COVID-19 and maternal health: is the virus a threat?

Laura Moro, experienced biomedical researcher and science writer, discusses the effect of COVID-19 on pregnancy and maternal health. 

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), continues to escalate worldwide, with Europe and the USA now the epicentres of the pandemic. As of April 15, there are almost two million declared cases and over 123,000 deaths globally, with many countries undergoing community transmission (1). Although a majority of infections with SARS-CoV-2 are mild, the elderly and people with comorbidities−including cardiovascular and respiratory diseases, hypertension, diabetes, and cancer− are at increased risk of severe disease and death (2,3). 

Pregnant women are particularly vulnerable to several infectious diseases that can cause both maternal and fetal adverse outcomes (4–6). Immunological and physiological adaptations occurring during gestation are behind this increased risk (7). During previous outbreaks caused by SARS-CoV and Middle East Respiratory Syndrome CoV (MERS-CoV), several pregnant women acquired the infection. SARS-CoV −a ‘cousin’ of SARS-CoV-2− was associated with severe maternal illness, maternal death, spontaneous abortion, severe intrauterine growth restriction, preterm delivery, and life-threatening gastrointestinal complications in the newborn (8). Among the few known cases of MERS-CoV-infected pregnant women, several maternal and neonatal deaths and stillbirths were reported (9).

The scientific and medical communities are putting an immense effort into sharing information about COVID-19. There are currently more than 20 published case reports and case series presenting pregnant women infected with SARS-CoV-2 and a few case-control studies, a majority of them from China. Pregnant women appear to show a similar disease presentation than their non-pregnant counterparts, being fever and coughing the most frequent symptoms (10). There is no evidence for vertical transmission of the virus from infected mothers to the fetus (11), although a few neonates tested positive a few hours after birth (12,13). Several maternal and fetal adverse outcomes have been reported, including preterm delivery, fetal distress, low birth weight, and respiratory symptoms in the newborn, among others (10,14). Preterm delivery, the leading cause of death in children under five, appears as the most common adverse pregnancy outcome caused by coronaviruses (15). Thus, future mothers should be considered in prevention and treatment strategies against COVID-19, ensuring the safety of drugs and vaccines during pregnancy.

Pregnant women and neonates in low-resource settings, as well as refugees and those in conflict zones, constitute one of the most vulnerable populations, and concerted efforts are urgently needed to ensure their health and wellbeing. Health service delivery−including, for example, malaria chemoprevention for pregnant women−should be guaranteed during the pandemic, avoiding the disruptive effect of previous disease outbreaks (16). 

The WHO, as well as other international organizations and national health authorities, have issued interim recommendations for the care and management of SARS-CoV-2-infected pregnant women (17). These recommendations advise against unnecessary caesarean deliveries and encourage breastfeeding if possible. Although we still have little data on the impact of COVID-19 on pregnant women and neonates, systematic screening and careful follow-up of any suspected SARS-CoV-2 infection during pregnancy is crucial to ensure maternal health.

About the author

Laura Moro, PhD, is a researcher and science & health writer. She is particularly interested in infectious diseases, global and planetary health. She conducted research for several years on infectious diseases affecting pregnant women in Sub-Saharan Africa. HIRE LAURA

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References

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16. World Health Organization. WHO urges countries to ensure the continuity of malaria services in the context of the COVID-19 pandemic [Internet]. [cited 2020 Apr 2]. Available from: https://www.who.int/news-room/detail/25-03-2020-who-urges-countries-to-ensure-the-continuity-of-malaria-services-in-the-context-of-the-covid-19-pandemic
17. World Health Organization. Clinical management of severe acute respiratory infection when COVID-19 is suspected. Interim guidance. 2020.