What is the current evidence regarding pregnancy outcomes for patients with COVID-19?

Posted on May 10, 2020 by Tomas Rapaport

Summary

The effects of COVID-19 on pregnant patients does not appear to be significantly different than those on the general population. That is, the rates of mild, moderate, and severe disease appear to be similar in both groups. However; the case series that indicate this are small and underpowered. The effects of COVID-19 on fetuses and neonates is even lesser known. There may be a weak possibility of vertical transmission and there are increased rates of pre-term birth, however; it is not certain if this is driven by spontaneous or iatrogenic pre-term births. There is no evidence of teratogenicity, miscarriages, or fetal demise secondary to COVID-19 at this time. 

I.   Canadian Society of Obstetricians and Gynaecologists (Updated April 2, 2020):

  • > 60 cases of pregnant patients with COVID-19  in China were studied and the vast majority had mild to moderate pneumonia, with one case of severe maternal morbidity requiring ECMO
  • Pregnancy outcomes in this case series have been largely good, the most common adverse outcome being spontaneous and/or iatrogenic pre-term labour
  • Limited data makes it difficult to draw conclusions, however; drawing on evidence of the SARS and MERS pandemics, the authors state that the adverse effects to fetus will be most correlated with degree of maternal illness, rather than any intrinsic viral factor 
  • There is no evidence of vertical transmission or teratogenicity at this time

II.   American College of Obstetricians and Gynaecologists (Updated April 23, 2020):

  • There is limited data from pregnant COVID-19 patients which shows that this population is not at increased risk of infection or severe morbidity (ei. Higher rates of ICU admission or mortality) compared to the general population
  • Pregnant patients with comorbidities appear to be at increased risk of severe illness consistent with the general population with similar comorbidities

III.   United Kingdom’s Royal College of Obstetricians and Gynaecologists & Royal College of Midwives (Updated April 17, 2020):

  • Case series from New York describes a similar pattern of disease severity in pregnant and non-pregnant adults with a sample size of 43, which is too small to draw definitive conclusions
  • Case reports indicate increased pre-term birth in patients with COVID-19 but it is unclear if these were iatrogenic or spontaneous
    • Data from the SARS and MERS pandemics showed that pregnant patients with these diseases were at increased risk of preterm birth after 28 weeks gestation, authors wonder if this will become apparent with COVID-19 as more data is collected
  • Given that pregnancy is known to be a hypercoagulable state and COVID-19 is increasingly becoming thought of as potentially increasing coagulation, it is possible that pregnant COVID-19 patients are at even higher risk of venous thromboembolisms, however; there is no evidence for this at this time
  • There is currently no data suggesting an increased risk of miscarriage or early pregancy loss related to COVID-19
  • There is currently no data suggesting that SARS-CoV-2 is teratogenic
  • There is a possibility that the virus can be vertically transmitted based on one study but we don’t know how many pregnancies this may have affected or if it is causes significant effects to neonates

Note on methods: Reviews by three leading Obstetrican and Gynaecological associations were summarized rather than conducting our own review of the primary literature.

Questions? Comments? Does this need to be updated? Do you have valuable points to add ? Please email ask.reakt@ubc.ca.

References

  1. Updated SOGC Committee Opinion –  COVID-19 in Pregnancy [Internet]. Sogc.org. 2020 [cited 2020 May 10]. Available from: https://www.sogc.org/en/content/featured-news/Updated-SOGC-Committee-Opinion__COVID-19-in-Pregnancy.aspx
  2. Novel Coronavirus 2019 (COVID-19) [Internet]. Acog.org. 2019 [cited 2020 May 10]. Available from: https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2020/03/novel-coronavirus-2019
  3. Information for healthcare professionals Coronavirus (COVID-19) Infection in Pregnancy 2 [Internet]. 2020 [cited 2020 May 11]. Available from: https://www.rcog.org.uk/globalassets/documents/guidelines/2020-04-17-coronavirus-covid-19-infection-in-pregnancy.pdf

Disclaimer

The above is intended to serve as a rapidly-created, accessible source of information curated by medical students and healthcare professionals. It is for educational purposes only and is not a complete reference resource. It is not professional medical advice, and is not a substitute for the discretion, judgment, and duties of healthcare professionals. You are solely responsible for evaluating the information above.