COVID-19 Pregnancy Research Produces Reassuring Results
Recent research into COVID-19 cases in pregnant women has demonstrated reassuring results. Despite the overall fear and confusion that the pandemic has caused, there have been relatively few maternal deaths in patients afflicted with a coronavirus strain. Some non-ideal outcomes have manifested in patients who are pregnant, however these have occurred in a minority of cases. Most pregnant women with coronavirus have recovered successfully.
In one UK-based study, 427 pregnant women were hospitalised with a confirmed infection over six weeks. Older women, women with a higher BMI and women from a black or other minority group were at greater risk of hospitalisation. In this study, 10% of women were admitted to the ICU and 1.2% died, with three deaths a result of COVID-19 complications.
Symptoms of COVID-19 During Pregnancy
The most common symptoms of women affected by a COVID-19 virus were fever, coughing and dyspnoea with 92% reported to have pneumonia. Mortality rates during another Chinese study rested at 12.3% of all patients suffering from all coronaviruses. Preterm birth was the most common adverse outcome of COVID-19-affected pregnancy in this study (41%), followed by miscarriage (39%), preeclampsia (16%) and FGR (12%). While not specified in the research, preterm births may have been induced by clinical staff in many cases for maternal indications.
Vertical Transmission of COVID-19 Non-Existent
Further research has demonstrated that maternal outcomes are no more severe than in the non-pregnant population of coronavirus patients. The conclusion of these smaller studies was that there is no vertical transmission of COVID-19 present in pregnant women either, however, not all neonates were tested and the test sample was very small.
There were, however, co-infections present in three cases in another, smaller study of nine patients. Two flu strains (H1N1 and Legionella pneumophila) were present in two and one patients, respectively. One of these neonatal patients tested positive for SARS-CoV-2, however this was not due to vertical transmission.
The take home message from this seems to be that there is an increased risk of preterm birth amongst women hospitalised with COVID-19. However, from a gynaecological perspective, the overall result is reassuring. However, we still recommend growth surveillance after patients have recovered from coronavirus and CEFM monitoring during labour.
Physical distancing of greater than 1m has been shown to reduce the risk of coronavirus infection by 10.2% compared with physical separation of less than 1m. The overall change in relative risk by increased physical distancing was 2.02 per metre distance. The use of face masks is associated with the largest reduction in transmission – 14.3%. Non-disposal masks have been most effective at preventing transmission of the disease. Eye protection also reduced the risk of transmission by 10.6%.
Although no intervention was associated with complete protection, these findings support the use of three simple interventions to mitigate COVID-19 transmission. Until a vaccine is widely available social distancing will remain a primary measure in the fight against viral transmission and in areas of increased transmission the use of face masks and eye protection should also be considered.