Am I at increased risk for COVID-19 during pregnancy?
The answer seems to be ‘yes,’ but with the important caveat that while the risk of severe COVID-19 in pregnant women is relatively higher than the risk of severe COVID-19 in non-pregnant reproductive age women, the absolute risk of severe disease in either group is still quite low. For example, a CDC report on over 23,000 pregnant women found the ICU admission rate to be 0.15% (or 1.5 in 1,000).
As of November 13, 2020, the CDC states, “Based on what is known at this time, pregnant women are at an increased risk for severe illness from COVID-19 compared to non-pregnant women. Additionally, pregnant women with COVID-19 might have an increased risk of adverse pregnancy outcomes, such as preterm birth.”
Reviewing two large datasets on the clinical course of COVID-19 in pregnancy, a team of Obstetrics and Gynecology experts on COVID-19 during pregnancy state, “Pregnancy and childbirth generally do not increase the risk for acquiring SARS-CoV-2 infection, but appear to worsen the clinical course of COVID-19 compared with nonpregnant individuals of the same sex and age; however, most (>90 percent) infected persons recover without undergoing delivery.”
Summarizing the two large datasets they reviewed:
- In a systematic review including over 11,000 pregnant and recently pregnant women with suspected or confirmed COVID-19 published in the British Medical Journal in September 2020, 4% of pregnant women required ICU admission (62% more than non-pregnant women of reproductive age). Increased maternal age (age >35 years), obesity, hypertension and pre-existing diabetes were contributing risk factors for severe disease. Pregnant women with COVID-19 were 3 times more likely to have preterm birth than those without COVID-19.
- In a report from the CDC COVID-19 Response Pregnancy and Infant Linked Outcomes Team including over 23,000 pregnant women and over 386,000 nonpregnant women of reproductive age with symptomatic laboratory-confirmed SARS-CoV-2 infection, pregnant patients had a higher risk of ICU admission (10.5 vs 3.9 per 1000 cases).
What about risks of miscarriage or preterm birth? The frequency of miscarriage does not appear to be increased, but data on first and second-trimester infections are limited. Preterm birth (birth before 37 weeks) and cesarean delivery rates have been increased in many studies, but not all.
In a CDC dataset of almost 4000 live births to women infected with COVID-19, the overall preterm delivery rate was 12.9%, slightly above the preterm delivery rate in the US of 10.2%. The overall rate of c-section delivery was 34%, slightly above the national rate of 31.9%. In one review of over 11,000 pregnancies with confirmed COVID-19 infection in the UK, most preterm deliveries were not spontaneous, but due to the decision to pursue early c-section, often because of a belief that management of severe maternal symptoms would be improved by delivery; however this hypothesis remains unproven.
Do we know of any congenital abnormalities caused by COVID-19? The answer is no. An increased risk for congenital anomalies from COVID-19 during pregnancy has not been reported.
Should we think about postponing trying to get pregnant? The team of obstetrics and gynecology experts mentioned above states the following in regard to reproductive decision-making during these times: “The COVID-19 pandemic has prompted questions about whether women should consider postponing pregnancy because of potential virus-related risks to maternal and newborn health…we believe that reproductive decisions (eg, pregnancy planning, pregnancy termination) should not be based primarily on health-related COVID-19 concerns. As others have pointed out, pregnancy-related risks associated with the virus have not been well-established, limited evidence suggests that pregnancy-related risks are not high or substantially above the risk associated with other conditions or exposures that are fairly common among pregnant women, and pregnancy-related risks can be reasonably minimized or mitigated by standard preventive measures.”
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Jennifer Abrams, MD, November 24, 2020