COVID-19 and Pregnancy
July 14, 2020
According to research, pregnant females can become sick and develop typical signs and symptoms of COVID-19 infection.
COVID-19 and Pregnancy
The COVID-19 outbreak has been one of the most controversial topics in the media since the start of the pandemic. The lack of research and changing information circulating in the news media and on social media has deepened the controversial nature of the topic. Pregnancy and COVID-19 is one aspect of the pandemic that has not been fully explored due to the fewer number of pregnant subjects included in research studies. As more data from research became available, we learned that pregnant women could get the disease, but current research shows that the baby rarely contracts the virus (1). Moreover, pregnant mothers have weakened immune systems, and they may develop more severe signs and symptoms of COVID-19 than the general population. The exclusion of pregnant subjects from initial research has made it impossible to have a full understanding of the topic. Another issue related to pregnancy and COVID-19 is inadequate contraceptive and sexual health provided to women and young girls. Below we discuss what pregnancy means in terms of COVID-19, what data shows on pregnant mothers, contraceptive health issues, risks for domestic violence, and effects of the virus on fetuses and newborn babies.
Risks in pregnancy
According to research, pregnant females can become sick and develop typical signs and symptoms of COVID-19 infection. According to one Spanish study, pregnant women ages 30-40 who are sick with the COVID-19 are at higher risk of developing pneumonia in comparison to the general population (2), and more comprehensive research based on 538 pregnancies showed that preterm births and cesarean delivery rates have increased (3). Pregnant women are susceptible to COVID-19, and special attention should be paid to the selection of drugs that are both effective for maternal diseases and friendly to the developing fetus. The pregnant individuals develop a similar clinical presentation of the symptoms to general populations, including fever, cough, myalgia, dyspnea, fatigue, and headache, which are classified as mild symptoms of COVID-19 (4). Also, this population is prone to develop more severe respiratory symptoms if sick with viruses from the corona family because of their weakened immune system. Still, only a few cases of critical and fatal outcomes were recorded (3,5). The CDC recommends pregnant women take regular precautions to prevent contracting the illness from others by washing their hands and social distancing, not touching their face, eyes, mouth, and staying away from sick people (5). According to some contributors to the discussion, this recommendation is based on historical data on other viruses and not the current research-based on actual SARS-CoV-2 cases (6). The CDC points out that there is no data about the worse prognosis for pregnant women and fetuses. Still, according to the CDC website, pregnancy makes women naturally more prone to respiratory illnesses than the general population (5). In pregnant women who develop COVID-19 pneumonia, early data show approximately the same rate of intensive care unit (ICU) admissions as in the nonpregnant population. The data also shows these women have an increased risk of preterm and cesarean deliveries, but not increased rates of congenital malformations (3). Pregnant health care workers are in a separate subgroup of vulnerable populations, but the guidelines on how to protect them are limited (3). There is hope that looking at these issues, collecting data, and providing research will result in changes in policies that will protect the pregnant health care workers.
There is not much information about the effect of COVID-19 on contraceptive health. According to the United Nations Foundation, women represent 70% of the combined global health and social sectors (7). Therefore, there is a need to address their rights for contraceptives, to carry the pregnancy to full term, and to give birth in a healthy environment. According to this same website, COVID-19 further marginalized the sexual and reproductive rights of women and young girls around the world who were already suffering in terms of vulnerability to reproductive and sexual health (7). The negative effects of the disparities affecting this sector will be visible months and years from now. According to Dr. Benjamin Black, a consultant in reproductive health and an obstetrician and gynecologist at Whittington Hospital in London, special attention should be paid to women in quarantined areas, those who are self-isolating, and those with limited access to transportation (8).
Intimate partner violence and COVID-19
The current limitations in seeing patients in person may increase rates of undetected intimate partner violence (IPV) because often, the first signs and symptoms of physical and sexual abuse are detected in gynecologist offices. It has been proven that pregnant women are at higher risk of physical abuse in comparison to the general population, especially as the pregnancy progresses, and during the postpartum period (9). Thus, the social isolation recommended by governments across the globe, in a hope to prevent the spread of the virus, can backfire in pregnant populations who are already vulnerable. According to the WHO website, their organization, along with FIFA, and the European Commission, have joined forces against violence with a campaign called #SafeHome, which supports and protects women and children who are at risk for domestic violence (10).
What about the baby?
