An international study organized by scientists from the University of Oxford and conducted in 18 countries around the world, including Russia, has shown that Covid-19 during pregnancy is associated with a significantly higher risk of serious complications for both mother and baby than previously thought. In one of the largest studies to date on the effects of Covid-19 during pregnancy, data from more than 2,100 pregnant women from 18 countries, including Russia, were presented. Pregnant women with Covid-19 have significantly worse outcomes, both in terms of the pregnancy itself and the viral infection. Together, they exponentially increase the risk of maternal mortality.
However, the authors of the paper urge people not to panic, not to jump to conclusions, and not to make hasty decisions. For example, do not postpone a planned pregnancy, and especially do not terminate one that has already begun. “I would like to emphasize separately that pregnancy during the pandemic is not a cause for panic,” assures Aris Papageorgiou, lead author of the study and professor who heads the maternal and child health research direction at the University of Oxford. “For the vast majority of women, pregnancy will end with a normal, healthy delivery, whether or not they were infected with the coronavirus.”
Nevertheless, Professor Papageorgiou points out that a pregnant woman infected with Covid-19 has a higher risk of developing a severe infection. This is not least because during pregnancy physiological changes occur in the future mother’s body that suppress the immune response – in order to prevent rejection of the fetus, which is still “partly a foreign implant”. In the second half of pregnancy, as the size of the fetus increases, the pressure of the uterus on the diaphragm increases, making the mother’s breathing shallower. The risk of oxygen deprivation is greatly increased when this natural process is combined with a viral lung infection.
The results of the study, which began in March last year, are significantly different from what scientists thought a year or even six months ago. Initially, WHO experts believed that the new coronavirus did not pose a particular threat to pregnant women, “unlike the swine flu” that caused the 2009 pandemic. However, this conclusion was reached when the number of confirmed cases of Covid-19 barely exceeded 50,000, almost all of them in mainland China. By the summer, when the outbreak became a full-blown pandemic, the number of pregnant women infected with COVID-19 had reached tens of thousands. It became clear that expectant mothers were at least one and a half times more likely to be admitted to intensive care than women of the same age who were not pregnant. It turned out that expectant mothers also needed to be connected to ventilators more often.
We explain quickly, simply and clearly what happened, why it matters and what will happen next. The number of episodes should remain the same. End of story Podcast advertising However, this data was unreliable: only one in four coronavirus patients of reproductive age knew whether they were pregnant or not. The consensus of experts is that a new study has been conducted to the highest scientific standards – so its conclusions are more convincing and deserve much greater trust. First, each participant was followed by scientists for the entire period from diagnosis to delivery and for some time afterward. Second, for each patient, an individual control group was selected for comparison – two pregnant women as similar as possible in age and health status, but without a coronavirus diagnosis.
It should be noted that the severe form of Covid-19 did not develop in all infected pregnant women. In Russia, for example, almost two-thirds of the study participants had mild or asymptomatic coronavirus. However, the overall difference between the groups was significant. In patients with Covid-19, pregnancies were more severe, and complications occurred more frequently, threatening not only the health but also the life of both mother and child. Severe secondary infections were three times more common with Covid-19, and pregnant patients with coronavirus were five times more likely to be admitted to intensive care. If in the control group pregnancy ended with the death of the mother in only one case out of 1424, in the group with Covid-19 11 out of 706 patients died – i.e. the risk of maternal death was 22 times higher there. However, the co-author of the “Russian” part of the study, obstetrician-gynecologist Alexey Kholin, notes that fatal outcomes occurred mostly in regions where, due to a lack of resources, patients had significantly more difficulty getting the necessary medical care.
In addition, women with Covid-19 were more likely to give birth prematurely, resulting in newborns with various complications such as underdeveloped lungs, bleeding in the brain and impaired vision. 13% of newborns were found to be infected with Covid-19, most likely inheriting the infection from their mother. At the same time, scientists have found that the virus is not transmitted to the baby through breast milk, but protective antibodies are. While it is impossible to maintain a safe distance while breastfeeding, the risk of transmission between mother and baby can be reduced to virtually zero by expressing milk and feeding babies “at a distance”. The authors of the study emphasize that the most reliable way to protect future mothers from the virus is vaccination, although pregnancy is one of the contraindications and it is not officially recommended for pregnant women. Although pregnant women were not included in the volunteer pool for testing the Covid-19 vaccine, scientists have gathered enough data to assert that the vaccine poses no risk to either the mother or the baby, confirms Professor Aris Papageorgiou. “In our opinion, all pregnant women should have the opportunity to receive the coronavirus vaccine,” he concludes.