PANAMA CITY: A pregnant woman wears a face masks amid concern over the spread of the COVID-19 ... [+]
In a new study of 427 pregnant women admitted to UK hospitals with a confirmed SARS-CoV-2 infection, researchers found that most women did not have a severe illness and were generally admitted to the hospital in their third trimester of pregnancy. More than half of the pregnant women belonged to Asian (25%), Black (22%) or other ethnic minority groups.
What we know about Covid-19 in pregnant women is currently limited to single case reports or small case series. “We don’t really have a lot of firm data that we can share with our patients,” says Huma Farid, who is an obstetrician/gynecologist (OB/GYN) at the Beth Israel Deaconess Medical Center, and an instructor at Harvard Medical School.
To learn more about Covid-19 in pregnant women, a group of researchers took a population-wide approach, where they used the UK Obstetric Surveillance System (UKOSS) to understand the outcomes of pregnant women across all 194 UK hospitals with an obstetric unit.
“[The UKOSS] is a system I set up in 2005, which allows us to conduct national studies of uncommon complications in pregnancy. We have reporting doctors and midwives in all obstetric units in the UK,” says lead study author Marian Knight, who is a professor of maternal and child population health at the University of Oxford’s National Perinatal Epidemiology Unit.
In 2011, Knight and her fellow researchers laid the foundations needed to launch a rapid investigation of the impact of influenza in pregnancy in case of a future pandemic. In wake of Covid-19, the UK Department of Health and Social Care activated this study in order to investigate the characteristics and outcomes of pregnant women admitted to hospitals with SARSCoV-2 infections between 1 March to 14 April 2020.
Most women did not have a severe illness, and were admitted in the third trimester of pregnancy
The study found that most pregnant women with a confirmed SARS-CoV-2 infection (81%) were admitted to the hospital in their third trimester of their pregnancy. Common symptoms were a fever, coughing and breathlessness. This, Knight says, highlights “the importance of paying attention to social distancing in the later stages of pregnancy.”
Most of the pregnant women did not have a severe illness: only 41 (10%) needed critical care. Of the women who needed critical care, 33 successfully delivered their babies, and the remaining eight women were successfully discharged after critical care and have yet to give birth.
“Women who had underlying health conditions, particularly diabetes and high blood pressure, were more at risk. We also noted that women who were overweight, or older, were more likely to be admitted [to hospitals] with Covid-19 in pregnancy,” says Knight, pointing out that these are risk factors to keep in mind.
More than half of women were from minority groups
Notably, the study found that just over half of the admitted pregnant women (56%) belonged to ethnic minority groups, where 25% and 22% of women were Asian and Black respectively.
“It is a finding that still needs further investigation,” says Knight, noting that the study found that factors, such as underlying health conditions or a higher incidence of Covid-19 in urban areas with higher proportions of women from ethnic minority groups, could not explain this disparity. “We need studies where we’re actually talking to women, and their health professionals, about what their experiences of care are, and whether there are any conscious or unconscious biases that are affecting their care, which might explain some of this.”
Farid, who is unaffiliated with this study, notes that the Centers for Disease Control and Prevention (CDC), and cities such as Boston and Milwaukee, are also tracking data based on race and ethnicity. “What we have seen here correlates with what is seen in the UK,” says Farid. “It is quite concerning that Black and Latina patients are more at risk of having an infection, and also tend to have worse outcomes when they do have an infection, whether you’re pregnant or not.”
In her own practice, Farid is having frank conversations with her patients who are Black or Latina, to “acknowledge, as physicians, that their communities are having disproportionately elevated rates of infection, and what we can do to decrease those risks.” She also notes that there’s been a lot of discussion in the lay media and scientific journals about why this may be the case, and that there are studies showing that “prior to Covid-19, there are actual tangible effects of systemic racism.”
“Even before Covid-19, as OB/GYNs, we knew that Black women, who are case-matched to white women, have worse outcomes compared to their counterparts,” says Farid. “These are important questions to ask. We don’t have great answers.”
Outcomes of pregnant women
At the time of this study’s publication, 262 women (62%) gave birth, with the remaining 161 (38%) still pregnant. Four of the admitted women (0.9%) had a miscarriage.
A total of five babies died. There were three stillbirths (0.7%) and two babies (0.47%) who died in the neonatal period (i.e. the first month). Of these five deaths, three were unrelated to Covid-19, though the cause of death in two of the stillbirths is unclear. In addition, five pregnant women (1.2%) who were admitted with a SARS-CoV-2 infection died, where three of these women died as a direct result of Covid-19 complications.
“There are anecdotal reports of increased risks of miscarriage - that has not actually been borne out of data,” comments Farid. “It is a concern for many pregnant women [...] that is one question that I would like to see in further studies: are there any higher rates of miscarriage among women with Covid-19?” Here, Farid notes that unfortunately, miscarriages are common, and so, there would have to be a “noticeably high jump” in order to conclude that there is a higher rate.
What’s next?
This study is ongoing, and will continue to collect data about pregnant women admitted to a UK hospital with a confirmed SARS-CoV-2 infection for the next three months. Knight notes that this study doesn’t account for pregnant women who may be asymptomatic or have mild Covid-19 symptoms.
“[Pregnant women] shouldn’t be scared of Covid-19. It shouldn’t prevent them attending for their pre-natal checks,” says Knight, noting that about five women per 1,000 giving birth were admitted to hospital with Covid-19. “There are other pregnancy complications, [such as] pre-eclampasia and high blood pressure, which are much more common, affecting around five in every hundred women. Those are severe complications that can be picked up early and treated by going to pre-natal visits.”
Knight adds that “the best solution to Covid-19, is to prevent yourself getting infected - so maintaining social distancing in the third trimester is particularly going to be important. And if you are at all concerned, phone. Phone your OB/GYN or midwife for advice.”
