Study looks at outcomes of COVID‐19 during pregnancy

By Angela Betsaida B. Laguipo, BSNApr 27 2020

With the world at a standstill as the novel coronavirus SARS-CoV-2 spreads across the globe, governments are struggling to slow down its wrath. Worldwide public health responses and emergency measures have been implemented to stem the impact of the coronavirus disease (COVID-19).

Study: Maternal and perinatal outcomes with COVID‐19: A systematic review of 108 pregnancies. Image Credit: MIA Studio / Shutterstock

There is a widespread focus on high-risk populations, including older people, those with underlying medical conditions, and those whose immune systems are compromised. However, there is not much focus on the risk of pregnant women and their children, even though they are vulnerable to viral infections.

Research on the effects of COVID-19 in pregnancy is still in its infancy. Now, a new study highlights the outcomes of a hundred or so pregnant women and their babies amid the COVID-19 pandemic.

A team of researchers from the Department of Obstetrics and Gynecology, Skanes University Hospital in Malmo- Sweden and the Lund University wanted to shed light on the clinical manifestations and outcomes of COVID-19 of pregnant mothers and their unborn babies.

Published in the journal Acta Obstetricia et Gynecologica Scandinavica (AOGS), the team searched for databases for all case reports between February 12 and April 4. The team used various terms and combinations, including pregnancy, COVID-19, maternal mortality, maternal morbidity, clinical manifestations, complications, intrauterine fetal death, neonatal morbidity, neonatal mortality, and SARS-CoV-2.

Clinical manifestations and outcomes

The team has found that from the 108 pregnancies, which are all in the third trimester, noted between December 8, 2019, and April 1, most reports that women who contracted the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), had fever and cough. Of all the women, 68 percent presented with fever, while 34 percent had a cough. Other clinical manifestations noted include lymphocytopenia and an elevated C-reactive protein—about 91 percent of all the women delivered via cesarean section.

Though there were admissions to the maternal intensive care unit, there were no deaths reported. However, one neonatal death and one intrauterine death, which means the fetus died inside the mother’s womb, were reported.

“Although the majority of mothers were discharged without any major complications, severe maternal morbidity as a result of COVID‐19 and perinatal deaths were reported. Vertical transmission of the COVID‐19 could not be ruled out. Careful monitoring of pregnancies with COVID‐19 and measures to prevent neonatal infection is warranted,” the authors concluded.

Further, the researchers revealed that there is still a possibility of severe maternal disease tied to COVID-19, which may warrant the need for ICU admission. Based on the data, there is no evidence of maternal-fetal transmission of SARS-CoV-2 in most of the cases. Still, one newborn baby had a positive test result about 36 hours after birth despite being isolated from the mother.

The researchers recommend that pregnant women diagnosed with COVID-19 should be monitored closely to ensure their health and well-being.

Surveillance and research on pregnancy

Another study published in The Lancet reiterates the importance of extensive surveillance and research on COVID-19 and pregnant women. Though pregnant women are not currently recognized as a vulnerable population amid the coronavirus pandemic, more research is needed to understand the effect of the novel coronavirus on the mother and the unborn baby.

The immune system during pregnancy becomes less aggressive, as not to attack the genetically different fetus inside the mother. The mother becomes susceptible to various infections, including viral diseases. Also, the size of the thoracic cavity, the space containing the lungs and the heart, becomes decreased during pregnancy. This leaves the lungs with less space to work in due to the pressure of the growing womb on the diaphragm. Pregnant women during the last trimester may feel shortness of breath. All these factors may lead to developing severe COVID-19.

Governments and health officials should implement many strategies to ensure the welfare of pregnant women. Surveillance can help improve the understanding of the disease course and potential complications during pregnancy. H, which may endanger not only the newborn baby but also the healthcare workers assisting in the delivery.

“The crucial information obtained from key surveillance and research studies will help to inform clinical recommendations and public health guidance and messages tailored to local contexts. Pregnant women and their neonates should not be ignored,” the researchers wrote on the paper.