COVID-19 and Pregnancy: Experts urge caution with more unknowns than answers

Based on previous coronavirus outbreaks like SARS and MERS, pregnant women may be at higher risk for more serious complications from COVID-19

COVID-19 and Pregnancy: Experts urge caution with more unknowns than answers

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As the COVID-19 pandemic continues worldwide, experts are working to better understand the disease and its risk to certain populations, including women who are pregnant. To date, little is definitively known about whether pregnant women are more susceptible to COVID-19, if those infected are more likely to become seriously ill or what long-term effects the virus can visit upon newborns.

That lack of information is leading to contradictory messaging, with some health experts advising caution while others offer reassurance.

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According to the Centers for Disease Control and Prevention (CDC) statement on COVID-19 and pregnancy, experts “do not currently know if pregnant women have a greater chance of getting sick from COVID-19 than the general public nor whether they are more likely to have serious illness as a result.”

However, the CDC’s statement acknowledges that when pregnant, a woman’s body undergoes physiological changes that pose an increased risk for some infections, including those from viruses in the same family as COVID-19 and other viral respiratory illnesses, such as influenza.

Kjersti Aagaard, M.D., Ph.D., a maternal-fetal medicine specialist at Texas Children’s Pavilion for Women, went beyond the CDC’s statement by saying that although there are many unanswered questions about COVID-19 and pregnancy, history indicates that pregnant women are very likely at an increased risk of serious infection.

“We know pregnancy is a higher-risk state, so if you take a 35-year-old woman with no significant medical complications and no chronic illnesses, and you compare that 35-year-old pregnant woman to a 35-year-old non-pregnant woman, in all other cases of lower respiratory infections, the pregnant woman is going to be more vulnerable for severe disease and death,” said Aagaard, who is also the Henry and Emma Meyer Chair in Obstetrics and Gynecology at Baylor College of Medicine. “Why COVID-19 would be any different is as yet unclear. That didn’t hold true in the SARS epidemic, it didn’t hold true in the MERS epidemic, it didn’t hold true in the H1N1 pandemic, and it hasn’t held true with annual influenza outbreaks. With every one of those instances, pregnant women are at a greater risk for severe respiratory morbidity and mortality.”

Aagaard’s point is echoed in the statement from the American College of Obstetricians and Gynecologists (ACOG). The organization notes that while currently available data does not indicate that pregnant women are at increased risk, pregnant women are known to be at greater risk of severe morbidity and mortality from other respiratory infections and, as such, pregnant women should be considered an at-risk population for COVID-19.

Even more, women who are pregnant are also in need of additional routine medical care, noted Umair Shah, M.D., MPH, executive director of Harris County Public Health and local health authority for Harris County. He mentioned the risk during a recent public health forum addressing the COVID-19 outbreak.

“We have had concerns that pregnant women, just because of everything that’s involved in pregnancy including, obviously, doctor visits, including eventually going to delivery,” Shah said. “There’s a whole ecosystem that goes along with that and now you’re not just caring for yourself but also another human being. … That’s the reason for that additional concern.”

Messaging worldwide is inconsistent, in part, because very little has been reported about pregnant women who have had COVID-19 infections. Also, some experts are reassuring pregnant women that they are at no greater risk for complications from COVID-19 than the general public.

In the United Kingdom, the Royal College of Obstetricians and Gynaecologists published a handbook on March 13 stated: “Pregnant women do not appear to be more susceptible to the consequences of infection with COVID-19 than the general population. Data are limited but special consideration should be given to pregnant women with concomitant medical illnesses who could be infected with COVID-19 until the evidence base provides clearer information. There are no reported deaths in pregnant women at the moment.”

Others, like Aagaard, are skeptical because it’s possible that COVID-19 complications and death for pregnant women have been underreported on a global scale.

“I think we need to show our humility in the face of this pandemic. … Our humility as physicians and as scientists should lead us to question whether the lack of evidence is because the cases have not occurred or because we don’t have the capacity to move forward the case reporting,” she said. “We simply don’t know. We cannot give false reassurance and we can’t create false alarm. Neither of those are in the best interest of medicine.”

She advises patients to heed her advice and take precautions.

“What I tell them is exactly this: I wish I could give you all the answers. I wish I could give you a number and make you feel better, make you feel less alarmed, but I can’t—and I wouldn’t be doing my job if I did. I have to tell you the hardest thing to say, which is ‘I don’t know,’” Aagaard said. “In the absence of really good strong evidence suggesting to the contrary, I would urge you to heed carefully to the CDC recommendations. Err on the side of caution, practice common sense, wash your hands, stay out of risky situations and the moment you’re not feeling well, with a chronic dry cough, a fever, chills, call us. We’re here and we’re ready to take care of you.”

For more information about COVID-19 and pregnancy, Texas Children’s Pavilion for Women has published this FAQ. The CDC is also updating their advisory as information becomes available.

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