Heightened COVID-19 risk among pregnant women

Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis. Image Credit: MIA Studio / Shutterstock

Since the emergence of the coronavirus disease (COVID-19) pandemic, little is known about the risks of COVID-19 to pregnant women. Now, a new study reveals that pregnant women with COVID-19 are less likely to experience symptoms of fever and myalgia than non-pregnant women of reproductive age, but maybe at a heightened risk of being admitted to intensive care.

Further, the researchers revealed that pregnant women with COVID-19 are at a heightened risk of delivering preterm.

A team of researchers at the Institute of Applied Health Research, University of Birmingham, United Kingdom, wanted to determine the clinical manifestations, risk factors, and maternal and perinatal outcomes in pregnant women with suspected and confirmed COVID-19.

COVID-19, which is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), may become potentially fatal in some populations, like those with underlying health conditions such as hypertension, diabetes, and heart disease, those who are older than 65 years old, and those with weakened immune systems. Children and younger people seem to experience only mild to moderate symptoms.

The study titled, “Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis” is published in the British Medical Journal.

The study

The research team reviewed 77 studies about COVID-19 in pregnant and recently pregnant women, published between December 1 and June 26. They scanned through sources such as Medline, Embase, WHO COVID-19 database, Cochrane database, the Wanfang databases, and the China National Knowledge Infrastructure (CNKI), along with social media, preprint servers, and reference lists.

Collectively, the team has gathered data on 13,118 pregnant and recently pregnant women with COVID-19, and more than 83,400 non-pregnant women of reproductive age who were also diagnosed with COVID-19.

The team revealed that 10 percent of pregnant women and those who were recently pregnant attending or admitted to hospital for any reason were diagnosed as having suspected or confirmed COVID-19. Also, the team has found that the most common clinical manifestations of the viral infection in women were fever and cough.

Compared with non-pregnant women, those who are pregnant or recently pregnant were less likely to report symptoms of fever and muscle pain. They were also more likely to be admitted to the intensive care unit and invasive ventilation.

About 73 pregnant women with confirmed COVID-19 died from any cause. For those who developed severe COVID-19, the most common contributory factors include increased maternal age, obesity, or high body mass index, chronic hypertension, and pre-existing diabetes.

“Pre-existing comorbidities, high maternal age, and high body mass index seem to be risk factors for severe COVID-19. Preterm birth rates are high in pregnant women with COVID-19 than in pregnant women without the disease,” the team said.

“The odds of any preterm birth were high in pregnant women with COVID-19 compared with those without the disease. A quarter of all neonates born to mothers with COVID-19 were admitted to the neonatal unit and were at increased risk of admission than those born to mothers without COVID-19,” they added.

Considered as a high-risk group

The researchers urge healthcare professionals to consider pregnant women as a high-risk group for COVID-19, along with those who are obese and of increased maternal age. Most pregnant women may not manifest any symptoms of the infection, but with the increased risk of being admitted to the ICU, clinicians need to monitor them regularly.

Also, pregnant women should practice infection control measures, such as proper hand hygiene, practicing social distancing, and wearing masks. They should also avoid going out of the house, going to public places, and visiting crowded places.

“Clinicians will need to balance the need for regular multidisciplinary antenatal care to manage women with pre-existing comorbidities against unnecessary exposure to the virus, through virtual clinic appointments when possible. Pregnant women with COVID-19 before term gestation might need to be managed in a unit with facilities to care for preterm neonates,” the team added.

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