Covid-19 increases risks in pregnant women and their babies

Covid-19 increases risk of death in pregnant women 1:14

(CNN) – If you are pregnant and sick with COVID-19, there is an increased risk of negative consequences for both you and your baby, according to a new study published Thursday in JAMA Pediatrics.

Expectant mothers with a covid-19 diagnosis in 18 different countries were at increased risk of adverse outcomes, such as pre-eclampsia, infections, admission to hospital intensive care units, and even death.

According to the study, the risk of death of pregnant women with covid-19 was 1.6%, that is, 22 times higher than that of uninfected pregnant women.

Babies of mothers infected with the coronavirus also had a slightly higher risk of preterm labor and low birth weight, according to the study.

“The results presented are sobering,” wrote pediatrician Dr. Catherine Mary Healy in an editorial. Healy is an adjunct professor at Houston Baylor College of Medicine specializing in pediatric infectious diseases.

‘High risk of bad results’

In the study, which began in March 2020 and ended in October of that same year, more than 2,000 pregnant women from 43 medical institutions in 18 countries participated: Argentina, Brazil, Egypt, France, Ghana, India, Indonesia, Italy, Japan , Mexico, Nigeria, North Macedonia, Pakistan, Russia, Spain, Switzerland, the United Kingdom and the United States.

Healy wrote that he believed the study to be one of the largest to date, collecting reports from different countries “in real time as the pandemic evolved from the first detected cases.”

Of the 2,130 women who participated in the study, 706 were diagnosed with covid-19; the remaining 1,424, who were not infected, were matched for demographic and gestation characteristics to reduce error.

Almost 60% of the infected women were asymptomatic, that is, they did not have a fever or other signs of the virus. Still, Healy wrote, these women “were at increased risk for poor outcomes, such as pre-eclampsia or eclampsia, severe infections, admission to an intensive care unit … and maternal death.”

Preeclampsia is a pregnancy complication characterized by high blood pressure and signs of damage to another organ system, in most cases the liver and kidneys. Eclampsia is a serious complication of preeclampsia that causes seizures.

According to the study, pregnant women who were diagnosed with COVID-19 and who were overweight or suffered from diabetes, heart disease, hypertension or chronic respiratory diseases were almost four times more likely to develop pre-eclampsia.

Why is pregnancy risky?

Why does pregnancy put women at greater risk from the virus? One reason is a woman’s lung capacity declines as the baby grows.

“You can develop respiratory deterioration, to the point of not being able to recover from it,” Dr. Kjersti Aagaard, a maternal-fetal medicine specialist at Texas Children’s Hospital, told CNN in January.

Additionally, Aagaard, who is also a senior professor of obstetrics and gynecology at Baylor College of Medicine, said that a pregnant woman’s heart pumps 1.5 times more than normal to provide adequate blood to the baby and the placenta.

“This oversaturation of the heart, which we call increased cardiac output, also puts pregnant women at risk for heart failure problems, which can be a manifestation and potential cause of death from covid-19 disease,” he explained.

Pregnant women are also more likely to have an overzealous immune system to protect the developing fetus, which can lead to a so-called cytokine storm, an exaggerated immune system response to COVID-19 that signals more serious disease and, often the need for intensive care, Aagaard said.

And finally, there is an increased chance of blood clotting during pregnancy, which can be made worse with COVID-19.

“Humans, like all placental mammals, are at risk of bleeding to death after the placenta separates from the wall of the uterus,” Aagaard said. “So 4.5 million years of evolution helps us clot a little more effectively when we are pregnant.”

The risks of the covid-19 vaccine appear low

On Wednesday, a study of 3,958 pregnant women ages 16 to 54 who received the vaccine from Moderna or Pfizer found few serious side effects from the vaccination.

The most common was pain at the injection site, which the study found to be more common in pregnant women who received the vaccine. However, pregnant women who got vaccinated reported fewer headaches, muscle aches, chills, and fever.

As part of the study, data collected by the Vaccine Adverse Event Reporting System (VAERS) of the United States Centers for Disease Control and Prevention between December 14, 2020 and February 28, 2021.

During this period, 221 pregnancy-related adverse events were reported, including 46 spontaneous abortions. The study compared those events with data on negative pregnancy outcomes before the pandemic.

‘Although not directly comparable, the calculated proportions of adverse pregnancy and neonatal outcomes in COVID-19 vaccinated people who had a full pregnancy were similar to the incidences reported in studies with pregnant women that were conducted before the covid-19 pandemic, “says the study.

Major medical groups in the United States have urged pregnant women to consider getting vaccinated against Covid-19.
“Regulatory bodies and medical experts in the US have clearly stated that all eligible pregnant individuals should have the option to receive the vaccine,” said Dr. Christopher Zahn, vice president of practice activities for the American College. Obstetricians and Gynecologists (ACOG), in a previous interview with CNN.

“There really is no theoretical reason to believe that it will cause harm to the mother or the fetus, and we are very confident that it will provide considerable benefits to both the mother and the baby,” added Dr. Richard Beigi, who is part of of the ACOG Working Group of Experts on Immunization, Infectious Diseases and Preparedness for Public Health.

For any pregnant woman who is hesitant to get vaccinated, “adherence to public health regulations on mask use, hand washing and physical distancing are the necessary first steps,” Healy wrote.

Pregnant women should also avoid crowds and activities with a high risk of transmission, such as eating at restaurants, he added.

CNN’s Lauren Mascarenhas and Jessica Firger contributed to this article.