In April, medical experts commented that was “remarkable” how little was known about COVID-19 in pregnancy. Now, more than six months into the pandemic and experts continue to echo that sentiment. This is concerning for millions of American families who are, or will become, pregnant during the pandemic. Families are concerned about illness, complications and birth injuries related to COVID-19.
One major question is “why?” With new information about the novel coronavirus COVID-19 emerging almost daily, why is there not more information about COVID-19 in pregnancy?
What We Do Know about COVID-19 in Pregnancy
Agencies like the Centers for Disease Control and Prevention (CDC) continue to study COVID-19 in pregnancy. Sadly, the results of those studies seem to ask more questions than they answer. In June, the CDC released its first report titled “Characteristics of Women of Reproductive Age with Laboratory-Confirmed SARS-CoV-2 Infection by Pregnancy Status – United States, January 22–June 7, 2020.” While the study included more than 8,000 women, it also noted that there is,
“Limited information is available about SARS-CoV-2 infection in U.S. pregnant women.”
So, what did the study add to the topic? According to the report, this particular study found the following:
- Hispanic and black pregnant women are disproportionately affected by COVID-19 in pregnancy.
- Pregnant women may be at a higher risk of severe illness than non-pregnant women.
- Pregnancy is associated with an increased risk of hospitalization and intensive care unit admission among reproductive-age women with COVID-19.
This information reiterates what we already know about COVID-19 in pregnancy. We know that there are healthcare disparities in prenatal and childbirth care . We also know that the COVID-19 pandemic is changing the way that parents manage pregnancy, labor and delivery. And finally, we know that the coronavirus risk to infants and children extends beyond pregnancy.
Why We Know So Little about COVID-19 in Pregnancy
The reasons why we know so little about COVID-19 in pregnancy may depend on who you ask. In a report from The New York Times, health experts weigh in on why they believe there is a shortage of information. According to the report, the reasons include:
Federal public health researchers rely on reports of COVID-19 from individual jurisdictions. This results in something of a patchwork of reports, rather than reliable and consistent information. Heather Huddleston, a reproductive endocrinologist at the University of California, says that the U.S. “falls short” by not having a nationalized healthcare system, which would provide a better way of tracking people and illnesses.
Lack of Details on Healthcare Forms
Healthcare providers do not always have time to put details into forms while caring for patients. With staffing shortages and an increase in the number of patients, healthcare workers are over-extended. Allison Bryant, a maternal-fetal medicine specialist and member of the American College of Obstetricians and Gynecologists’ working group on COVID-19 in pregnancy, says,
“We were on fire taking care of pregnant patients or patients across the institution who were really, really sick. In these conditions, the case reporting, while important, becomes less of a priority.”
A good example of this is that for the month of June, the CDC reported 10,537 positive COVID-19 tests among pregnant women. Only one-quarter of those case reports indicate whether the women were treated in intensive care or required mechanical ventilation.
Lag in COVID-19 Research
The U.S. continues to face a lag in COVID-19 research and response times. Data collection is slow, but researchers hope to change that. The CDC is expanding a data collection system that gathers data on pregnant women and their children. The expanded system will include information on the first three years of life, including surveillance on COVID-19 in pregnancy.
One of the few methods that seems to be working is a nationwide registry set up by the University of California San Francisco and the University of California Los Angeles. The nationwide registry relies on information provided by women through questionnaires. Women have the option of releasing medical records and providing samples, such as breast milk, blood or other biological specimens. For this registry, pregnancy is the “primary inclusion criteria.” Women do not have to have a referral, and they can participate from anywhere.
At least 30 states are working to report additional surveillance data. Some researchers believe this effort is far behind, and that better information gathering and reporting should have been implemented months ago.
Working to Understand COVID-19 in Pregnancy
While there is definitely more work to be done to understand COVID-19 in pregnancy, experts believe that the CDC’s report and current data can serve as a “signal.” That signal being that pregnant women may be more vulnerable to serious illness and more severe COVID-19 symptoms.
Experts believe that this information is not surprising, since we know that pregnant women are more vulnerable to respiratory illnesses, including the flu and pneumonia. These sentiments are echoed by experts in other countries, who have found similar results.
Recommendations for Pregnant Women During the COVID-19 Pandemic
Using what is currently known about COVID-19 in pregnancy, the CDC offers recommendations for women to reduce their risk of getting the coronavirus. The CDC recommendations include:
- Limit interactions with other people as much as possible.
- When you do interact with others, practice social distancing.
- When in public, wear a face covering.
- Wash your hands frequently, especially after being around others.
- If you are unable to wash your hands, use a hand sanitizer with at least 60 percent alcohol. Beware of toxic hand sanitizers or fake hand sanitizers.
- Avoid crowds or gatherings where people are not wearing face coverings.
- If you feel sick, talk to your healthcare provider immediately.
- If you are sick or have a fever, stay home.
- Do not skip prenatal appointments. If you don’t feel safe going to the doctor, see if you can arrange a telehealth appointment.
Of course, there is no way to guarantee who will or will not get COVID-19. As Dr. Allison Bryant notes,
“The best way to avoid severe Covid is really to avoid Covid altogether.”