Pregnant women diagnosed with the novel coronavirus (COVID-19) appear to be at increased risk of admission to intensive care units (ICUs) than non-pregnant women of a similar age, a recently published study in The British Medical Journal (BMJ) has found.
Whilst less likely to show symptoms, pregnant patients are also more likely to give birth prematurely, and their newborns are more likely to be admitted to a neonatal unit.
Being older, overweight, and having pre-existing medical conditions, such as hypertension and diabetes, also seem to increase the risk of having a severe case of the coronavirus among these women, the findings show.
Pregnant women are thought to be a high-risk group for infection with the virus, and there are concerns about the virus’ potential adverse effects on both the mother and the baby. It is important to highlight that published reviews on COVID-19 in pregnancy may quickly become outdated, as new data emerges.
An international team of researchers conducted a living systematic review to compare the clinical features, risk factors, and outcomes of COVID-19 in pregnant and recently pregnant women, with non-pregnant women of a similar age.
Living systematic reviews are useful in fast moving research areas, such as COVID-19, because they can be updated regularly as new information becomes available.
The BMJ study findings are based on 77 studies reporting rates, clinical features (including symptoms, laboratory and x-ray findings), risk factors, and outcomes for 11,432 women. The test cases were either pregnant or had recently been pregnant, and had been admitted to hospital suspected or confirmed as having the coronavirus.
The studies were designed differently, and were of varying quality, but the researchers were able to allow for that in their analysis.
Compared with non-pregnant women of reproductive age, researchers found that pregnant and recently pregnant women with COVID-19 were less likely to report symptoms of fever and muscle pain (myalgia). They were, however, more likely to need admission to an ICU, and need ventilator treatment.
Maternal risk factors associated with severe COVID-19 include older age during pregnancy, high body mass index, chronic high blood pressure, and pre-existing diabetes.
The odds of giving birth prematurely were also higher in pregnant and recently pregnant women with COVID-19, compared to those without the disease.
A quarter of all babies born to mothers with the virus were admitted to a neonatal unit, and were at increased risk of admission than those born to mothers without the virus. However, stillbirth and newborn death rates were low.
The researchers point to some study limitations that may have affected their results, including differences in study size, design, and definitions of symptoms, tests, and outcomes. However, strengths included the large sample size, and robust search methods to minimise the risk of missing studies and duplicate data.
As such, the studies say healthcare professionals should be aware that pregnant women with COVID-19 might need access to ICU care and specialist baby care facilities.
Furthermore, mothers with pre-existing conditions will need to be considered as a high risk group for the virus, along with those who are obese and of older age, they add.
Finally, the studies note that their living systematic review will produce a strong evidence base for living guidelines on COVID-19 and pregnancy, and will enable rapid updates as new data emerge.