COVID-19 During Pregnancy

There were many unknowns about the 2019 novel Coronavirus, especially how it would affect specific populations like pregnant individuals, when it first emerged. Due to lack of research, when COVID-19 began to spread through the United States, physicians did not have guidelines to advise patients who had contracted the virus during pregnancy. The CDC estimates from 2020-2021, almost 150,000 pregnant patients were infected with COVID-19, 241 of whom died from COVID-19 related complications. There were 122,000 pregnant patients who were hospitalized in that time period, with about 20% of patients hospitalized for COVID-19 complications.

Pregnancy is a known stressor on the body that can increase the likelihood of conditions like gestational diabetes, hypertension, and pulmonary embolism. The COVID-19 pandemic increased those risks, both in patients who contracted the virus and in patients who did not. A 2021 study by Sun et al compared rates of pregnancy complications from the COVID-19 pandemic (March 1 – Dec 31, 2020) to a control period before.¹ 150,000 patients were analyzed. Researchers found a statistically significant increase in rates of gestational diabetes, gestational hypertension, poor fetal growth, and preeclampsia, a condition involving high blood pressure and end organ damage. Another study, by Ko et al, investigated how pregnant patients with COVID-19 were affected.² Pregnant patients with COVID-19 had significantly increased risk for acute respiratory distress syndrome, death, need for mechanical ventilation, shock, ICU admission, and thromboembolic disease. Their results highlight the need for prevention of pregnant patients contracting COVID-19. One of the ways to prevent infection is with the COVID vaccine series. A 2021 study by Kachikis et al analyzed the short-term effects of the COVID vaccine on pregnant or lactating women.³ The patients self-reported fatigue, fever, and pain at the injection site, which are typical after any vaccination. There were few obstetrical complications which suggests the vaccination is safe for pregnant individuals. The current guidelines for obstetricians are to recommend COVID vaccination for pregnant patients.

There is also a question of how COVID-19 infection in pregnant mothers affects their children down the line. A recent JAMA cohort study analyzed the association of maternal COVID infection with the immune response of the infants.⁴ They found out of 21 mothers who tested positive, there was only 1 mother-infant vertical virus transmission. Infants who received breastmilk in the first two months of life had detectable IgA antibody levels to COVID. The researchers suggested antigen complexes in breastmilk can stimulate the neonate immune system. Another study looked at neural development of babies who were born during the COVID-19 pandemic.⁵ The babies studied had a significant decrease in scores in gross motor, fine motor, and personal-social domains compared to babies born during a previous time period. Interestingly, COVID-19 exposed babies performed similarly to non-exposed babies, suggesting birth during the pandemic is associated with developmental delays while exposure is not.

The current research demonstrates COVID-19 infection during pregnancy can increase negative health outcomes and that the COVID vaccine is safe for pregnant patients. Preliminary research in infants suggests there is low risk of maternal infection being transferred to the infant. However, pandemic conditions have negative effects on infant development, like developmental delay. There are still many unknowns. There is a great need for long term studies of COVID-19 on pregnant individuals and the aftereffects on their children.

References 

1. Sun S, Savitz DA, Wellenius GA. Changes in Adverse Pregnancy Outcomes Associated With the COVID-19 Pandemic in the United States. JAMA Netw Open. 2021 Oct 1;4(10):e2129560. doi: 10.1001/jamanetworkopen.2021.29560. PMID: 34652449; PMCID: PMC8520131. 

2. Ko JY, DeSisto CL, Simeone RM, Ellington S, Galang RR, Oduyebo T, Gilboa SM, Lavery AM, Gundlapalli AV, Shapiro-Mendoza CK. Adverse Pregnancy Outcomes, Maternal Complications, and Severe Illness Among US Delivery Hospitalizations With and Without a Coronavirus Disease 2019 (COVID-19) Diagnosis. Clin Infect Dis. 2021 Jul 15;73(Suppl 1):S24-S31. doi: 10.1093/cid/ciab344. PMID: 33977298; PMCID: PMC8136045. 

3. Kachikis A, Englund JA, Singleton M, Covelli I, Drake AL, Eckert LO. Short-term Reactions Among Pregnant and Lactating Individuals in the First Wave of the COVID-19 Vaccine Rollout. JAMA Netw Open. 2021 Aug 2;4(8):e2121310. doi: 10.1001/jamanetworkopen.2021.21310. PMID: 34402893; PMCID: PMC8371565. 

4. Conti MG, Terreri S, Piano Mortari E, et al. Immune Response of Neonates Born to Mothers Infected With SARS-CoV-2. JAMA Netw Open. 2021 Nov 1;4(11):e2132563. doi: 10.1001/jamanetworkopen.2021.32563. PMID: 34730817; PMCID: PMC8567114. 

5. Shuffrey LC, Firestein MR, Kyle MH, et al. Association of Birth During the COVID-19 Pandemic With Neurodevelopmental Status at 6 Months in Infants With and Without In Utero Exposure to Maternal SARS-CoV-2 Infection. JAMA Pediatr. 2022 Jan 4:e215563. doi: 10.1001/jamapediatrics.2021.5563. Epub ahead of print. PMID: 34982107; PMCID: PMC8728661.