Q&A: Pregnant women remain at higher risk for complications from COVID-19

Key takeaways:

• Clinicians should raise awareness of the efficacy and safety of COVID-19 vaccination during pregnancy.
• More research is needed to better understand what leads to gender differences in the allergy/asthma space.

At the start of the pandemic, there were no data to show whether asthma put pregnant women at higher risk for complications from COVID-19, according to a review published in The Journal of Allergy and Clinical Immunology: In Practice.

However, there are now increasing data demonstrating the efficacy and safety of vaccines among pregnant women.

S. Shahzad Mustafa

“Pregnancy is a risk factor for more severe cases of COVID-19,” S. Shahzad Mustafa, MD, lead physician of allergy, immunology and rheumatology at Rochester Regional Health and clinical associate professor of medicine at University of Rochester School of Medicine and Dentistry, told Healio. “Other allergic conditions such as asthma do not meaningfully affect this risk.”

Healio spoke with Mustafa to learn more about the impact of COVID-19 on pregnancy and its interrelationships with asthma and allergy.

Healio: What prompted you and your colleagues to write this review?

Mustafa: Although infection with COVID-19 no longer carries significant health risks for the majority of individuals, certain groups, such as pregnant women, remain at higher risk for COVID-19-related complications. Individuals in high-risk groups should consider strategies to minimize their risk for infection, such as staying up to date with vaccination. If an individual in a high-risk group acquires COVID-19, treatment with oral antivirals should be promptly considered.

Healio: Your review mentions there has been conflicting evidence on the impact of asthma on pregnant women with COVID-19. Generally, how should these patients be managed?

Mustafa: Asthma during pregnancy can be unpredictable, with one-third of women experiencing worsening asthma, one-third experiencing milder asthma, and one-third experiencing no change in asthma from baseline. Pregnant individuals with asthma should know there are safe and effective medications that can and should be used during pregnancy to optimize asthma control and minimize respiratory symptoms and the potential need for oral steroids.

For individuals who acquire COVID-19 infection and progress to more severe illness with respiratory involvement and decreased oxygen levels, dexamethasone is the first line of treatment, and this applies to pregnant women as well.

Healio: During the pandemic, telemedicine proved to be an invaluable tool to treat allergic reactions at home. How can telemedicine continue to be utilized to coordinate treatment at home for pregnant patients with immunodeficiencies or other allergic conditions?

Mustafa: Telemedicine can be a valuable tool to complete remote evaluations. It lends itself very well to appointments where testing is not necessary.

Whereas some evaluations benefit from in-person appointments, such as those needing testing, many can be done remotely, which is often preferable for patients and clinicians alike. Although telemedicine is not for everyone, many patients and clinicians prefer this mode of evaluation.

Healio: According to the CDC, only 23% of pregnant women are estimated to have received a bivalent booster dose before or during pregnancy. Why might this be the case and how can this percentage be increased?

Mustafa: Many pregnant women are not aware of the risk associated with COVID-19 infection, not only to themselves, but also their unborn baby. Clinicians need to raise awareness that COVID-19 vaccines are not only safe during pregnancy, but have been shown to decrease the risk for COVID-19 infection and improve the outcomes for both the mother and child.

Healio: What additional research would you like to see in the allergy/asthma space in the setting of pregnancy or women’s health more broadly?

Mustafa: There are well-recognized gender differences in many health conditions, and this applies to asthma/allergy as well. Although the differences are well known, the reason for the differences remain poorly understood. Better understanding regarding what leads to these gender differences is important research that needs to be done.

Reference:

Mustafa SS, et al. J Allergy Clin Immunol Pract. 2023;doi:10.1016/j.jaip.2023.08.022.

For more information:

S. Shahzad Mustafa, MD, can be reached at shahzad.mustafa@rochesterregional.org.