COVID-19 in Pregnancy Tied to Problems in Mother and Newborn

By Megan Brooks

October 18, 2021

NEW YORK (Reuters Health) - Pregnant women with symptomatic COVID-19 are more likely to have emergency deliveries, compared with peers with COVID but no symptoms, and their newborns are more likely to require oxygen support and a stay in the neonatal intensive-care unit (NICU), according to a single-center experience.

"The results were pretty surprising and unexpected," senior author Dr. Rovnat Babazade of the University of Texas Medical Branch, in Galveston, said in a phone interview with Reuters Health.

He presented the study findings at Anesthesiology 2021, the annual meeting of the American Society of Anesthesiologists (ASA).

The researchers took a look back at 101 pregnant women who tested positive for COVID-19 and were admitted for delivery from March to September 2020. Of these, 69 were asymptomatic and 32 were symptomatic - 42% had fever, 39% had a cough, 26% had shortness of breath, 16% had muscle pain, 16% had chills and 10% had chest pain.

Comparing the symptomatic and asymptomatic groups, the symptomatic mothers had a higher percentage of cesarean deliveries (65.6% vs. 60.9%) with an increase in emergent circumstances (59.4% vs. 44.9%), the authors report in their meeting abstract.

"This increase in the prevalence of emergent cesarean sections with symptomatic infection could be caused by the reduced oxygenation and endothelial cell dysfunction. This potential for poor oxygenation could also contribute to the difference in neonatal outcomes recorded," they write.

Compared with asymptomatic mothers, the neonates of symptomatic mothers were more likely to need respiratory support (31.3% vs. 29.0%) and be admitted to the NICU (43.8% vs. 36.2%).

One neonate tested positive for COVID after delivery, which is "concerning" for possible vertical transmission of COVID-19, the researchers said. The newborn had respiratory distress and required NICU admission and oxygen support. A second COVID test at 48 hours was again positive.

"All care providers have to work together to make sure that we are well prepared for the possible adverse outcomes for the baby and mother," Dr. Babazade told Reuters Health.

Reached for comment, Dr. Mark Zakowski, chair of the ASA's committee on obstetric anesthesia, said this single-center study "confirms what we've seen in other studies, which is pregnant women with COVID may be sicker and therefore wind up with a higher rate of severe infection and babies admitted to the NICU."

"This is not surprising, and similar to mothers with other significant diseases, the baby may not tolerate the stress of labor. And particularly with COVID, if they come in symptomatic and mom can't oxygenate, they're not going to be able to oxygenate the baby either and that will lead to signs of fetal distress and changes in fetal heart rate, which could lead to cesarean section," Dr. Zakowski noted.

SOURCE: http://bit.ly/2N4kQ0Y Anesthesiology 2021 Annual Meeting, presented October 9, 2021.

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