Pregnant women with Covid-19 are at a seven times increased risk of death, according to a new study published January 16 in the BMJ (British Medical Journal) Global Health. Covid-19 during pregnancy also increases the risk of the mothers being admitted to an intensive care unit or suffering from pneumonia. Moreover, SARS-CoV-2 infection at any time during pregnancy is associated with serious illness in both mothers and their newborns. As a result, Covid-19 during pregnancy could increase the risk of the baby being admitted to an intensive care unit.
According to an international team of researchers led by George Washington University, the findings of the study reinforce the need for global efforts to minimise Covid-19 infection risks during pregnancy through targeted vaccination campaigns and other protective measures.
In a statement released by George Washington University, Emily R Smith, the lead author on the paper, said the study provides the most comprehensive evidence to date suggesting that Covid-19 is a threat during pregnancy. She added that the findings underscore the importance of Covid-19 vaccination for all women of childbearing age.
While there is a vast and growing body of research on Covid-19 infection during pregnancy, extensive differences in study design, methods and comparison groups make it difficult to reach any firm conclusions. Very few studies have been conducted in low income countries.
How the study was conducted
In April 2020, the team of researchers formed an international consortium to obtain high quality prospective data from relevant studies being carried out in several countries. Also, the researchers applied a uniform analytical approach to avoid the issues associated with previous research.
There is growing knowledge about the risks of Covid-19 during pregnancy. Despite this, many women of childbearing age in the United States and other countries remain unvaccinated.
There are some instances of women hesitating or refusing to get vaccinated because they do not believe Covid-19 poses risks to young women or they feel unsure about the safety of the Covid-19 vaccine during pregnancy.
Smith said some doctors may hesitate to give the vaccine to a pregnant woman, even though it is recommended.
The BMJ research comprises the results of the first individual level pooled data analysis of studies on Covid-19 infection during pregnancy, and assesses the risks of ill health and death among pregnant women with or without confirmed or probable Covid-19 infection.
The researchers pooled individual patient data from 12 studies conducted in 12 countries, as part of the study. The 12 studies involved 13,136 pregnant women. The countries in which the studies were conducted are China-Hong Kong, Ghana, Kenya, Nigeria, Italy, South Africa, Sweden, Spain, Turkey, Uganda, the Democratic Republic of Congo, and the United States.
What risks did pregnant women with Covid-19 face?
The BMJ study found that pregnant women infected with SARS-CoV-2 were about seven times as likely to die as their uninfected peers, nearly four times as likely to require intensive care, more than three times as likely to be admitted to an intensive care unit, and 15 times as likely to require mechanical ventilation. Covid-19 patients might require mechanical ventilation in severe cases to survive because the disease can affect the ability to breathe.
Pregnant women with Covid-19 who need ICU care are also more likely to die than their uninfected peers.
According to the study, pregnant women with Covid-19 were more than 23 times as likely to be diagnosed with pneumonia and more than five times as likely to have serious blood clots, compared to their uninfected peers. Pneumonia is a potentially life-threatening condition, especially in pregnant women or those who have just given birth.
The formation of serious blood clots Is called thromboembolic disease, and can lead to swelling, pain, or other life-threatening complications.
What risks did newborn babies face?
Newborn babies whose mothers were infected with Covid-19 during pregnancy were found to be almost twice as likely to be admitted to a neonatal intensive care unit after birth, compared to neonates born to women who were not suffering from Covid-19 during pregnancy.
Neonates born to women with Covid-19 infection were nearly three times as likely to be born moderately premature. A baby is considered premature if he or she is born before 34 weeks.
Neonates were 19 per cent more likely to be underweight at birth than babies born to uninfected women.
According to George Washington University, Smith said preterm babies are at high risk of having lifelong health problems, including delays in early childhood cognitive development.
Covid-19 infection was not linked to a heightened risk of stillbirth at or beyond 28 weeks of pregnancy, nor restricted growth, unlike the findings of previous reviews, according to a BMJ statement.
Significance of the study
In the George Washington University statement, Smith said more than 80 countries still do not recommend that all pregnant and lactating women get vaccinated against Covid-19. She added that the meta analysis provides public health officials and the public with clear, consistent and compelling findings.
Smith said the study shows the risk of getting Covid-19 for both mother and baby, and all countries should make access to Covid-19 vaccines an urgent priority in order to save lives and prevent health problems.
The authors said the findings underscore the need for global efforts to prevent Covid-19 during pregnancy through targeted administration of vaccines and non-pharmaceutical interventions.
Limitations to the study
The authors noted some limitations to the study, including the fact that the selection of pregnant women with Covid-19 depended on when and how they were tested for SARS-CoV-2. This factor changed over time across sites, depending on the availability of test kits.
Another limitation to the study was that it did not consider the differential impact of SARS-CoV-2 variants that have emerged since the pandemic started.
