Pregnancy and COVID-19

In a document released just under one month ago, the CDC explained that pregnant women who contract COVID-19 are 50% more likely to be admitted to the ICU, and 70% more likely to need intubation than non-expectant women of the same age. Additionally, there are racial differences as well, with pregnant women of color contracting COVID-19 at a much higher rate than white women.

However, there is still much about the virus – and its impact on this vulnerable patient population – that we are unaware of. What we do know so far is that:

• At least 30 pregnant women or new mothers who contracted COVID-19 have died.
• 5 weeks ago, there were 326,000 cases of COVID-19 in American women of reproductive age.
• Data on pregnant women with COVID-19 did not track pre-existing conditions, ICU stays, ventilation needs, or reason for hospitalization. For this reason, the data is unclear whether certain patients were admitted to give birth or because of health issues associated with COVID-19.
• Over 16,000 American women may contract coronavirus while giving birth.
• There are few cases of pregnant women transmitting COVID-19 to babies in the womb.
• Typical adverse reactions include pulmonary complications and placental abnormalities.

Says OB-GYN Cindy M. P. Duke:

“It’s shocking to realize that we do not have a uniform system in place [to collect pregnancy-related information from pregnant women, new mothers, and infants].”

Tracking Pregnancy Data in the United States

Moving forward, the CDC hopes to enact more targeted data tracking regarding pregnancy. First, health departments must check a box on a Case Report Form for any pregnancies. Additionally, health departments have the option to fill out an additional form regarding disease severity and patient outcomes. However, at this point in time, this form is not required. Some attribute this to a lack of care about women, or female health, within American policy.

Admittedly, however, there are some efforts to run studies on the intersection between pregnancy and COVID-19. First, the National Institute of Child Health and Human Development is working to run a series of studies, including on looking at how COVID-19 progresses in 1,500 pregnant women. Other potential studies include:

• Priority, the Pregnancy Coronavirus Outcomes Registry. This nationwide registry will follow COVID-19 positive women who are or were pregnant for a period of at least 12 months. During this time, the registry will track births, miscarriages, and abortions, as well as overall patient outcomes. Currently, researchers are looking to build Priority as a racially and socioeconomically inclusive study.
• Aspire, a registry around early pregnancy (1st trimester) and how COVID-19 affects fetal development during this time.

Data Tracking Abroad

Unlike in America, the United Kingdom swiftly stepped up to the plate in regards to data tracking, despite the fact that the U.K. has 5x less births annually than America. Within a week of being asked to surveil pandemic-related data, many organizations within the U.K. already had data in hand.

One such data collection measure was a comprehensive study proposed by the U.K. Obstetric Surveillance System, which researches rare disorders associated with or related to pregnancy. Within this study, data was collected from 194 hospitals through an electronic form. All patients are anonymous.

Their initial findings, analyzing data from hospitalized pregnant women with COVID-19 over a period of 1-1.5 months, found:

• 5 mothers, and 5 babies, died. This was out of a total of 427 expectant mothers.
• Pregnancy outcomes were worse for H1N1 and SARS than COVID-19.
• White women were less likely to be hospitalized than black, Asian, or Middle Eastern women.
• Around 1 in 10 (10%) women needed ventilation or other respiratory assistance.

To see the full results of the study, check out the data published in The BMJ.

Ultimately, this data allowed the United Kingdom to recommend specific guidelines and information for pregnant women of color, as well as guidelines on how women in the 3rd trimester of pregnancy should participate in work or other settings.