#15,416
For the second day in a row (see yesterday's PAHO Epi Alert: Complications & Sequelae Of COVID-19), we have an Epidemiological Alert from PAHO (Pan American Health Organization) - this time on the risks of COVID-19 during pregnancy.
Ten days ago in Pregnancy & COVID-19: Still More Questions Than Answers, we looked at the long and tragic history of pandemics and pregnancy, along with several recent COVID studies, including a CDC MMWR from last June entitled:
Characteristics of Women of Reproductive Age with Laboratory-Confirmed SARS-CoV-2 Infection by Pregnancy Status — United States, January 22–June 7, 2020
Weekly / June 26, 2020 / 69(25);769–775
Sascha Ellington, PhD1; Penelope Strid, MPH1; Van T. Tong, MPH1; Kate Woodworth, MD1; Romeo R. Galang, MD1; Laura D. Zambrano, PhD1; John Nahabedian, MS1; Kayla Anderson, PhD1; Suzanne M. Gilboa, PhD1 (View author affiliations)View suggested citation
Summary
What is already known about this topic?
Limited information is available about SARS-CoV-2 infection in U.S. pregnant women.
What is added by this report?
Hispanic and non-Hispanic black pregnant women appear to be disproportionately affected by SARS-CoV-2 infection during pregnancy. Among reproductive-age women with SARS-CoV-2 infection, pregnancy was associated with hospitalization and increased risk for intensive care unit admission, and receipt of mechanical ventilation, but not with death.
What are the implications for public health practice?
Pregnant women might be at increased risk for severe COVID-19 illness. To reduce severe COVID-19–associated illness, pregnant women should be aware of their potential risk for severe COVID-19 illness. Prevention of COVID-19 should be emphasized for pregnant women and potential barriers to adherence to these measures need to be addressed.
The finding that Hispanic and non-Hispanic black pregnant women appear to be disproportionately affected by SARS-CoV-2 infection would suggest the impact of COVID-19 on pregnant women may be higher in some regions than in others.
Which brings us to an 8-page PAHO (Pan American Health Organization) Epidemiological Alert: COVID-19 During Pregnancy - 13 August 2020 released on August 14th. Due to its length, I've only reproduced the introduction.Follow This LINK to download the PDF and read it in its entirety.
Recently published results and studies based on COVID-19 surveillance data have indicated an increased risk among pregnant women of presenting with severe forms of COVID-19 and, therefore, of being hospitalized and admitted to intensive care units (ICU).
The Pan American Health Organization / World Health Organization (PAHO/WHO) requests that Member States intensify efforts to ensure access to prenatal care services, as well as to implement preventive measures to reduce morbidity and mortality associated with COVID-19 across all levels of the health system, in order to maintain the commitment to reducing maternal and perinatal mortality and the progress achieved to date.
Introduction
Countries and territories in the Region of the Americas have faced not only the inherent challenges of responding to the COVID-19 pandemic, but also the challenges of sustaining the public health achievements made thus far. These efforts are all in parallel with continuing to offer the necessary healthcare services for women of childbearing age, and particularly for pregnant women, without interruption.
The implementation of measures restricting the movement of people, and the closure of some healthcare centers, have made it difficult for pregnant women to receive the appropriate number of prenatal checks corresponding to the respective gestational age. This could potentially result in the delayed detection of issues related to the pregnancy (such as gestational diabetes or hypertension) or to the fetus directly (such as intrauterine growth restriction) and,therefore, pose a risk to both the mother and fetus.
The challenge of adopting timely corrective measures has been exacerbated by the scarcity of scientific information available regarding the effects of the SARS-CoV-2 virus on pregnancy and the fetus.
Acknowledging that the characteristics of pregnant women in the Region of the Americas may differ from that of pregnant women in Europe, some studies conducted among pregnant womenin Europe can be considered for identifying risk factors to mitigate the potential impact of COVID-19 on pregnancy and the fetus.
One such study conducted amongst a cohort of 427 pregnant women who were hospitalized with confirmed SARS-CoV-2 infection between 1 March 2020 and 14 April 2020 in the United Kingdom found that the majority of those admitted to the hospital were in the late second or third trimester of pregnancy. Overall, 233 were Black or Other ethnic minority group, 281 were overweight or obese, 175 were 35 years or older, and 145 had pre-existing comorbidities. Forty-one women admitted to the hospital required respiratory support and 5 women died.
The study indicated that 266 of the women gave birth or had a pregnancy loss; 196 gave birth at term. Twelve of 265 newborns tested positive for SARS-CoV-2 RNA, including 6 within the first 12 hours after birth. 1
In another study conducted in Spain, antibody testing for SARS-CoV-2 was conducted for 874 pregnant women consecutively attending first trimester screening trimester (between 10-16 weeks of gestation, 372 women) or delivery (502 women) between 14 April and 5 May 2020 at three university hospitals 2 in Barcelona. Seroprevalence was similar between women in the first trimester of pregnancy and women in the third trimester, suggesting a similar risk of infection; however, both the proportion of women with symptoms and the proportion of women requiring hospitalization were higher amongst those in their third trimester compared to those in the first trimester. 3
Below is a summary of the situation of pregnant women and maternal mortality in the context of COVID-19 in countries of the Region of the Americas for which information was available.
