COVID-19 in pregnancy
| COVID-19 in pregnancy | |
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| Virtual model of coronavirus | |
| Risk factors | Severeinfection |
| Prevention | Covering cough, avoid interacting with sick people, cleaning hands with soap and water orsanitizer |
| Part ofa serieson the |
| COVID-19 pandemic |
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 COVID-19 portal |
COVID-19 infectioninpregnancyis associated with severalpregnancy complications.[1]However, pregnancy does not appear to increase the susceptibility of becoming infected by COVID-19.[2]Recommendations for theprevention of COVID-19include the same measures as non-pregnant people.[3]
Effect of COVID-19 in pregnancy[edit]
| Complication | Odds ratio | 95%confidence interval |
|---|---|---|
| Pre-eclampsia | 1.33 | 1.03 to 1.73 |
| Preterm birth | 1.82 | 1.38 to 2.39 |
| Stillbirth | 2.11 | 1.14 to 3.90 |
According to asystematic reviewand meta-analysis in 2021, COVID-19 is associated withstillbirth,pre-eclampsiaandpreterm birth.[1]According to the same review, compared with mild COVID-19, severe COVID-19 is strongly associated with preeclampsia, preterm birth, gestational diabetes and low birth weight.[1]
A review in 2022 suggests that pregnant women are at increased risk of severe COVID-19 disease, with an increased rate of being hospitalized to the intensive care unit and requiring ventilation death, but was not associated with a statistically significant increase in mortality.[4]
A systematic review update in 2022 demonstrated that pregnant women are at increased risk of severe COVID-19. It also found thatrisk factorsfor severe COVID-19 in pregnant people includedhigh body mass index,being of anolder age,being of non-whiteethnic origin,having pre-existingcomorbidities,havingpre-eclampsiaorgestational diabetes.[5][6]
A 2023 meta-analysis concluded that COVID-19 infection at any time during a pregnancy increases the risk of maternal dealth, severe maternal morbidities and neonatal morbidity, but not stillbirth or intrauterine growth restriction.[7]Unlike earlier reviews, this study did not find a link between COVID-19 infection during pregnancy and increased risk of stillbirth at or beyond 28 weeks' gestation.[7]This study used the first large set of pregnancy cohort data from sub-Saharan Africa.[7]
Recommendations[edit]
Prevention[edit]
TheWorld Health Organization(WHO) andCenters for Disease Control and Prevention(CDC) of the United States advises pregnant women to do the same things as the general public to avoid infection, such as covering cough, avoid interacting with sick people, cleaning hands with soap and water orsanitizer.[3][8]
Vaccination against COVID-19was not associated with an increase in miscarriage or reduction in live birth.[9]Meta-analysis has not identified any pregnancy-specific safety concerns with vaccines.[10]
The data overwhelming support maternal vaccination as being effective at reducing the risk for infection and severe illness.[10]
Studies seem to show that completion of a two dose mRNA vaccination during pregnancy reduces hospital admissions for COVID-19 among infants under 6 months, but there is insufficient evidence for how long protection continues for an infant after birth.[10]
The WHO states that pregnant women can receive covid-19 vaccines and, if not already vaccinated, should have access toWHO Emergency Use Listing-approved vaccines, as the benefits of vaccination during pregnancy outweigh potential risks.[10]TheRoyal College of Obstetricians and Gynaecologistsin the UK strongly recommend vaccination in pregnancy and prefers that the Pfizer-BioNTech or Moderna mRNA vaccines are offered where available due to greater amounts of data on that vaccine type. In America, the CDC, theAmerican College of Obstetricians and GynecologistsandSociety for Maternal-Fetal Medicineencourage pregnant women to get COVID-19 vaccines.[10]TheFederation of Obstetric and Gynaecological Societies of Indiarecommend vaccination, though it is not currently recommended by the Government of India.[10]More than 80 countries do not currently recommend that all pregnant and lactating women should be vaccinated.[7]
Treatment[edit]
A state of the art review published in 2022 stated that the basic principles of diagnosing and managing COVID-19 should be the same for pregnant patients as for non-pregnant patients. It recommnended that treatment withcorticosteroidsshould be modified to usenon-fluorinated glucocorticoidsand thatIl-6 inhibitorsandmonoclonal antibodiescould be used, as could specific antiviral therapies.[11]
Pregnancy is not a contraindication for therapies including respiratory support with oxygen, non-invasive ventilation, ventilation in a prone position, intubation and ventilation, andextracorporeal membrane oxygenation.[11]
See also[edit]
- Vertically transmitted infection
- Gendered impact of the COVID-19 pandemic
- Impact of the COVID-19 pandemic on abortion in the United States
References[edit]
- ^abcdWei SQ, Bilodeau-Bertrand M, Liu S, Auger N (2021)."The impact of COVID-19 on pregnancy outcomes: a systematic review and meta-analysis".CMAJ.193(16): E540–E548.doi:10.1503/cmaj.202604.PMC8084555.PMID33741725.
