Pregnant women with COVID-19 more likely to need intensive care, study finds

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Pregnant women seen in hospitals with the novel coronavirus (COVID-19) are less likely to show symptoms, and seemed to be at increased risk of needing admission to an intensive care unit than non-pregnant women of similar age, according to a new study published in The BMJ.

Additionally, pregnant patients were more likely to experience preterm birth and their newborns are more likely to be admitted to a neonatal unit. Being older, overweight, and having pre-existing medical conditions such as hypertension and diabetes also seemed to increase the risk of having severe COVID-19, the study found.

Pregnant women are thought to be a high-risk group for COVID-19 infection, and there are concerns about potential adverse effects of the virus on both mother and baby.

For the study, researchers began a living systematic review to compare the clinical features, risk factors, and outcomes of COVID-19 in pregnant and recently pregnant women with non-pregnant women of similar age. Living systematic reviews are useful in fast moving research areas such as COVID-19 because they can be updated regularly as new information becomes available, the researchers said.

The findings are based on 77 studies reporting rates, clinical features such as symptoms, laboratory, and x-ray findings, risk factors, and outcomes for 11,432 pregnant and recently pregnant women admitted to hospital and diagnosed as having suspected or confirmed COVID-19.

Compared with non-pregnant women of reproductive age, the researchers found that pregnant and recently pregnant women with COVID-19 were less likely to report symptoms of fever and muscle pain, but were more likely to need admission to an intensive care unit and need ventilation.

Maternal risk factors associated with severe COVID-19 were increasing age, high body mass index, chronic high blood pressure, and pre-existing diabetes. The odds of giving birth prematurely was also higher in pregnant and recently pregnant women with COVID-19 compared to those without the disease.

A quarter of all babies born to mothers with COVID-19 were admitted to a neonatal unit and were at increased risk of admission than those born to mothers without the disease, according to the study. However, stillbirth and newborn death rates were low.

The researchers said some study limitations may have affected their results, including differences in study size, design, and definitions of symptoms, tests, and outcomes. However, strengths include the large sample size and robust search methods to minimize the risk of missing studies and duplicate data.

As such, the researchers said in an official statement that healthcare professionals should be aware that pregnant women with COVID-19 might need access to intensive care and specialist baby care facilities.

Editor's note: Click here for more information and ongoing COVID-19 updates for integrative healthcare professionals.