Review: In women of reproductive age with COVID-19, pregnancy confers worse CV outcomes
Click Here to Manage Email Alerts
In women of reproductive age who have COVID-19, those who are pregnant are more likely to have poor CV outcomes than those who are not, according to a review published in JACC: Advances.
“Data suggest increased risk of adverse outcomes in pregnant compared with nonpregnant women of reproductive age with COVID-19 infection, including need for intensive care unit admission, mechanical ventilation and extracorporeal membrane oxygenation utilization,” the researchers wrote.
The CV complications of COVID-19 that may be seen in this population include MI, arrhythmias, HF and long-haul symptoms that mimic CV complications of pregnancy, the researchers wrote.
“Pregnant people need to know that they are increased risk of a severe COVID-19 infection, including ICU admissions, cardiac complications, need for critical care and death for the patient or fetus. Unfortunately, pregnant women have lagged behind other groups getting vaccinated,” Joan Briller, MD, a cardiologist and professor of clinical obstetrics and gynecology at the University of Illinois at Chicago, said in a press release. “Available data support vaccination in pregnancy with good safety profile and protective transfer to neonates. The CDC, American College of Obstetrics and Gynecologists, and Society of Maternal-Fetal Medicine, among others, recommend vaccination in pregnancy. I believe we should support this recommendation with our patients.”
Previous statements addressing CV complications of COVID-19 did not include those which appear similar to CV complications of pregnancy, including peripartum cardiomyopathy, spontaneous coronary artery dissection and preeclampsia, the authors wrote, noting that such complications can lead to early delivery and other modifications of management of pregnancy.
Management strategies for cardiac complications in pregnancy can be adapted for pregnant patients with COVID-19, including the assembly of a Pregnancy Heart Team, which should comprise “providers comfortable with high-risk pregnancy, obstetric anesthesia, cardiology, critical care and neonatal care, depending on the nature of the complication, stage of pregnancy and severity of disease,” the authors wrote.
If a pregnant patient has myocardial injury due to COVID-19, medications should be adjusted to avoid teratogenicity and a multidisciplinary team should be convened to discuss timing of delivery and how best to stabilize the cardiac symptoms, Briller and colleagues wrote.
COVID-19 is known to elevate rates of preeclampsia in pregnant women, and women with COVID-19 in preeclampsia should be treated the same as women with preeclampsia but without COVID-19, they wrote.
“Most cardiac complications described outside of pregnancy such as arrhythmias, myocardial injury, thromboembolic complications, and long-haul symptoms are reported in women during pregnancy,” the authors wrote. “Additional concerns include increased risk of preterm labor and delivery and development of preeclampsia. Cardiologists should be vigilant in assessing women with COVID-19 for cardiac complications.”
Perspective
Back to Top
We know that pregnant patients are undergoing a 9-month stress test while pregnant. When you add on additional risk factors like hypertension, diabetes and obesity, these risk factors for CVD are amplified during pregnancy. I always tell my patients that pregnancy is the ultimate first stress test, and this can bring out CV risk factors in this young, otherwise healthy patient population. This may be the first time they are seeking medical care since they were followed by a pediatrician.
When you add on the COVID-19 pandemic, which brings another significant layer of risk and overlapping symptoms of CVD to these patients, it is not surprising that pregnant patients with COVID-19 do worse than their non-pregnant cohorts. We need to take advantage of this opportunity in this high-risk patient population and ensure the safety of the mother during and after the pregnancy. Just because she is pregnant, does not mean that you cannot explore and treat her for another disease process. If she has a STEMI, she needs to go to the cath lab. If she has COVID-19, she needs to be treated appropriately. The emphasis of a cardio-obstetrics team who can provide a true multidisciplinary approach for the best treatment of the mother and baby is essential to having good outcomes in this extremely high-risk population.
The review raises the need for a true multidisciplinary cardio-OB team to ensure the appropriate care of the pregnant patient with CV risk factors. As cardiologists, we need to work closely with the maternal fetal medicine teams to ensure a safe delivery plan for both mom and baby. Also, we need close follow up with these patients after delivery to treat long-term CV outcomes.
Emphasizing the importance of vaccination in this high-risk pregnant patient population is essential in preventing the long-term sequelae that may be associated with COVID-19.
There needs to be more data and trials with pregnant patients in general and pregnant patients with COVID-19.
There also needs to be more education for patients and providers to ensure that pregnant patients are vaccinated and have immunity to COVID-19.
Also, there should be more awareness to providers about the long-term cardiac risk associated with pregnancy and COVID-19. These young female patients deserve to be followed by a cardiologist to risk stratify and implement secondary prevention measures to ensure they have good CV long-term outcomes.
I commend the authors for writing this state-of-the-art review on an important and relevant topic which brings more attention to the essential role that cardio-OB clinics have in providing the best possible care that results in great outcomes for our pregnant patients with cardiac risk factors.
Collapse
Click Here to Manage Email Alerts