Pregnant Women Are at Higher Risk for Serious COVID-19 Infection

Being pregnant during the COVID-19 pandemic has been anxiety-producing for many expectant mothers, and public health officials now say they have good reason to be afraid. Find out how pharmacists and other health professionals can advise pregnant women of increased risks for serious novel coronavirus cases and ways to better protect themselves and their unborn child.

ATLANTA – Pregnant women have had a lot of questions about what the COVID-19 outbreak might mean for them and their unborn child. Based on new public health guidance, pharmacists should caution expectant mothers that they are at increased risk for severe novel coronavirus illness and need to take special precautions.

In new guidance, the national Centers for Disease Control and Prevention warns that, to reduce severe COVID-19–associated illness, pregnant women should be aware of their potential risks.

“Prevention of COVID-19 should be emphasized for pregnant women and potential barriers to adherence to these measures need to be addressed,” according to the report in the Morbidity & Mortality Weekly Report.

CDC researchers explain that, during pregnancy, women experience immunologic and physiologic changes that could increase their risk for more severe illness from respiratory infections, although they add that data to assess the prevalence and severity of COVID-19 among pregnant U.S. women and determine whether signs and symptoms differ among pregnant and nonpregnant women are limited.

From Jan. 22 to June 7, CDC says it received reports of 326,335 women of reproductive age (15–44 years) who had positive test results for SARS-CoV-2, the virus that causes COVID-19. Data on pregnancy status were available for 91,412 (28.0%) women with laboratory-confirmed infections; among these, 8,207 (9.0%) were pregnant.

The report advises that while symptomatic pregnant and nonpregnant women with COVID-19 reported similar frequencies of cough (>50%) and shortness of breath (30%), pregnant women less frequently reported headache, muscle aches, fever, chills, and diarrhea. Chronic lung disease, diabetes mellitus, and cardiovascular disease were more commonly reported among pregnant women than among nonpregnant women, however.

Yet, among women with COVID-19, about one third (31.5%) of pregnant women were reported to have been hospitalized compared with 5.8% of nonpregnant women. “After adjusting for age, presence of underlying medical conditions, and race/ethnicity, pregnant women were significantly more likely to be admitted to the intensive care unit (ICU) (aRR = 1.5, 95% confidence interval [CI] = 1.2–1.8) and receive mechanical ventilation (aRR = 1.7, 95% CI = 1.2–2.4),” the authors noted.

Furthermore, 16 (0.2%) COVID-19–related deaths were reported among pregnant women aged 15–44 years, and 208 (0.2%) such deaths were reported among nonpregnant women (aRR = 0.9, 95% CI = 0.5–1.5), suggesting that “among women of reproductive age with COVID-19, pregnant women are more likely to be hospitalized and at increased risk for ICU admission and receipt of mechanical ventilation compared with nonpregnant women, but their risk for death is similar.”

The CDC recommends that pharmacists and other healthcare professionals counsel pregnant women about the potential risk for severe illness from COVID-19, and about measures to prevent infection with SARS-CoV-2 for pregnant women and their families.

Specific actions include not skipping prenatal care appointments, limiting interactions with other people as much as possible, taking precautions to prevent getting COVID-19 when interacting with others, having at least a 30-day supply of medicines, and talking to their healthcare provider about how to stay healthy during the COVID-19 pandemic, the CDC states.

“Although these findings could be related to the increased risk for illness, they also could be related to the high proportion of reproductive-aged women for whom data on pregnancy status was missing, if these women were more likely to not be pregnant,” the article pointed out. “The higher-than-expected percentage of COVID-19 cases among women of reproductive age who were pregnant might also be attributable to increased screening and detection of SARS-CoV-2 infection in pregnant women compared with nonpregnant women or by more frequent health care encounters, which increase opportunities to receive SARS-CoV-2 testing.”

The report notes that several inpatient obstetric health care facilities have implemented universal screening and testing policies for pregnant women upon admission.

The authors posit that, while differences in hospitalization by pregnancy status might reflect a lower threshold for admitting pregnant patients or for universal screening and testing policies that some hospitals have implemented for women admitted to the labor and delivery unit, “ICU admission and receipt of mechanical ventilation are distinct proxies for illness severity, and after adjusting for age, presence of underlying conditions, and race/ethnicity, the risks for both outcomes were significantly higher among pregnant women than among nonpregnant women.”

CDC researchers advise that those findings are similar to those from a recent study in Sweden, which found that pregnant women with COVID-19 were five times more likely to be admitted to the ICU and four times more like to receive mechanical ventilation than were nonpregnant women.

“The findings in this report suggest that among adolescents and women aged 15–44 years with COVID-19, pregnancy is associated with increased risk for ICU admission and receipt of mechanical ventilation, but it is not associated with increased risk for mortality,” the authors conclude. “This report also highlights the need for more complete data to fully understand the risk for severe illness resulting from SARS-CoV-2 infection in pregnant women.”