Clinical update on COVID-19 in pregnancy: A review article

Bottom Line:

Current evidence does not suggest increased risk of severe COVID-19 infection in pregnant women, although high-risk obstetrical patients should be appropriately evaluated and managed.

Reference:

Gillian, RA. et al. Clinical update on COVID‐19 in pregnancy: A review article. The Journal of  Obstetrics and Gynaecology Research .2020). https://doi.org/10.1111/jog.14321

Date Published:

4 June 2020

Synopsis:

In general, pregnant women are understood to be at greater risk of respiratory infections such as H1N1 and varicella pneumonia. The majority of pregnant women (85%) with COVID-19 experience mild disease, and commonly report symptoms such as fever, cough and shortness of breath. There is no increased risk of severe disease (e.g. resulting in intensive care unit (ICU), admission or death) in pregnant women compared to the general population, and no mode of delivery (vaginal birth vs. caesarian section) places them at greater risk. However, women with high-risk pregnancies such as those with pre-existing diabetes, high blood pressure, asthma, or HIV infection are more vulnerable to the severe effects of COVID-19 disease. There is minimal transmission of the disease from the mother to child, and there is no evidence currently regarding increased risk of serious perinatal mortality (e.g. miscarriage, early pregnancy loss). Importantly, the pregnant women who do develop COVID-19 face challenges with regards to disease management such as intubation, as well as medical treatment. Furthermore, as pregnant women are more susceptible to thrombosis (blood clotting), and this can be exaggerated in COVID-19 disease due to the inflammation in blood vessels, all pregnant women with COVID-19 will be assessed for their risk of thrombosis, and given medications pre-emptively if they are feeling unwell. With respect to corticosteroid use, while some evidence suggests worse disease outcome in patients with steroid use, these studies include 4- or 5-times the amount of steroid use than that used in pregnant women for developing fetal lung maturity. As such, there is no evidence currently to alter the routine perinatal care with this respect in light of the pandemic. Furthermore, for mothers wishing to breastfeed, precautions such as the use of a face mask must be taken for women with COVID-19 disease. Lastly, the psychological impact of the pandemic should further be evaluated in pregnant patients.

Summary by: Sheida Naderi-Azad