Pregnancy and COVID-19

Contributed by Dr Rajiv Kartik, Dr Ashwini Tayade

Even as the Covid pandemic continues to wreck havoc worldwide with the total number of cases exceeding 5.5 million, there is limited data about the clinical characteristics of pregnant women with the disease. Viral pandemics such as the 2009 Swine flu pandemic showed that pregnant women are more at risk for severe disease and complications than the general population.

Pregnant women do not seem to be at higher risk than non-pregnant individuals of severe COVID-19 infection requiring hospital admission. Several reviews and recently a large study of 16,749 individuals hospitalized in the UK with COVID-19, showed that the proportion of pregnant women hospitalized (6%) was similar to the proportion in the general population, and pregnancy was not associated with increased mortality, unlike in influenza, SARS- CoV and MERS-CoV. Many remained asymptomatic or with mild symptoms only. Symptomatology was not different from the general population. Case fatality rate for pregnant women hospitalized with COVID-19 was 1.2% (95% CI 0.4–2.7%).

In the UKOSS study the median gestational age at hospital admission was 34 completed weeks (IQR 29–38). Most women were hospitalized in the third trimester of pregnancy or peri-partum (81%). Several studies showed that the majority of women had caesarean births; most of these were because of maternal or fetal compromise, the remainder for obstetric reasons (e.g. progress in labour, previous caesarean birth) or maternal request. The need for general anaesthesia varied from 7- 20%, required because of severe COVID-19 symptoms or urgency of birth.

There are currently no data suggesting an increased risk of miscarriage or early pregnancy loss in relation to COVID-19. A systematic review including 252 pregnant COVID-19 patients reported that 15 percent delivered before 37 weeks. There is no evidence currently that the virus is teratogenic. Very recent evidence has, however, suggested that it is probable that the virus can be vertically transmitted, although the proportion of pregnancies affected and the significance to the neonate has yet to be determined. PCR testing for COVID19 in samples from 30 cord blood, 23 amniotic fluid, and 12 placentas were all negative. Data on breastfeeding were reported for 29 newborns, with 18 newborns breast fed. All samples of breast milk from 26 women tested negative for COVID - 19.

In conclusion the currently available data suggest that COVID - 19 infection during pregnancy has a similar clinical presentation and illness severity to non-pregnant adults and may not be associated with poor maternal or perinatal outcomes.

References

  1. Docherty AB, Harrison EM, Green CA, et al. Features of 16,749 hospitalised UK patients with COVID-19 using the ISARIC WHO Clinical Characterisation Protocol. medRxiv 2020.04.23.20076042
  2. Elshafeey F, Magdi R, Hindi N, et al. A systematic scoping review of COVID-19 during pregnancy and childbirth. Int J Gynaecol Obstet. 2020 Apr 24
  3. Knight M, Bunch K, Vousden N, et al. Characteristics and outcomes of pregnant women hospitalised with confirmed SARS-CoV-2 infection in the UK: a national cohort study using the UK Obstetric Surveillance System (UKOSS). medRxiv 2020.05.08.20089268