According to several studies, fetuses from mothers with COVID-19 can be infected with the virus, but it rarely occurs, and the prognosis for both infants and their mothers is good (4). Moreover, there is evidence of only one infant contracting the virus from the infected mother (4). According to one study based on nine pregnant women with COVID-19 who delivered their babies via cesarean sections, none of the babies contracted the virus, which was checked by testing for the presence of SARS-CoV-2 in amniotic fluid, cord blood, and neonatal throat swab samples (1). In another study testing seven pregnant women and their babies, one of the children became infected, and the baby didn’t develop acute signs and symptoms of the illness; therefore, there was no need to treat it (4). According to the experts from Vanderbilt University, at this time, there is no data of an increased risk of congenital disabilities, but there has been a reported increase in preterm delivery; however, that does not appear to be directly related to the virus (5). The risk of miscarriage is not known to be directly affected by COVID-19 (3). More data is needed for babies who were delivered naturally because most of the current research is based on C-section deliveries. Additionally, more research is required in order to know if and how fetuses are affected by the virus when contracted from a sick mother.
The COVID-19 crisis is still evolving, and there is not much known about its effects on pregnancy due to limited research. The pandemic showed the disparities in health and inequalities across underserved populations. Among these concerns is the issue of contraceptives and sexual health, as well as the collection of data among pregnant women, which was lacking from the beginning of the pandemic. Due to these factors and the lengthy process of pregnancy, the data is scarce. According to the CDC and other sources, the recommendations for pregnant women are based on protecting themselves and isolation from others in the hope of not contracting the illness. This, on the other hand, can cause the issue of increased mental problems due to mandated isolation and an increase in domestic violence against pregnant women. Because the vast majority of the pregnant individuals and their newborns included in the current research present with mild signs and symptoms, there are no guidelines to which medications should be used to treat COVID-19 infection.
1. Chen H, Guo J, Wang C, Luo F, Yu X, Zhang W, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. The Lancet. 2020 Mar 7;395(10226):809–15.
2. Jeff Craven, Katie Lennon. Asymptomatic COVID-19 Spread Deemed “Rare,” WHO Says [Internet]. 2020 [cited 2020 Jun 10]. Available from: https://www.medscape.com/viewarticle/931984
3. Coronavirus disease 2019 (COVID-19): Questions and answers - UpToDate [Internet]. [cited 2020 Jun 10]. Available from: https://www-uptodate-com.unh.idm.oclc.org/contents/coronavirus-disease-2019-covid-19-questions-and-answers?search=coronavirus%20routes%20of%20transmission&source=search_result&selectedTitle=8~150&usage_type=default&display_rank=7#H3612843842
4. Yu N, Li W, Kang Q, Xiong Z, Wang S, Lin X, et al. Clinical features and obstetric and neonatal outcomes of pregnant patients with COVID-19 in Wuhan, China: a retrospective, single-centre, descriptive study. Lancet Infect Dis. 2020 May 1;20(5):559–64.
5. If You Are Pregnant, Breastfeeding, or Caring for Young Children Other LanguagesPrint Page [Internet]. 2020 [cited 2020 Jun 23]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/pregnancy-breastfeeding.html#pregnancy-considerations
6. MD HF. Pregnant and worried about the new coronavirus? [Internet]. Harvard Health Blog. 2020 [cited 2020 Jun 23]. Available from: https://www.health.harvard.edu/blog/pregnant-and-worried-about-the-new-coronavirus-2020031619212
7. Jalan Seema. Addressing Sexual and Reproductive Health and Rights in the COVID-19 Pandemic [Internet]. 2020 [cited 2020 Jun 23]. Available from: https://unfoundation.org/blog/post/addressing-sexual-and-reproductive-health-and-rights-in-the-covid-19-pandemic/?gclid=Cj0KCQjw0Mb3BRCaARIsAPSNGpUH-fU_apq_CUZnYG3efa-V8vvIyYSOyTuzLs88Z4Ct_BFujep4IeEaAlfoEALw_wcB
8. Anne Harding. COVID-19’s Sexual Health Repercussions Put Most Vulnerable at Risk [Internet]. Medscape. [cited 2020 Jun 23]. Available from: http://www.medscape.com/viewarticle/927561
9. Finnbogadóttir H, Dykes A-K. Increasing prevalence and incidence of domestic violence during the pregnancy and one and a half year postpartum, as well as risk factors: -a longitudinal cohort study in Southern Sweden. BMC Pregnancy Childbirth. 2016 Oct 26;16(1):327.
10. FIFA, European Commission and World Health Organization launch #SafeHome campaign to support those at risk from domestic violence [Internet]. [cited 2020 Jun 24]. Available from: https://www.who.int/news-room/detail/26-05-2020-fifa-european-commission-and-world-health-organization-launch-safehome-campaign-to-support-those-at-risk-from-domestic-violence
11. Coronavirus (COVID-19) Guidance for Pregnant Workers | Coronavirus (COVID-19) Information for Employees and Patients [Internet]. [cited 2020 Jun 23]. Available from: https://www.vumc.org/coronavirus/coronavirus-covid-19-guidance-pregnant-workers