Pregnant women – particularly those from ethnic minority backgrounds – have been at increased risk of severe COVID-19 and more likely to need intensive care or invasive ventilation than non-pregnant women with the virus, researchers report today.
An ongoing global study, led by academics at the University of Birmingham, UK, and the World Health Organisation found the risk is also heightened if the pregnant women have pre-existing conditions such as obesity, high blood pressure and diabetes.
Their research, published in the BMJ today, analyses the results of 192 studies – an additional 115 studies than were included in their August 2020 publication – into the impact of COVID-19 on pregnant women and their babies.
The review found that one in 10 pregnant and recently pregnant women attending or admitted to hospital for any reason were diagnosed with COVID-19.
Of the 41,664 women involved in 59 studies, 339 (0.02%) pregnant women with confirmed COVID-19 died from any cause. The review also found that the overall rates of stillbirth and neonatal death are low in women with suspected or confirmed COVID-19.
The most common clinical symptoms of COVID-19 in pregnant women were fever (40%) and cough (41%), although compared to non-pregnant women of reproductive age, pregnant and recently pregnant women with COVID-19 were more likely to be asymptomatic.
The researchers found that increased maternal age, high body mass index, non-white ethnicity and pre-existing comorbidity, including chronic hypertension and diabetes, were risk factors for pregnant women developing severe COVID-19.
There is also emerging evidence from the review that pre-eclampsia and gestational diabetes may be associated with severe COVID-19, but the authors of this review say more data are needed to assess that.
First author Dr John Allotey, of the University of Birmingham-based WHO Collaborating Centre for Global Women’s Health, said: “Pregnant women should be considered a high-risk group, particularly those identified to have risk factors, for severe COVID-19 based on our findings. Mothers should also be reassured that the risks to their babies is very low.”
Corresponding author Professor Shakila Thangaratinam, co-director of the WHO Collaborating Centre for Global Women’s Health at the University of Birmingham, added: “In the current situation, where evidence is rapidly produced, our living systematic review – underpinned by robust methods and continually updated at regular intervals – is crucial to address important research questions and to shape healthcare policy and clinical decision-making.
“Pregnant women and healthcare professionals will need to take into account the additional risks faced by pregnant women with COVID-19 in making decisions such as taking-up of vaccines if offered to prevent COVID-19, and plan management in pregnancy.”
Allotey J et al. Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis. BMJ 11 March 2021.
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