{{cite journal}}:CS1 maint: multiple names: authors list (link) - ^Wei SQ, Bilodeau-Bertrand M, Liu S, Auger N (2021)."The impact of COVID-19 on pregnancy outcomes: a systematic review and meta-analysis".CMAJ.193(16): E540–E548.doi:10.1503/cmaj.202604.PMC8084555.PMID33741725.
{{cite journal}}:CS1 maint: multiple names: authors list (link) - ^ab"Coronavirus Disease 2019 (COVID-19)".Centers for Disease Control and Prevention.11 February 2020.Retrieved19 March2020.
- ^Wang H, Li N, Sun C, Guo X, Su W, Song Q; et al. (2022)."The association between pregnancy and COVID-19: A systematic review and meta-analysis".Am J Emerg Med.56:188–195.doi:10.1016/j.ajem.2022.03.060.PMC8986277.PMID35413655.
{{cite journal}}:CS1 maint: multiple names: authors list (link) - ^"Update to living systematic review on covid-19 in pregnancy".BMJ.377:o1205. 2022-05-30.doi:10.1136/bmj.o1205.ISSN1756-1833.PMID35636775.
- ^Allotey, John; Fernandez, Silvia; Bonet, Mercedes; Stallings, Elena; Yap, Magnus; Kew, Tania; Zhou, Dengyi; Coomar, Dyuti; Sheikh, Jameela; Lawson, Heidi; Ansari, Kehkashan; Attarde, Shruti; Littmoden, Megan; Banjoko, Adeolu; Barry, Kathryn (2020-09-01)."Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis".BMJ.370:m3320.doi:10.1136/bmj.m3320.ISSN1756-1833.PMC7459193.PMID32873575.
- ^abcdSmith, Emily R.; Oakley, Erin; Grandner, Gargi Wable; Ferguson, Kacey; Farooq, Fouzia; Afshar, Yalda; Ahlberg, Mia; Ahmadzia, Homa; Akelo, Victor; Aldrovandi, Grace; Barr, Beth A. Tippett; Bevilacqua, Elisa; Brandt, Justin S.; Broutet, Nathalie; Buhigas, Irene Fernández (2023-01-01)."Adverse maternal, fetal, and newborn outcomes among pregnant women with SARS-CoV-2 infection: an individual participant data meta-analysis".BMJ Global Health.8(1): e009495.doi:10.1136/bmjgh-2022-009495.hdl:10044/1/104684.ISSN2059-7908.PMC9895919.PMID36646475.
- ^"Q&A on COVID-19, pregnancy, childbirth and breastfeeding".www.who.int.Retrieved6 April2020.
- ^ Michael P Rimmer, Jhia J Teh, Scott C Mackenzie, Bassel H Al Wattar, The risk of miscarriage following COVID-19 vaccination: a systematic review and meta-analysis, Human Reproduction, 2023https://academic.oup.com/humrep/advance-article/doi/10.1093/humrep/dead036/7043098?login=false
- ^abcdefBadell, Martina L.; Dude, Carolynn M.; Rasmussen, Sonja A.; Jamieson, Denise J. (2022-08-10)."Covid-19 vaccination in pregnancy".BMJ.378:e069741.doi:10.1136/bmj-2021-069741.ISSN1756-1833.PMC9363819.PMID35948352.
- ^abNana, Melanie; Hodson, Kenneth; Lucas, Nuala; Camporota, Luigi; Knight, Marian; Nelson-Piercy, Cathy (2022-04-26)."Diagnosis and management of covid-19 in pregnancy".BMJ.377:e069739.doi:10.1136/bmj-2021-069739.ISSN1756-1833.PMID35473709.