Review suggests the COVID-19 paradox during pregnancy

Pregnant patients with COVID-19 are more likely to require intensive care but are less likely to present with symptoms, according to a “living systematic review.”

Pregnant women with COVID-19 are 60% more likely to require admission to the intensive care unit (OR 1.62, 95% CI 1.33-1.96) and invasive compared to non-pregnant women The risk of ventilation was almost doubled (OR 1.88, 95% CI 1.36-2.60), according to John Allotey, PhD, and colleagues at the University of Birmingham, UK.

Pregnant COVID-19 patients were also less likely to report symptoms of fever (OR 0.43, 95% CI 0.22-0.85) and myalgia (OR 0.48, 95% CI 0.45-0.51), the researchers said. Is writing BMJ..

Pregnant patients with confirmed COVID-19 were also at high risk of preterm birth, and babies born to these mothers were more likely to be admitted to the neonatal intensive care unit.

“Health care professionals should know that pregnant and recently pregnant women with COVID-19 may have fewer symptoms than the general population,” Allotey and colleagues said, with existing conditions, obesity, or old age. Added that mothers of age are at greatest risk.

“Clinicians balance the need for regular multidisciplinary prenatal care to manage women with existing comorbidities to unnecessary exposure to the virus, preferably through virtual appointments. Will need to be taken,” the authors added.

Kjersti Aagaard, MD, PhD, a maternal fetal medicine expert and professor at Baylor College of Medicine in Houston, asked her for her views and a live systematic review (meaning to be updated on a regular basis) to conduct clinical trials. Decisions regarding the care of this at-risk population based on current evidence that

However, Argard, who was not involved in the study, proposed a cautious interpretation of the findings, which presume the risk, especially that pregnant women are less likely to be symptomatic.

“The reason that the data looks like that is because one of the early surveillance cohorts most of us were engaged in was pregnant women,” Aagaard said. MedPage today..

“The statement that pregnant women are more likely to appear asymptomatic than non-pregnant women is mainly a by-product, as most hospitals conducted extensive surveillance tests at admission of labor. May be a by-product of,” she said.

Aagaard also cautioned when interpreting mortality data.

Pregnant women have been identified as at-risk for COVID-19, she noted, with past respiratory virus outbreaks enduring worse outcomes than the general population.

The Allotey group investigated existing literature, which will be updated monthly. In the first iteration, from December 2019 to June 2020, we searched for publications on the Medline, Embase, Cochrane database, World Health Organization, China National Knowledge Base, Wanfang database, and preprint servers and blogs. Studies with duplicate data were excluded.

After identifying over 20,000 candidate studies, the Allotey group selected 77 for final analysis. Of the studies included, 34% were from the United States and 31% were from China.

Overall, about 10% of pregnant or recently pregnant women hospitalized were diagnosed with COVID-19. Among the symptomatic cases, the most common symptoms were fever (40%) and cough (39%).

Older maternal age, higher BMI, chronic hypertension, and preexisting diabetes were all identified as risk factors for severe COVID-19 disease.

In patients with COVID-19, spontaneous and overall preterm birth rates were 6% and 17%, respectively. About a quarter of all newborns born to COVID-19 mothers were admitted to the neonatal intensive care unit.

Of the over 11,000 pregnant women with COVID-19 in 26 studies, 73 died.

Allotey and colleagues have recognized some limitations of their research. First, the study included in this review identified women with COVID-19 using a variety of testing methods and reported on women who were suspected of having been infected and were confirmed, and who primarily required an outpatient visit. Did. Furthermore, the effects of treatment on COVID-19 disease were indistinguishable, as the criteria for cesarean section, admission to the neonatal unit, and cause of preterm birth were not recorded.

Aagaard stressed the importance of a comprehensive assessment of COVID-19 pregnant women’s data, given the increased risk. But for SARS-CoV-2 infections and COVID-19, she added, she needs to call for more pregnant women to enroll in clinical trials.

“They’re disproportionately affected and they’re undervalued,” Argard said. “We have to change that. It’s uncomfortable for women who vow to take care of us.”