COVID-19 linked to serious health complications during pregnancy

07 February 2022 09:00

Media alert: Dr Metz will be available via ZOOM for media questions at 11:30 a.m. MT, Monday, February 7, 2022

According to a national study conducted by a University of Utah Health obstetrician.

The researchers concluded that the severity of COVID-19 symptoms is a key indicator of increased risk of pregnancy complications. This was particularly evident in the most seriously ill people, who were three times more likely to develop pregnancy complications than those who tested negative or were less affected by the disease.

“We already knew that pregnant women are at a higher risk of complications from COVID-19 itself,” says Jorri D. Metz, MD, MS, a maternal-fetal medicine specialist and associate professor of obstetrics and gynecology at U of U Health who led the multicenter effort. “Our research is among the first to discover that infection with SARS-CoV-2 can increase the risk of serious consequences related to the progression of common pregnancy complications such as the development of high blood pressure, postpartum bleeding -partum or acquisition of an infection other than SARS. This is why we must ensure that pregnant women are vaccinated.

The study appears in the February 7, 2022 issue of JAMA.

Researchers analyzed the electronic medical records of 14,104 pregnant women treated at 17 medical centers across the country participating in the Eunice Kennedy Shriver NICHD Maternal-Fetal Medicine Unit (MFMU) Network between March 1, 2020 and December 31, 2020.

About 2,350 of those people tested positive for SARS-CoV-2 during pregnancy or within six weeks of giving birth. More than 13% of those who tested positive developed pregnancy complications during the study, compared to 9% of those who tested negative. All five maternal deaths occurred in the SARS-CoV-2 positive group. Additionally, the researchers found that:

Complications were more common with moderate to severe COVID-19.

Compared with those who had mild (flu-like) symptoms or who were asymptomatic, pregnant women who had moderate or severe symptoms, requiring treatment with supplemental oxygen or intensive care, were about three times (26 .1% vs. 9.2%) more likely to have serious pregnancy complications.

These problems included eclampsia, severe high blood pressure, kidney failure and others target organ damage caused by high blood pressure, sepsis infections other than SARS-CoV-2, and endometritis requiring prolonged administration of intravenous antibiotics.

Premature birth was more likely in those infected.

SARS-CoV-2 infection was significantly associated with preterm birth and NICU admission. However, maternal SARS-CoV-2 has not been associated with any other adverse outcomes in newborns. In fact, only 1.2% of newborns tested positive for the virus before discharge.

People with certain characteristics were more likely to have complications.

People who tested positive and later developed pregnancy complications were more likely to have a body mass index (BMI) of 30 or higher and identify as Hispanic or black. These findings are consistent with other demographic findings in non-pregnant people infected with the virus, Metz says.

Pregnant women who had moderate or severe symptoms of COVID-19 also had a significantly higher risk of cesarean delivery (45.4% versus 32.4%) than those without SARS-CoV-2. However, cesarean birth rates were similar in those with mild symptoms or asymptomatic compared to those without SARS-CoV-2.

“Some pregnant women with COVID-19 are just too sick for us to attempt a vaginal birth,” says Metz. “Under certain circumstances, such as the onset of preeclampsia, the fetus is also much less likely to tolerate it.”

Among the limitations of the study, 80% of SARS-CoV-2 infections were detected during the third trimester, hampering efforts to assess the effects of the virus on complications in early pregnancy.

The study was also conducted before the widespread availability of mRNA vaccines. However, Metz says, the new findings strengthen the scientific rationale for efforts to vaccinate people who are pregnant or planning to have a child.

“The pregnancy complications we observed were mostly in people who had moderate to severe symptoms of COVID-19,” says Metz. “We know from other studies that vaccination prevents the most severe symptoms of the disease. So this is just another piece of the puzzle that should encourage pregnant women to get vaccinated.

Watch this Q&A video with Torri Metz, the study’s principal investigator.

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The study, “Association of SARS-CoV-2 Infection with Serious Maternal Morbidity and Mortality from Obstetric Complications,” appears in the February 7, 2022 issue of JAMA. He was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and National Center for Advancing Translational Sciences.

In addition to U of U Health, institutions participating in this study include George Washington University, University of Alabama, Northwestern University, Brown University, University of Texas Medical Branch , University of Pittsburgh, Case Western University, University of North Carolina, Ohio State. University, Columbia University, University of Pennsylvania, University of Texas Health Sciences Center-Houston and University of Texas-Austin.

Conflicts of Interest: Torri D. Metz has received personal fees and grants from Pfizer as well as grants from Gestvision; Brenna L. Hughes received personal honorarium from Merck; Hyagriv N. Simihan is a co-founder LLC of Naima Health and has received personal fees from UptoDate outside of the ongoing study; Alan TN Tita has received grants from Pfizer; Maged Costantine has reported a relationship with Baxter International, Momenta Pharmaxeuticals, Progenity, AMAG Pharmaceuticals and ObsEva. No other authors report any conflict of interest.

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