Additional evidence shows COVID-19 increases risk for pregnancy complications

More research shows that COVID-19 increases the risk for adverse pregnancy outcomes.

Specifically, a recent NIH-funded study demonstrated that moderate to severe disease was associated with higher risks for cesarean delivery, preterm birth, maternal and neonatal death, and serious illness from hypertensive disorders of pregnancy, postpartum hemorrhage and infections other than SARS-CoV-2.

However, mild or asymptomatic disease was not associated with increased pregnancy risks, researchers said. Although the evidence of the impact of COVID-19 on pregnancy outcomes has been mixed, the findings add to a growing number of studies that show that SARS-CoV-2 infection presents significant health risks to women and their babies.

“Pregnant individuals with COVID-19 are at increased risk of intensive care unit admission, mechanical ventilation and death compared with both pregnant individuals without SARS-CoV-2 infection and nonpregnant adults with SARS-CoV-2 infection,” Torri D. Metz, MD, MSCR, associate professor of obstetrics and gynecology and vice chair of OB/GYN research at the University of Utah Health, and colleagues wrote. “While COVID-19 increases the risk of maternal morbidity related to the virus (eg, as a result of severe acute respiratory syndrome), it remains unknown whether pregnant individuals with SARS-CoV-2 infection experience higher risk of serious morbidity from obstetric complications.”

Metz and colleagues analyzed data from 14,104 pregnant women (mean age, 29.7 years) — 2,352 of whom had COVID-19 — who delivered at 17 U.S. hospitals between March 1 and Dec. 31, 2020, before COVID-19 vaccines were available.

Moderate to severe disease was significantly associated with the primary outcome — a composite of maternal death or serious morbidity related to hypertensive disorders of pregnancy, postpartum hemorrhage or infection other than SARS-CoV-2 — compared with those without a positive SARS-CoV-2 test result (26.1% vs. 9.2%; difference = 16.9% [95% CI, 13.3%-20.4%]; adjusted RR = 2.06 [95% CI, 1.73-2.46]), the researchers wrote.

Patients with moderate or severe disease were also more likely than uninfected patients to have a cesarean delivery (45.4% vs. 32.4%; difference = 12.8% [95% CI, 8.7%-16.8%]; aRR = 1.17 [95% CI, 1.07-1.28]) or preterm birth (26.9% vs. 14.1%; difference = 13 [95% CI, 9.4-16.6]; aRR = 1.56 [95% CI, 1.32-1.86]), and fetal or newborn death was also more likely among women with SARS-CoV-2 infection (3.5% vs. 1.8%; difference = 1.7 [95% CI, 0.2-3.2]; aRR = 1.69 [95% CI, 0.98-2.92]), according to the researchers.

There were no significant associations between mild or asymptomatic infection and adverse pregnancy outcomes compared with no infection.

“The findings underscore the need for women of child-bearing age and pregnant individuals to be vaccinated and to take other precautions against becoming infected with SARS-CoV-2,” Diana Bianchi, MD, director of NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development, said in the press release. “This is the best way to protect pregnant women and their babies.”

References:

• Metz TD, et al. JAMA. 2022;doi:10.1001/jama.2022.1190.
• NIH-funded study suggests COVID-19 increases risk of pregnancy complications. https://www.nih.gov/news-events/news-releases/nih-funded-study-suggests-covid-19-increases-risk-pregnancy-complications. Published Feb. 7, 2022. Accessed Feb. 7, 2022.