There is no evidence that pregnancy increases the risk of COVID-19 morbidity or severity

Pregnancy is generally considered to be an important risk factor for the outcome of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and more severe coronavirus disease (COVID-19), but it is multinational In a recent study by a team of researchers, symptoms were generally comparable between female pregnant and nonpregnant cohorts, except for gastrointestinal symptoms. This paper is currently medRxiv* Preprint server.

As soon as the COVID-19 pandemic began, pregnant women were assessed for morbidity and mortality based on the theoretical risk of relative immunosuppression during pregnancy and previous studies of small coronavirus outbreaks. Immediately considered a vulnerable group to the increase.

But more solid conclusions needed more robust data. Since its introduction, smartphones and web-based applications for population-based syndrome monitoring have become citizen science tools that greatly facilitate the rapid acquisition of extensive epidemiological data as this pandemic evolves.

As a result, researchers from the UK, US and Sweden (led by Dr. Erika Molteni King’s College London) Using these data to test the hypothesis of whether pregnant women in the community differ in COVID-19 symptom profile and disease severity compared to non-pregnant women. Did.

A bright example of participatory epidemiology

This study used a participatory epidemiological approach, leveraging two remote cohorts that allowed for rapid assessment of COVID-19 during pregnancy. Specifically, the Discovery Cohort was collected from 400,750 women in the United Kingdom, Sweden, and the United States, and self-reported symptoms and events on their smartphones. It was positive in 79 pregnant women.

The replicated cohort, meanwhile, was drawn from 1,344,966 women in the United States and comprised a cross-sectional, self-reported sample of active user bases on social media. In this cohort, 162 pregnant women tested positive for SARS-CoV-2.

In short, the long-term nature of the discovery dataset provides a door for comparing the duration of illness, the time from onset to peak symptoms, as well as the specificity of hospitalization between pregnant and non-pregnant women. Open.

The purpose of this study was to compare the frequency of symptoms and events. These include self-reported SARS-CoV-2 tests and the difference between pregnant and non-pregnant women who are hospitalized after recovery in the community. Multivariate regression was used to investigate disease severity and the impact of comorbidities.

Trajectories of similar diseases

This study reported more frequent tests for the presence of SARS-CoV-2, although pregnant women generally did not experience a more severe course of disease. In other words, the disease trajectories of these two groups were similar, but the time from disease onset to peak symptom was slightly longer in pregnant than in non-pregnant women (ie, 2.8 days). And 2.2 days).

Conversely, gastrointestinal symptoms were significantly different between pregnant and nonpregnant women with a poor prognosis, with reduced skipped meals in the discovery cohort and increased nausea/vomiting in the replication cohort.

“Preexisting lung disease was most closely associated with the severity of symptoms in hospitalized pregnant women,” the study authors say. “Heart and kidney disease and diabetes were additional factors in the increased risk,” the study authors said.

In addition, certain cardiopulmonary symptoms such as chest pain, dyspnea, and persistent cough are more frequently observed in hospitalized pregnant women, leading to the conclusion that cardiopulmonary symptoms are an important discriminant for hospitalization.

Comparison of presentation of symptoms in the Discovery (DC) and Replication (RC) cohorts. Results are positive and suspected positive for SARS-CoV-2 and require hospitalization (DC, dark shade) or seen in hospital (RC, light shade) non-pregnant (orange) and pregnant (blue) ) About women. Results are reported as the age-standardized proportion of women reporting each symptom in each subcohort.

Clinical and research implications

Pregnancy is widely regarded as a risk factor for SARS-CoV-2 infection and more severe outcomes, and, despite being undoubtedly associated with a higher propensity for testing, was associated with symptom profiles in these community-based cohorts. Severity-pregnant women-excluding gastrointestinal symptoms

However, pregnant women with significant cardiopulmonary symptoms and pre-existing lung disease may actually need special attention during the COVID-19 outbreak. In summary, lung disease had the strongest impact on disease severity during pregnancy.

“Clinicians need to be more vigilant for pregnant women with pre-existing health conditions, prominent respiratory symptoms, or higher Severity Index-as in the general population,” a cautionary study on this. Author of medRxiv Investigation.

In any case, further studies specifically targeting high-risk pregnancy and outcomes over the third trimester are needed to improve the definition of outcomes in this population. Similarly, severity indicators and hospitalization rates need to be interpreted in light of policy changes that may vary by situation and country.

*Important Notices

medRxiv It publishes preliminary, non-peer reviewed scientific reports and should not be considered conclusive and should not guide clinical practice/health-related behavior or be treated as established information.