What the latest COVID-19 data tells us about pregnant women's risk

July 9th Update: A note from Maven Medical Director and OB-GYN Dr. Jane van Dis

With the latest research out of Italy making headlines today about the potential for pregnant women to transmit COVID-19 in-utero to their babies, we want pregnant women to know that this is not cause for alarm. The new research previewed today is an extremely small sample size: two babies tested positive out of 31 pregnant women infected with COVID-19. Both infants recovered quickly.

While this reinforces that in-utero transmission is possible, what all of the available data to-date tells us is that it is relatively rare. And, importantly, we have seen similar studies throughout the pandemic, all demonstrating transmission is a rare event and that infants commonly test negative within a few days of testing positive. In this recent review published in June in Obstetrics & Gynecology, of 310 pregnancies, researchers found a vertical transmission rate of 0%. And this review found a 1.7% rate (3 out of 179) for infants testing positive for infection.

If you’re pregnant and these headlines are making you anxious, you’re not alone. I encourage you to reach out to a Maven Mental Health Provider to talk through your anxiety, and we also have OB-GYNS ready for a video appointment right now on Maven’s app who can help talk you through the risks of COVID-19, and how to keep you and your baby safe. We’re here for you.

The bottom line is we still don’t know enough about COVID-19’s impact on pregnancy. Continue to take precautions to keep you and your baby healthy: wear a mask at all times when you leave your house, wash your hands frequently, and maintain at least six-feet distance from others.

June 26, 2020 Update

The U.S. Centers for Disease Control (CDC) released a new dataset on June 25th exploring the impact of COVID-19 on pregnant women—the largest analysis of this key population to date.

These numbers represent the most up-to-date information that healthcare professionals have to inform treatment and care for pregnant women so far, and help provide more clarity for new or expecting mothers concerned about their health and wellbeing during this trying time.

We sat down with Maven Medical Director and OB-GYN, Dr. Jane van Dis, to discuss some of the major takeaways from this new data, what pregnant women should keep in mind as they read these findings, and how they can stay healthy.

1. What does this latest study tell us about how pregnant women are affected by COVID-19?

We learned from the release of the largest data analysis of how COVID-19 impacts pregnant women—the CDC's Morbidity and Mortality Weekly Report (MMWR) released June 25th—that pregnant women with COVID-19 are more likely to be hospitalized (31.5% vs. 5.8%), admitted to the ICU, and put on a ventilator than women who are not pregnant.

One of the reasons the data was so high for hospital admission could be due to pregnancy conditions and/or delivery, not necessarily COVID-19 complications. That’s really important to know when looking at the data.  

Between January 22 and June 7, 2020, a cohort of 8,207 pregnant women were enrolled in this database and compared against their non-pregnant cohort of 326,335 women between the ages of 15-44.

While there are many possible confounders affecting the disparity in hospital admission of pregnant versus non-pregnant women, there were fewer possible explanations for the differences seen between pregnant and non-pregnant women who were admitted to the ICU:

• After adjusting for age and other conditions, pregnant women were 5.4 times more likely to be admitted to the ICU than were non-pregnant women.
• They were 1.5 times more likely to require mechanical ventilation in the ICU.

While these numbers look startling too, it’s important to remember that ICU admission data was only available for 26.5% of women, and mechanical ventilation data only available for 23.1% of women. Had the researchers had the additional approximately 75% of data available, that might have significantly changed the increased risk for ICU admission and ventilation.

One of the reasons the data was so high for hospital admission could be due to pregnancy conditions and/or delivery, not necessarily COVID-19 complications. That’s really important to know when looking at the data.

2. Why are pregnant women more at risk?

The answer as to why pregnant women would be at increased risk of ICU admission and mechanical ventilation if they contract COVID-19 is likely multifactorial but may be due, in part, to changes in the physiology and anatomy of the maternal adaptation to pregnancy including:

• hormonal effects on vasculature
• changes in immune function
• decreased residual capacity of the lungs and increased resting ventilation
• increased blood volume, work of the heart, and entire cardiovascular system

Another possible contributor is the increased risk for micro- and macro-thrombosis (blood clots) in pregnant women with COVID-19. Lastly, of those pregnant women who experience severe cases of COVID-19, some exhibit the exaggerated inflammatory response (cytokine storm), which has been known to lengthen the course and severity of COVID-19.  

3. Are there things pregnant women can do to try to protect themselves?

Wear a mask, wash your hands frequently, and definitely don’t let your guard down to the risks of contracting COVID-19. While society has changed between March and June, today, the virus has not changed. It’s important to remember that keeping everyone healthy through this pandemic is a marathon, not a sprint. There are still asymptomatic persons who are infected, but not yet aware. We still don’t know enough about COVID-19’s effect on pregnancy for women to let their guard down.  

4. What would you say to someone who is expecting and is worried about COVID-19?

Continue to take precautions to stay safe and healthy: wear a mask whenever you leave your house, wash your hands frequently, and avoid any indoor gatherings. When you can, take walks outdoors: getting fresh air and exercise is also good for mind and body.

If you’re feeling anxious or stressed, know that you’re not alone. At Maven, we’ve seen marked utilization of our mental health services to support pregnant women—as well as all of our members. Surveys show that up to 85% of women have increased anxiety and/or depression during this time. We encourage women to reach out for support, whether through talk therapy alone, or, if necessary, with medication.