The global COVID-19 pandemic has disrupted life as we know it around the world. In particular, the coronavirus outbreak may be causing additional stress for pregnant women and those planning a pregnancy.
At the moment, a lack of data means research is sparse and subject to change. In an effort to keep you informed we will be updating this page on a regular basis with new research findings, as they emerge. Many academic journals have given free access to coronavirus-related research, so you can take advantage of this to access the original texts.
Still many unknowns remain
A recent review published in JAMA highlights a number of open questions about COVID-19 and pregnancy that remain unanswered. Are pregnant women more susceptible to COVID-19? What are the effects on newborn babies? Can COVID-19 be transmitted to the baby via breastmilk?
Unfortunately at this stage, there is little data available to answer these questions. For now, health experts recommend practicing good hygiene and social distancing/isolation measures to avoid contracting COVID-19 while pregnant.
We understand how frustrating this is for pregnant women or those planning a pregnancy. This is a key motivation for why we have developed Velmio as a research platform for pregnancy health, reducing the delay in collecting the right data to answer these questions.
Research examines mental health of new mothers
A new study from Canada published in the journal Frontiers in Global Women's Health has found that new mothers are experiencing heightened depression and anxiety during the COVID-19 pandemic. The study surveyed 900 women (58% currently pregnant and 42% in the first year after delivery) about their mental health, physical activity and social distancing/isolation measures.
The researchers found a significant increase in reports of depression and anxiety among women. There was also a decrease in the amount of physical activity undertaken by pregnant women during the pandemic, though the researchers noted that women who engaged in at least 150 minutes of physical activity each week reported improved mental health outcomes.
Small study of effects on placenta
A major unanswered question is whether COVID-19 can cause damage to the unborn baby. To date, little data exists on this topic so it is hard for experts to answer this conclusively.
A small study published in the American Journal of Clinical Pathology examined 16 pregnant women with COVID-19. The researchers discovered a form of damage to the placenta called vascular malperfusion, which can impair blood flow from the mother to the fetus. However, experts have suggested that the small sample size and contrasting results from other studies means it's far too early to conclude the exact effects of COVID-19 on the placenta.
UK study of 427 pregnant women
Preliminary results from a UK study suggest that pregnant women are not at higher risk of severe infection from COVID-19 than the wider population. These findings are consistent with other research we've reported on this page, which should hopefully come as reassuring news for pregnant women.
The study analyzed 427 pregnant women diagnosed with COVID-19 and is yet to be peer-reviewed. The researchers' preliminary results found an association between black and minority ethnicity and hospitalization with COVID-19 in pregnancy. Other potentially at-risk groups identified by the study include older pregnant women, those who are overweight or obese, and those with pre-existing conditions such as high blood pressure and diabetes.
The majority of women with severe illness were in the late second or third trimester of pregnancy. The Royal College of Obstetricians & Gynaecologists says that this result emphasizes the current advice for strict social distancing for pregnant women, particularly for those in their third trimester.
Studies currently in progress
There are a number of studies currently under way aiming to recruit large sample groups (1000+ women) to examine the effects of COVID-19 on pregnancy. Once we see results emerge in the coming weeks/months we will report them here.
- A study led by the US National Institutes of Health is examining several aspects of the pandemic. They will analyze medical records of up to 21,000 women to evaluate whether changes to healthcare delivery during the pandemic increased the rate of pregnancy complications and cesarean delivery. They will also examine whether COVID-19 can be transmitted to the fetus and they will monitor the health of 1,500 pregnant women with confirmed cases of COVID-19 for six weeks after childbirth.
- The INTERCOVID study led by researchers at the University of Oxford is a large global study of the effects of COVID-19 in pregnancy and the neonatal period. For every participant with COVID-19, the study will recruit two pregnant women without COVID-19 to evaluate the true risk that COVID-19 poses to pregnant women. 62 medical institutions in 29 countries have already agreed to participate in the study.
- Researchers at a Woman's Hospital in the US are recruiting 1200 pregnant women to examine the effects of the COVID-19 pandemic on pregnant women. They aim to understand how the pandemic is affecting pregnant women's health, feelings, behaviors and home/work situations. The study is open to women worldwide, so check out the details here if you're interested in participating.
World Health Organization
Systematic review of 108 pregnancies
Researchers from Lund University, Sweden, have analyzed the findings from 108 pregnancies reported with a confirmed COVID-19 infection.
Most of these women were in the third trimester and their most common symptoms included fever (68% of cases) and coughing (34% of cases). The majority of mothers were discharged without any major complications, with 91% of the women delivering by cesarean section (with most cases citing fetal distress as the reason for cesarean delivery). However, one neonatal death and one intrauterine death was reported, with the researchers concluding that severe maternal morbidity as a result of COVID-19 and maternal-fetal transmission could not be ruled out. The researchers from the study summarize their findings in this article.
Centers for Disease Control and Prevention
The Centers for Disease Control and Prevention has released interim guidance on breastfeeding. Limited data suggests breastmilk is not likely to be a source of transmission for COVID-19. A mother with a confirmed case of COVID-19 should take precautions to prevent spreading the virus to her infant, including hand hygiene and wearing a cloth face covering.
Review of 43 COVID-positive cases in New York City
The researchers found that the disease severity in pregnant women in New York City appears similar to that in non-pregnant adults. 37 women (86%) exhibited a mild disease, 4 (9.3%) severe disease and 2 (4.7%) critical disease. However, they do note that the sample size of the study is small. The full text can be accessed at this link.
Pregnant women with COVID-19 in Wuhan, China
Researchers in China identified 118 pregnant women with COVID-19 in Wuhan, between December 8, 2019 and March 20, 2020. As of March 20, 109 of the women had been discharged and there were no deaths. The researchers concluded that the data did not suggest an increased risk of severe disease among pregnant women.
The researchers also examined the birth outcomes, with 68 of the women (58%) delivering during the study period. There were 3 spontaneous abortions, 2 ectopic pregnancies and 4 induced abortions (owing to concerns about COVID-19). Some newborns were tested for COVID-19 (using throat swabs of 8 newborns and breast-milk samples of 3 mothers), with no positive cases reported. The researchers' findings is summarized in this note.
Pregnancy and SARS
This study from 2003 looks at the effects of SARS on pregnancy and perinatal outcomes. SARS is also a coronavirus, so experts hypothesize that the effects of COVID-19 on pregnancy may be similar. However, more data is needed to confirm this.
It is well understood that the immune system becomes weaker during pregnancy and as a result, pregnant women are more susceptible to viral infections. Breathing difficulties are a common experience during pregnancy (particularly during the later stages), due to increased pressure from the growing uterus against the diaphragm. Therefore, respiratory infections like SARS and COVID-19 may be more severe for pregnant women.