVID-19 were asymptomatic; the rest had a cough, fever and muscle aches. As for the women with severe and critical COVID-19, all required supplemental oxygen, and some received other interventions such as hydroxychloroquine in the early stages and steroids toward the end of the study.

The controls, uninfected pregnant women, were matched to coronavirus disease 2019 cases on a 2:1 ratio based on delivery date. Researchers abstracted information on maternal demographic characteristics, coronavirus disease 2019 symptoms, laboratory evaluations, obstetrical and neonatal outcomes, as well as clinical management, from medical records.

The study team was looking for two indicators:

(1) a composite of adverse maternal outcome, defined as preeclampsia, venous thromboembolism, antepartum admission, maternal intensive care unit admission, need for mechanical ventilation, supplemental oxygen, or maternal death, and

(2) a composite of adverse neonatal outcome defined as respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, 5-minute Apgar score of <5, persistent category 2 fetal heart rate tracing despite intrauterine resuscitation, or neonatal death.

Results indicated that the odds of adverse composite maternal outcome were 3.4 times higher among cases than controls (18.0% vs 8.2%; adjusted odds ratio, 3.4; 95% confidence interval, 1.2–13.4). In addition, the odds of adverse composite neonatal outcome were 1.7 times higher in the case group than to the control group (18.0% vs 13.9%; adjusted odds ratio, 1.7; 95% confidence interval, 0.8–4.8).

“Stratified analyses by disease severity indicated that the morbidity associated with coronavirus disease 2019 in pregnancy was largely driven by the severe or critical disease phenotype,” the authors explained. “Major risk factors for associated morbidity were black and Hispanic race, advanced maternal age, medical comorbidities, and antepartum admissions related to coronavirus disease 2019.”

Specifically, Black and Hispanic women, women who were obese, women over 35 and those with medical conditions such as diabetes and high blood pressure were at greatest risk of having severe or critical COVID-19, according to the study. The researchers report that those women were at risk of delivering early, having preeclampsia, requiring supplemental oxygen or mechanical ventilation, and extended hospital stays.

Premature births largely drove the neonatal risks, which including respiratory distress, bleeding in the brain, bowel inflammation, low Apgar scores, an abnormal fetal heart rate despite interventions to increase oxygen and blood flow to the placenta, and higher admissions to the NICU, the authors pointed out.

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