Professor Hora Soltani MBE, PhD, MMedSci, BSc, RM
I am not an expert in communicable diseases, particularly with this strange virus which caught all of us offhand. However, out of professional and personal curiosity, I have been looking at the literature surrounding COVID-19 and pregnancy adverse outcomes and explored some recent evidence on the short profile of this complex health risk in relation to pregnancy and I would like to share my understanding with you.
In terms of mortality data, a rapid report by MBRRACE-UK showed 16 maternal deaths between 1 March and 31 May 2020, out of a total of 160,000 births. Of these, 10 (8 directly and 2 indirectly) were related to COVID-19 infection in pregnancy and the remaining mortality cases were mainly related to mental health and psychosocial issues (4 suicide and 2 domestic violence). You can download the report here. From a quick comparison, maternal death rates from this rapid review during the pandemic were not significantly higher (10 per 100,000) compared to the last report (9.2 per 100,000 from MBRRACE for 2015-2017), which may be due to the sample size limitations. This report also identified that a high number of the women who died, were from Black, Asian and Minority Ethnic (BAME) groups, which indicates health inequality for pregnant mothers in line with the overall population trends. These health disparities could be associated with either being from a more deprived socio-economic status or being at higher risk jobs.
It is very important to make sure we do not increase anxiety for mothers when addressing health risks during pregnancy, while providing evidence-based and clear information for mothers and families to enhance their care in such uncertain times.
A systematic review of 11 case series including a total of 104 pregnant women with laboratory confirmed COVID-19 indicated that the evidence is too weak to state that COVID-19 results in poorer maternal outcome, although they have found a higher maternal mortality ratio in women with COVID-19 compared to those without it. It may be of interest to know that based on this review, fever (58.6%) and cough (30.7%) were the most common symptoms in affected pregnant mothers. Other symptoms included dyspnea (14.4%), chest discomfort (3.9%), sputum production (1.0%), sore throat (2.9%), and nasal obstruction (1.0%).
Another systematic review which focused on the possible vertical transmission of COVID-19 and generation of antibodies against SARS‐CoV‐2 among infants born to mothers with COVID‐19, including 33 articles with a total of 205 infants born to COVID‐19 positive mothers, showed a low possibility of vertical transmission of COVID‐19 (~6%) and that antibodies against SARS‐CoV‐2 were detected among (90% of) vertically exposed but negative infants. They recommended more investigations on vertical transmission and antibodies against COVID‐19 as well as further research on impact of this virus on the long term health of the children.
Finally, other research has raised concerns over negligence and a lack of sufficient attention to pregnant women. In a report that involved data from 13 key informant interviews and a survey with over 100 civil society respondents, women and infants were identified among the most vulnerable or most at risk of being left behind in the response to COVID-19. It is therefore important to consider that where access to health delivery is limited or there is a fear of contamination and restricted contact, these populations particularly those with chronic or additional complications, are not overlooked in the fight against COVID-19. More information can be found here.
In summary, based on the current evidence, the risks from COVID-19 in pregnancy generally appears to be low, particularly in those with asymptomatic or mild infections. It is very important to make sure we do not increase anxiety for mothers when addressing health risks during pregnancy while providing evidence-based and clear information for mothers and families to enhance their care in such uncertain times. We have to make sure pregnancy care is not compromised and women receive adequate care and support from health care professionals and their partners/families. Particular attention should also be given to women from ethnic minority backgrounds who are at a higher risk of suffering from this condition.
About the author
Professor Hora Soltani MBE, PhD, MMedSci, BSc, RM
Professor of Maternal and Infant Health, Sheffield Hallam University