Pregnant Women With COVID-19 'More Likely to Need Intensive Care'

Peter Russell

September 02, 2020

Pregnant women with COVID-19 are less likely to show the major symptoms of infection with SARS-CoV-2 than non-pregnant women of similar age, research has found.

However, the study, published in The BMJ,  found they might be more at risk of admission to a hospital intensive care unit.

Preterm birth rates were also found to be higher amongst pregnant women with COVID-19 than pregnant women without the disease.

Pre-existing comorbidities were noted as significant extra risk factors for severe COVID-19.

Review of Available Evidence

Pregnant women are considered a high-risk group because of concerns about the effect of COVID-19 during and after pregnancy, and on their offspring.

To help understand the clinical implications for maternity services against rapidly evolving evidence, a team of experts from the World Health Organisation and the University of Birmingham, analysed data from 77 studies.

Most of the literature was from the United States and China but also included studies from Italy, Spain, the UK, France, and eight other countries.

The studies reported rates, clinical features, risk factors, and outcomes for 11,432 pregnant and recently pregnant women admitted to hospital and diagnosed with suspected or confirmed COVID-19.

Overall, 10% of pregnant and recently pregnant women who attended or were admitted to hospital were diagnosed with COVID-19.

Compared with non-pregnant women, the pregnant and recently pregnant cohort were less likely to show symptoms of fever and myalgia.

They were also 62% more likely to need intensive care, and 88% more likely to require invasive ventilation.

Increased maternal age was a factor that increased risk, as were comorbidities including higher BMI, hypertension, and diabetes.

Pregnant women with a pre-existing maternal comorbidity were more than four times more likely to be admitted to intensive care than women who did not have pre-existing comorbidities.

The odds of giving birth prematurely were also higher in pregnant and recently pregnant women with COVID-19 compared to those without the disease.

A quarter of all babies born to mothers with COVID-19 were admitted to a neonatal unit and were at increased risk of admission compared with those born to mothers without the disease.

However, stillbirth and newborn death rates were low.

Study Demonstrates 'A Need for Increased Awareness'

The researchers point to some study limitations, including differences in study size, design, and definitions of symptoms, tests, and outcomes. However, they said they had adopted a robust approach to ensuring data was sound.

Shakila Thangaratinam, a professor of maternal and perinatal health at the University of Birmingham, who led the study, said: "Our study has demonstrated a need for increased awareness for health care professionals around the symptoms and effects of COVID-19 on pregnant and recently pregnant women, and early identification of pregnant women with risk factors.

"We shall be updating our findings on a regular basis as new evidence emerge."

Andrew Shennan, professor of obstetrics at King's College London commended the researchers for a large and well conducted summary of available evidence.

He told the Science Media Centre: "It confirms that COVID-19 is not serious for the vast majority of women in pregnancy. Only 1 in 1000 affected women died and this is likely to be an overestimate, as this data tends to report higher risk women and includes deaths from causes other than COVID-19.

"Early labour is also not increased but early delivery to help manage the sick woman may be needed. Pregnant women are slightly more likely to be admitted to intensive care.

"Like non-pregnant individuals, age, weight, high blood pressure, and diabetes are significant risk factors. Pregnant women were less likely to have high temperature and muscle pains, possibly because they are routinely tested rather than present with symptoms."

Dr Edward Morris, president of the Royal College of Obstetricians and Gynaecologists, commented: "This study highlights a possible increase in the need for intensive care among pregnant women with coronavirus. 

"This is also true for pregnant women should they contract flu. This year, it is particularly important that pregnant women take up the offer of the free flu vaccine, which is safe in all trimesters of pregnancy, to protect them from becoming seriously unwell with flu.

"The findings of this paper highlight the need for more research into the effects of the virus on pregnant women and their babies in order for health services to better respond to their needs during this time."

Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis, BMJ 2020;370:m3320. Paper.

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