TMC PULSE

t m c n e w s . o r g 28 Are Expecting Mothers at Greater Risk for COVID-19? A new study hopes to answer questions related to maternal and newborn health W hen COVID-19 started to spread across the United States in early March, experts scrambled to better understand the disease and its risk to certain popu- lations, including pregnant women. Even now, little is definitively known about whether expecting mothers are more susceptible to COVID-19, if those infected are more likely to become seriously ill or what long-term effects the virus can visit upon newborns. That lack of information has led to contradictory messaging, with some health experts advis- ing caution and others offering reassurance. But a multi-institutional study funded by the National Institutes of Health (NIH) hopes to provide some answers to patients and pro- viders by comparing outcomes of pregnancies during the pandemic to data collected before the SARS- CoV-2 virus began to circulate. "The study is basically almost two studies in one," said George Saade, M.D., who will lead research at The University of Texas Medical Branch at Galveston (UTMB), one of the institutions participating in the national study. "We're going to look at the outcome of pregnant women with COVID infections—do they have a preterm birth, do they have a normal birth and normal pregnan- cies, are there any complications, how many of them are asymptomatic, as well as what happens to the babies. The second part is to look at the impact of the pandemic on everybody, on all pregnant women, to see if the pandemic has affected care." He explained that the second part of the study is important because many pregnant women may be avoiding routine prenatal care for fear of being exposed to the virus in a health care setting—something he urged patients not to do. "Things in pregnancy can deteriorate very quickly, so the risk of staying away from the health system is worse than catching an infection or worrying about an infection," said Saade, the Jennie Sealy Smith Distinguished Chair in the department of obstetrics and gynecology and chief of obstetrics and maternal fetal medicine at UTMB. "In the end, it's still safer in the hospital than anywhere else." Current federal messaging around pregnant women and COVID-19 is limited. According to a Centers for Disease Control and Prevention (CDC) statement on COVID-19 and pregnancy, "pregnant people appear to have the same risk of COVID-19 as adults who are not pregnant." However, the CDC's statement acknowledges that when pregnant, a woman's body undergoes physiolog- ical changes that pose an increased risk for some infections, including those from viruses in the same family as COVID-19 and other viral respiratory illnesses, such as influenza. Although there are many unanswered questions about COVID-19 and pregnancy, history indicates that pregnant women may be at an increased risk for serious infection, said Kjersti Aagaard, M.D., Ph.D., a maternal-fetal medicine specialist at Texas Children's Pavilion for Women. "We know pregnancy is a higher-risk state, so if you take a 35-year-old woman with no signifi- cant medical complications and no chronic illnesses, and you compare that 35-year-old pregnant woman to a 35-year-old non-pregnant woman ... the pregnant woman is going to be more vulnerable for severe disease and death," said Aagaard, the Henry and Emma Meyer Chair in Obstetrics and Gynecology at Baylor College of Medicine. "Why COVID-19 would be any different is as yet unclear. That didn't hold true in the SARS epidemic, it didn't hold true in the MERS epi- demic, it didn't hold true in the H1N1 pandemic, and it hasn't held true with annual influenza outbreaks. With every one of those instances, pregnant women are at a greater risk for severe respiratory morbidity and mortality." Aagaard's point is echoed in a statement from the American College of Obstetricians and Gynecologists (ACOG). The organization notes that while currently available data does not indicate that pregnant women are at increased risk for COVID-19, pregnant women are known to be at greater risk of severe morbidity and mortality from other respiratory infections. Yet Saade is approaching the NIH-funded study with optimism. "Whatever we thought we knew two months ago has changed, and prob- ably will change in two, three months. But right now, I can tell you that the B y A l e x a n d r a B e c k e r A pregnant woman stands in her home wearing a protective mask during the coronavirus epidemic. Credit: Sipa via AP Images

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