More data show COVID-19 increases risk for birth, neonatal complications
Pregnant women who had symptomatic SARS-CoV-2 infection were more likely than those with asymptomatic infection to have an emergency delivery, and their infants more often experienced adverse outcomes, a recent study showed.
A second study also revealed an increased risk for adverse outcomes among infants born to mothers who had symptomatic SARS-CoV-2 infection.
The findings were released amid reports from the CDC that despite an increasing amount of evidence demonstrating the safety and efficacy of COVID-19 vaccination during pregnancy, only 31% of pregnant women are fully vaccinated against COVID-19, compared with 56.2% of the total U.S. population.
‘Severe systemic effects’
In the first study, Kristine Lane, a fourth-year medical student at the University of Texas Medical Branch, and colleagues retrospectively reviewed data from 101 mothers who had tested positive for SARS-CoV-2. Among these women, 32 exhibited symptoms upon presentation at a single institution to give birth.
“Pregnant mothers may be more susceptible to severe respiratory infections and thromboembolic complications,” Lane said during a pre-recorded presentation for the annual meeting of the American Society of Anesthesiologists. “There is limited evidence that in utero infection is a significant risk factor for vertical transmission.”
Lane and colleagues reported that emergent circumstances during childbirth — complications that led a woman to change her original delivery plan — more frequently occurred in those with symptomatic infection than those with asymptomatic infection (59.4% vs. 44.9%). The women with COVID-19 symptoms were also more likely to have a cesarean section (65.6% vs. 60.9%) or experience birth complications, including the fetus being breech, lower amounts of fetal movement, insufficient amniotic fluid or slowing or stopping the labor procedure.
In addition, infants of women with COVID-19 symptoms were more likely to need respiratory support (31.2% vs. 29%) and be admitted to the NICU (43.8% vs. 36.2%). The most common complications among the neonates were prolonged decelerations, decreased fetal movement and premature rupture of membranes; one infant born to a symptomatic mother tested positive for COVID-19 after it was born, according to Lane.
“COVID-19 has severe systemic effects on the body, especially symptomatic patients. It is possible that these effects are amplified in pregnant mothers, who have increased fetal and maternal oxygen demands,” Lane said in a press release.
“The decreased oxygenation could contribute to the increase in cesarean deliveries, as well as the possibility that physicians caring for symptomatic patients are cautious of the virus’ unpredictable nature, so they proactively recommend a cesarean delivery for medium- to high-risk deliveries,” she said.
Adverse neonatal outcomes
In the second study, researchers retrospectively analyzed information from 2,299 women who had tested negative for SARS-CoV-2 and 172 women with a confirmed diagnosis, 56 of whom were symptomatic. The women gave birth at the Mayanei Hayeshua Medical Center in Israel.
Among the women with COVID-19, only one needed mechanical ventilation, according to researchers. There were no instances of maternal death, severe neonatal asphyxia or neonatal death.
“Composite maternal adverse outcomes were not significantly different between the three groups,” the researchers wrote.
However, the findings, published in The Journal of Maternal-Fetal & Neonatal Medicine, revealed a significantly greater risk for composite neonatal adverse outcomes — including respiratory distress syndrome, transient tachypnea of the newborn and very low birthweight — among infants of mothers who tested positive for SARS-CoV-2 compared with those whose mothers tested negative (adjusted OR = 2.1; 95% CI, 1.1-3.8).
Researchers also found significant differences between women who tested positive and those who tested negative, with the former group having higher rates of gestational diabetes, low lymphocyte counts and postpartum hemorrhage.
“Now that the vaccine is available, it is imperative for doctors to do everything possible to convince patients to get vaccinated,” study author Elior Eliasia, MD, a physician at Mayanei Hayeshua Medical Center, told Healio Primary Care.
Adverse complications for COVID positive pregnant women and their newborns adds further weight to vaccination calls. https://www.eurekalert.org/news-releases/930784. Originally published under embargo Oct. 7, 2021. Originally accessed under embargo Oct. 7, 2021.
American Society of Anesthesiologists. Pregnant women with symptomatic COVID-19 more likely to have emergency deliveries. https://www.eurekalert.org/news-releases/930491. Originally published under embargo Oct. 7, 2021. Originally accessed under embargo Oct. 7, 2021.
CDC. COVID-19 data tracker weekly review. https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covidview/index.html. Accessed Oct. 12, 2021.
CDC. COVID-19 vaccination for pregnant people to prevent serious illness, deaths and adverse pregnancy outcomes from COVID-19. https://emergency.cdc.gov/han/2021/han00453.asp. Accessed Oct. 12, 2021.
CDC. COVID-19 vaccines while pregnant or breastfeeding. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/pregnancy.html. Accessed Oct. 12, 2021.
Lane KS, et al. Differences between neonatal outcomes in symptomatic and asymptomatic COVID-19 positive patients: A single center experience (A-4111). Presented at: The ANESTHESIOLOGY annual meeting; Oct. 8-12, 2021; (hybrid meeting).