COVID-19 During Pregnancy Means Higher Risk for Complications
  • New study stresses the risk of complications in pregnant people who have COVID-19.
  • Pregnant people are 15 times more likely to be put on a ventilator than non-pregnant people when they have COVID-19.
  • Doctors urge pregnant people to be up to date on COVID-19 vaccines.

For years, doctors have warned that COVID-19 can be more severe in people who are pregnant. Now, there’s a study that demonstrates just how much worse the virus can be for expectant moms.

The study, which was published in BMJ Global Health, analyzed data from 13,000 pregnant people across 12 studies conducted in 12 countries, including the U.S. Of those study participants, about 2,000 had a confirmed or suspected case of COVID-19, and their outcomes were compared against about 11,000 pregnancies where the patient tested negative for COVID-19 when they delivered.

The findings were eye-opening: Pregnant people who contracted COVID-19 were nearly four times more likely to be admitted to the ICU compared to those who weren’t infected, and were 15 times more likely to need to be put on a ventilator. They were also seven times more likely to die.

It didn’t end there. Pregnant people also had a higher risk for serious complications like pre-eclampsia, blood clots, and high blood pressure issues, and their babies were at an increased risk of preterm birth and low birth weight.

As a whole, about 3% of women with COVID-19 needed to be admitted to the ICU and 4% required critical care—but the numbers are much greater than those who did not contract the virus.

“These findings are very, very important,” says William Schaffner, M.D., an infectious disease specialist and professor at the Vanderbilt University School of Medicine. “This emphasizes again just how dangerous COVID can be to people who are pregnant.”

The study results aren’t shocking, but they underscore research that has also found COVID-19 can be particularly bad for pregnant people, says Michael Cackovic, M.D., a maternal-fetal medicine physician at The Ohio State University Wexner Medical Center. “The more evidence that we have like this will lead to more public policy and provider counseling regarding the untoward effects of this virus in pregnancy,” he says.

But why can COVID-19 be so dangerous for pregnant people and what should you do if you’re pregnant or trying to conceive? Here’s what you need to know.

Why is COVID-19 so dangerous for pregnant people?

The Centers for Disease Control and Prevention (CDC) stresses that people who are pregnant or were recently pregnant are more likely to get severely ill from COVID-19 compared to people who aren’t pregnant. Certain risk factors make it even more likely that someone who is pregnant will get severely ill from COVID, the CDC says, including:

  • Having certain underlying medical condition like asthma or diabetes
  • Being older than 25 years
  • Living or working in a community with high numbers of COVID-19 cases
  • Living or working in a community with low levels of COVID-19 vaccination
  • Working in places where it is difficult or not possible to avoid contact with people who might be sick with COVID-19
  • Being part of some racial and ethnic minority groups, who have been put at increased risk of getting sick due to health inequities

But…why? Researchers are still studying this, but there are some theories. “It’s probably due to multiple factors,” Dr. Schaffner says. One is that the diaphragm, a large, dome-shaped muscle that contracts during breathing, is pushed up during pregnancy, which squeezes the lower parts of the lungs and makes them more susceptible to pneumonia and complications of COVID-19, he says. Another is that pregnancy requires changes in your immune system in order to protect the fetus while still fighting against viruses and bacteria. “That also raises the risk that things would be more serious if they should get a COVID infection,” Dr. Schaffner says.

“We also often see under-treatment of pregnant people, because maybe the pregnant person or their physician feels nervous about treatments,” says Emily R. Smith, M.P.H., an epidemiologist at the George Washington University Milken Institute School of Public Health, and lead author of the new BMJ study.

In pregnancy, “both the cardiovascular and respiratory systems are stressed already,” says women’s health expert Jennifer Wider, M.D. “As a result, pregnant bodies are more vulnerable to severe infection by viruses like COVID,” she says. Pregnant people are also at a higher risk of severe complications from the flu, Dr. Schaffner points out.

How to stay safe if you’re trying to conceive

This is the perfect time to make sure you’re up to date on your COVID-19 vaccines, Smith says. The American College of Obstetricians and Gynecologists (ACOG) and CDC both recommend that people who are pregnant or trying to become pregnant get up to date on COVID-19 vaccines and boosters. “We see the benefits of vaccines and the harms of COVID—this is something that people should do,” Smith says.

“I would also recommend vaccination against influenza,” Dr. Schaffner says. It’s also a good idea to check in with your doctor. “Definitely speak with your healthcare provider to put a plan in place,” Dr. Wider says.

How to stay safe if you’re already pregnant

If you haven’t gotten your COVID-19 vaccines or aren’t fully up to date, it’s a good idea to get them, Dr. Schaffner says. (Again, ACOG and the CDC recommend that pregnant people get the vaccine and booster shots, if they haven’t already.)

“It has now been well demonstrated that it’s safe to be vaccinated during pregnancy,” Dr. Schaffner says. Data has also shown that getting the COVID-19 vaccine during pregnancy is not linked with increased risk for preterm birth, stillbirth, small-for-gestational age, low Apgar score, or admission into the NICU.

Dr. Schaffner also recommends wearing a mask in public indoor spaces—something the CDC encourages pregnant people to do right now as well. “If you are pregnant and out and about, absolutely put that mask back on,” Dr. Schaffner says. “That will give you an additional layer of protection against COVID and influenza.”

It’s also a good idea to try to avoid people who are sick, when you can, Smith says. “Taking some extra precautions during this time is a good idea,” Smith says.

Korin Miller is a freelance writer specializing in general wellness, sexual health and relationships, and lifestyle trends, with work appearing in Men’s Health, Women’s Health, Self, Glamour, and more. She has a master’s degree from American University, lives by the beach, and hopes to own a teacup pig and taco truck one day.

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