Pregnant Women Are At Higher Risk For Severe Covid-19 And Death

(Posted on Monday, November 9, 2020)

A recent study, published by the Centers for Disease Control and Prevention (CDC), confirms that pregnant women are in fact at higher risk for severe Covid-19 and death compared to nonpregnant women in the same age range. Prior to this study, there was concern that pregnancy could increase the risk of severe outcomes from Covid-19, but not enough data to say for certain.

Addressing a major gap in the research about the impact of Covid-19 on pregnant women, this large CDC study analyzed data from over 400,000 women between the ages of fifteen and forty-four, 23,434 of whom were pregnant. All of the women included had tested positive for the Covid-19 virus using a PCR test and were experiencing symptoms.

After adjusting for age, race, ethnicity, and underlying conditions such as diabetes, cardiovascular disease, and chronic lung disease, pregnant women were three times more likely to be admitted to the intensive care unit (ICU), and 2.9 times more likely to receive mechanical ventilation compared to nonpregnant women in the same age group. While the absolute risk of death among pregnant women with Covid-19 remains low at 1.5 per 1,000 women, the risk is 70% higher in pregnant women compared to nonpregnant women. Physiological changes that women go through during pregnancy may account for this increased risk for severe Covid-19. These changes include increased heart rate and oxygen consumption, decreased lung capacity, and decreased function of the immune system.

Some of the most striking differences in outcomes between pregnant women and nonpregnant women came in women ages thirty-five to forty-four. In this age group, pregnant women were four times more likely to require mechanical ventilation and two times more likely to die compared to nonpregnant women of the same age group. 

There are racial and ethnic disparities in pregnancy outcomes even in the absence of Covid-19. Unfortunately, these disparities are only amplified with the addition of Covid-19 infection. This study highlights the increased risk of severe outcomes among women of color who have Covid-19 during pregnancy. Asian women who were pregnant were 6.6 times more likely to be admitted to the ICU compared to nonpregnant Asian women. Native Hawaiian/Pacific Islander women had an increased risk of ICU admission of almost four times. The risk of death among Hispanic pregnant women was 2.4 times higher than the risk in nonpregnant Hispanic women. 

Black women in this study experienced a disproportionate number of deaths, irrespective of pregnancy status. Black women represented 14.1 percent of women in this study but accounted for 36.6 percent of the total deaths. Not only were women of color in this study at higher risk for more severe outcomes from Covid-19, but they were also at an increased risk of infection. Because of these disparities in infection rates and severity of outcome among women of color due to Covid-19, the CDC presents a call to action to address drivers of Covid-19 infection risk in these populations. In addition to decreasing Covid-19 infections among pregnant women, especially pregnant women of color, we must ensure that women have access to quality and affordable healthcare throughout their pregnancy and beyond, so that they can receive the care they need if they do become infected with Covid-19.

The CDC also released a smaller study this week looking at the impact of Covid-19 in pregnancy on birth and infant outcomes. Of the almost 4,000 infants born to women with the Covid-19 virus infection in this study, 12.9 percent of them were born pre-term (less than 37 weeks). In the general population, only about 10.2 percent of babies are born pre-term. Of the 610 infants who were tested for Covid-19 virus through the study, 2.6 percent tested positive for the virus, although it is unclear how transmission occurred. Most of these babies were born to mothers who had recently been infected with Covid-19.  

Maternal infections early in pregnancy often have a larger impact on an infant developmentally than infections that occur later on. Now that the virus has been with us for over nine months, there must be an increased focus on research to discover the impacts of Covid-19 infection early in pregnancy on both pregnant women and infants.

In the wake of these studies, the CDC recommends pregnant women continue going to prenatal care visits, stay up to date on their vaccinations, pay special attention to social distancing guidelines, wash their hands frequently, wear a mask in public, and avoid those who are not wearing masks. Pregnant women should avoid enclosed spaces and public transportation as much as possible. When absolutely necessary to be in an enclosed space, the time spent there should be limited. While in an enclosed space or a crowded place where others may not be wearing a mask, pregnant women should wear disposable gloves, an N95 or KN95 mask and a face shield. After taking off disposable gloves, mask, and face shield, pregnant women should wash their hands thoroughly. Face shields should not be used as a substitute for face masks, however, when worn in conjunction with a face mask, they can provide an extra level of protection from droplets that can enter through the eyes.

In addition to these measures, we must all take responsibility and follow social distancing guidelines, wear masks in public, and wash our hands frequently to control the spread of Covid-19 in our entire population if we want to keep pregnant women and their children safe and healthy.

Read the full article on Forbes.

Originally published on November 9, 2020.