COVID-19 strikes fear in many, but pregnant women may have special concerns. If you are not yet pregnant, but thinking about having a baby, it makes sense that coronavirus will play a role in your decision. What is the impact of coronavirus on pregnancy, and what are your chances for having a healthy baby? As of this writing, we know that COVID-19 increases the risk for stress, anxiety, and depression in pregnant women. The good news is that women who get coronavirus in pregnancy are often asymptomatic or have mild symptoms, and their babies are usually fine.
But knowing the facts is one thing, reading the news is another. The media loves to feed us stories that play on our emotions. It’s not hard, therefore, to find both heartbreaking and heartwarming news stories of pregnant women who have contracted the virus. The important thing is not to put too much stock in these stories, and not to assume these outcomes are typical.
Google “COVID-19 pregnancy” and you might find, for example, the (heartbreaking) story of the woman who died of coronavirus before she got a chance to hold her newborn son. The video of her crying, grief-stricken brother is almost too painful to watch. There’s also, on the other hand, the recent (heartwarming) story of the pregnant woman who got coronavirus and required intubation, but left the hospital with her baby in her arms. (During the worst of this woman’s illness, the family had been asked whom to save: the mother or the baby.)
Pregnant Women Often Have Mild Symptoms, Babies are Fine
Despite all the media hype, in the vast majority of cases, pregnant women get only a mild case of coronavirus, if at all, and their babies are fine. Even so, it is natural and normal for pregnant women to worry. That worry, of course, is not completely without cause.
While COVID-19 in pregnancy tends to be asymptomatic or mild, pregnant women and their babies have a higher risk for severe complications from infection in general, and not just from COVID-19. This is because of known changes to a woman’s endocrine and immune systems during pregnancy. According to the CDC, of the women aged 15-49 hospitalized for COVID-19 from March 1 to August 22, 2020, a full quarter of them were pregnant. These pregnant women, as it turns out, were more likely to require a ventilator.
Related to these changes in the immune and endocrine systems, a team of researchers at Johns Hopkins University, noted that pregnant women with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) had decreased antiviral antibody responses. The women were also seen to have an inflammation of the placenta. The authors of this study hope their findings will lead to improved treatment of coronavirus in pregnant women.
Pregnant Women More Likely Need Intubation
Dr. Avi Patil, founder and CEO of Nixxi, a woman’s health company on a mission to improve pregnancies and their outcomes, says that the decreased immunity of pregnancy may indeed be an issue. “Pregnancy has been associated with increased severity of COVID-19, possibly related to the decreased immunity associated with pregnancy. An analysis of pregnant women with COVID-19 demonstrated a 3-fold higher risk of admission to the ICU or intubation compared to non-pregnant women. Additionally, there was a 70% increase in deaths due to COVID-19 in pregnant women compared to non-pregnant women.
“Particular groups of women appear to be more susceptible, including those with pre-existing medical conditions, older women, and minority women. It is important to note that the data is continuing to evolve as healthcare providers develop better strategies to screen and treat women with COVID-19, and these statistics will likely improve over time with the implementation of vaccinations and new treatments to reduce disease severity.”
Patil still sees reason for encouragement. “Although the relative risk of COVID-19 complications is higher during pregnancy, the overall risk to a pregnant woman is still relatively low: intubation occurs in 2.9 out of 1,000 infected individuals, while death occurs in 1.5 per 1,000 infected individuals. Additionally, the available evidence suggests that there is a very low risk of transmission of COVID-19 to the fetus, and no clear evidence of increased rates of miscarriage or birth defects. Poor pregnancy outcomes such as preterm birth and growth restriction are possible based on similar viral infections, though more data is needed to determine the association of these outcomes with COVID-19.”
Pregnant Women May Have Prolonged Symptoms
Aside from the higher rates of complications in pregnant women with COVID-19, the course of the disease appears to be different. Pregnant women, it seems, may have more prolonged symptoms from COVID-19, lasting two months or longer. That’s the upshot of a national study performed by UC San Francisco and UCLA. This study was the largest to date on non-hospitalized pregnant women with COVID-19. Researchers looked at the course of the disease and outcomes for 594 pregnant women who tested positive for the SARS-CoV-2 virus.
The researchers found that most of the pregnant women experienced cough, sore throat, fever, and body aches, which is to be expected. But half of the participants were still experiencing symptoms after three weeks, while a quarter of them were still symptomatic after eight weeks. Could that be due to pregnancy-related changes to the immune and endocrine systems? It’s certainly plausible.
Knowledge, on the other hand, is power. Knowing that pregnant women may be more vulnerable to infections, means taking more precautions to keep them healthy and well. Just don’t expect this to include giving pregnant women the vaccine, once a vaccine is offered. That’s because pregnant women, being vulnerable to infections, have been excluded from human trials for vaccines, which is normal. Except that since pregnant women are excluded from the trials, there’s no way to know if it’s safe to vaccinate them. Which is why they aren’t getting the vaccine.
