The Impact of Epidemiology on Fertility and Prenatal Care During the COVID-19 Pandemic

Jodie Dionne-Odom; Sigal Klipstein

Disclosures

Am J Epidemiol. 2021;190(5):701-706. 

In This Article

Abstract and Introduction

Abstract

The emergence of the novel coronavirus disease 2019 (COVID-19) presented the field of reproductive medicine with many challenges due to an absence of data to guide clinical decision-making and inform patient counseling and management in the early days of the pandemic. Epidemiological studies rapidly filled key gaps in our understanding of the susceptibility of reproductive-aged women to the virus, transmission dynamics during pregnancy and lactation, and the effect of infection during the prenatal, pregnancy, and postpartum periods. This data guided the development of clinical guidelines written by the American Society for Reproductive Medicine as patients and clinicians navigated reproductive decisions during a time of uncertainty. We present a review of epidemiologic studies published between March and December 2020 that have directly informed prenatal and fertility care during the COVID-19 pandemic. Despite a significant increase in our knowledge base over the past year, many questions remain about the impact of COVID-19 on conception, pregnancy, fetal development, and lactation. In the future, a commitment toward inclusion of pregnant persons and those attempting pregnancy in the design of observational and interventional trials is necessary to gain earlier insights about outcomes and assist providers and patients in making data-driven decisions.

Introduction

The appearance and rapid spread of the novel coronavirus disease 2019 (COVID-19) in 2020 presented the field of reproductive medicine with a number of challenges. At the beginning of the outbreak, our knowledge base to inform clinical care was limited. How infectious is the virus and how is it transmitted? Are pregnant women at higher risk of COVID-19 acquisition or progression to severe disease? Does infection affect in utero fetal development? Is fertility affected? Limited data on these fundamental questions restricted our ability to provide accurate, data-driven counseling to patients who were facing an altered reality caused by the pandemic. Suddenly, providers who care for women of reproductive age were fielding many questions about the ideal timing of conception, risks associated with infection, and the management of women with COVID-19 infection or exposure during preconception, pregnancy, and postpartum periods.

Clinicians routinely counsel individual patients about the risks of untoward events, and we are comfortable managing certain types of uncertainty. Examples from daily practice include the chance of success with fertility treatments and the risk of pregnancy complications after an infection. The goal of shared clinical decision-making relies on a detailed understanding of risk that is usually defined by epidemiologic studies. While clinicians cannot predict the precise probability of an event (such as a spontaneous abortion or a pregnancy-related complication), we can counsel individuals who are pregnant or seeking pregnancy by discussing the range of possible outcomes. The COVID-19 pandemic presented the medical field with the challenge of operating within a context where the risk of adverse outcomes was largely unknown.

Epidemiologic data illuminated the range of possible reproductive health outcomes of COVID-19. These data provide the framework for our frequently updated clinical recommendations as members of the American Society for Reproductive Medicine COVID-19 Taskforce.[1] Once the pandemic was recognized, epidemiologists around the world responded swiftly by mobilizing high-quality data collection and designing large cohort studies and clinical trials. Collaborative research teams with experts in epidemiology and clinical medicine homed in on some of the most important questions in each field. Early studies documented the distribution of infection in various populations, factors associated with viral acquisition or severe disease, and methods to mitigate transmission. After peer review, high-quality published findings were rapidly incorporated into clinical guidance documents that were developed by national and international organizations to improve patient management on the front lines. In the setting of uncertainty, rapid community spread, and an evolving understanding of COVID-19, there has been increased demand to translate new scientific epidemiologic data into clinical guidelines that can equip clinicians with the most up-to-date information for decision-making.[2]

In this commentary, we cite specific examples of epidemiologic studies that changed the discussions we had about COVID-19 risk, prevention, and treatment with individuals who were pregnant or seeking pregnancy. We close with a discussion of knowledge gaps and a call to action to support the principle of inclusivity when designing future cohort studies and clinical trials to address and improve reproductive health outcomes of COVID-19.

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