Pregnant Women and Vaccination
The irony of pregnant women not receiving the vaccine is that health care workers are getting vaccinated first. That’s because health care workers are more likely to come in contact with the virus and become sick, as a result. A full three-quarters of health care workers are women, on the other hand, and it only makes sense that at least some of them are pregnant. That means that many of the most vulnerable members of society, won’t be receiving the vaccine, which is worrisome, to say the least.
Still, there’s plenty of good news to consider. There was the mother who contracted coronavirus during her first trimester who had only mild symptoms. Her baby was fine and the kicker is, the baby was born with antibodies to the virus. And as of yet, no coronavirus has been found in samples of amniotic fluid or in breast milk. Meanwhile, pregnant women who have had COVID-19 have, in at least one study, been found to have a lower incidence of preterm births.
But that study was small, and socioeconomic factors may have affected the results. Which is why the National Institutes of Health is gearing up to analyze the medical records of some 21,000 pregnant women. They plan to track the health of expectant mothers with confirmed COVID-19 for up to six weeks after they have their babies. This will give experts a better idea of whether or not pregnant women with COVID-19 really have a lower incidence of preterm birth, or if there are rather, as suspected, other factors in play. Then again, not all pregnant women are alike. “Some pregnant patients are at increased risk for developing preeclampsia and preterm labor. At this time, there are no risk predictors to determine which pregnant women will develop these conditions,” says Dr. Linda Burke, an obstetrician with more than 30 years of experience. “African American and LatinX women are at increased risk, however, especially if they reside in rural or urban communities. Poor access to prenatal care is also a risk factor.”
Pregnant Women are High Risk
Christian Pettker, MD, Chief of Obstetrics, Gynecology & Reproductive Sciences at Yale Medicine and an associate professor at Yale School of Medicine, stresses that pregnancy places women squarely in the high-risk category for COVID-19. “Pregnancy appears to be a high-risk condition that predisposes pregnant people to severe COVID-19, hospitalization, and death and the CDC has added pregnancy to its ‘increased risk’ category. The information we have at this time suggests that those who are pregnant are at risk for more severe COVID-19 related complications than those who are not. Additionally, there may be an increased risk for preterm birth and stillbirth in people with COVID-19, though this data is somewhat more limited.”
While pregnant women may be at an increased risk for COVID-19 complications, not all the news is bad. One piece of encouraging news comes by way of a study from UT Southwestern in Dallas. It seems that 95% of women who experienced severe acute respiratory syndrome coronavirus 2 (SARS coV-2) infection during pregnancy experienced no higher risk for complications of pregnancy. That’s fantastic news, though the picture is not all rosy. Aside from the health risks of COVID-19 during pregnancy, there’s also the emotional toll to consider.
A study on pregnant and postnatal women coming out of Brigham and Women’s Hospital found that COVID-19 health worries and grief over lost loved ones have increased symptoms of depression, anxiety, and post-traumatic stress disorder (PTSD) in pregnant women and in women who have recently given birth. The study surveyed 1,123 such women between May 21 and August 17, 2020 and found that over 1 in 3 of the women (36.4 percent) had clinically significant levels of depression. This is a notable rise, compared to the 15-20 percent of women who experienced depression during or after pregnancy before the pandemic.
Strong Sense of Grief
The researchers also found that some 9 per cent of participants said they felt a strong sense of grief, loss, or disappointment because of the pandemic. The women in this group was around five times more likely to experience significant signs of mental health symptoms. Another 18 percent of the respondents said they were “very worried” or “extremely worried” about health risks from COVID-19 and were four times more likely to exhibit significant clinical signs of psychiatric symptoms.
Should You Get Pregnant?
Knowing all this, should women delay getting pregnant right now? Dr. Pettker has been answering this question since the pandemic hit, and his answer remains the same. “Timing pregnancy is always hard; there is always the risk that an issue in someone’s life (changes in relationships, jobs, family) will complicate the timing of a pregnancy. One can wait for COVID-19 to go away, but certainly another life issue will come up. It is safe enough now for people who are considering getting pregnant to get pregnant now. Hospitals and the offices of doctors and midwives are extraordinarily safe places to visit right now, when you need to visit. If you follow the guidance of public health officials, your doctors and midwives, and the hospital in your community the chances are you will have a very safe pregnancy.”
Keeping Both Expectant Mother and Baby Safe
What about if you’re already pregnant? What should you be doing right now to stay healthy and keep your baby safe?
“Our recommendations for pregnant people are the same as they are for all people. Masking, hand hygiene, social distancing, and limiting the extent of your social circles are all really important parts of staying safe from COVID-19. That said, it is also important to remain focused on eating right, staying active, and going to all of your prenatal visits. COVID-19 in the community is not a reason to stay away from hospitals and offices, which have all incorporated safe practices at this time,” says Pettker. “We have learned a lot about telehealth video visits and are occasionally using those in practice to substitute some in-person visits. And if you think you have symptoms of COVID-19, call your pregnancy provider and get tested.”