Thursday, September 17, 2020

MMWR: Two New Reports On Pregnancy & COVID-19









#15,459

Twice over the last six weeks we've looked at the thorny issue of COVID-19's impact on pregnancies, starting with a look back at the impacts from past influenza pandemics and a review of several recent studies (see Pregnancy & COVID-19: Still More Questions Than Answers), followed up 10 days later with a PAHO Epi Alert: COVID-19 During Pregnancy - 13 August 2020.

The CDC maintains a Data on COVID-19 during Pregnancy website, but cautions that:
Because only about a quarter of case report forms include information on pregnancy status, these numbers likely do not include all pregnant women with COVID-19 in the United States and must be interpreted with caution. The completeness of this variable continues to improve each week.


Hispanic and non-Hispanic black pregnant women appear to be disproportionately affected by SARS-CoV-2 infection during pregnancy. 


While the data remains incomplete, we've two new early releases from the CDC's MMWR that attempt to better quantify the impact and risks from COVID-19 in pregnancy.  Both reports are detailed and lengthy, and so I've only reproduced the links and summaries below.

Early Release / September 16, 2020 / 69

Lakshmi Panagiotakopoulos, MD1; Tanya R. Myers, PhD1; Julianne Gee, MPH1; Heather S. Lipkind, MD2; Elyse O. Kharbanda, MD3; Denison S. Ryan, MPH4; Joshua T.B. Williams, MD5,6; Allison L. Naleway, PhD7; Nicola P. Klein, MD, PhD8; Simon J. Hambidge, MD, PhD5,6; Steven J. Jacobsen, MD, PhD4; Jason M. Glanz, PhD9; Lisa A. Jackson, MD10; Tom T. Shimabukuro, MD1; Eric S. Weintraub, MPH1 (View author affiliations)View suggested citation
Summary

What is already known about this topic?

Pregnant women might be at increased risk for severe illness from SARS-CoV-2 infection.

What is added by this report?

Prevalences of prepregnancy obesity and gestational diabetes were higher among pregnant women hospitalized for COVID-19–related illness (e.g., worsening respiratory status) than among those admitted for pregnancy-related treatment or procedures (e.g., delivery) and found to have COVID-19. Intensive care was required for 30% (13 of 43) of pregnant women admitted for COVID-19, and one pregnant woman died from COVID-19.
What are the implications for public health practice?

Antenatal counseling emphasizing preventive measures, including use of masks, frequent hand washing, and social distancing, might help prevent COVID-19 among pregnant women, especially those with prepregnancy obesity and gestational diabetes.

Early Release / September 16, 2020 / 69
Miranda J. Delahoy, PhD1,2; Michael Whitaker, MPH1,3; Alissa O’Halloran, MSPH1; Shua J. Chai, MD1,4; Pam Daily Kirley, MPH4; Nisha Alden, MPH5; Breanna Kawasaki, MPH5; James Meek, MPH6; Kimberly Yousey-Hindes, MPH6; Evan J. Anderson, MD7,8; Kyle P. Openo, DrPH7,8,9; Maya L. Monroe, MPH10; Patricia A. Ryan, MS10; Kimberly Fox, MPH11; Sue Kim, MPH11; Ruth Lynfield, MD12; Samantha Siebman, MPH12; Sarah Shrum Davis, MPH13; Daniel M. Sosin, MD14; Grant Barney, MPH15; Alison Muse, MPH15; Nancy M. Bennett, MD16; Christina B. Felsen, MPH16; Laurie M. Billing, MPH17; Jessica Shiltz, MPH17; Melissa Sutton, MD18; Nicole West, MPH18; William Schaffner, MD19; H. Keipp Talbot, MD19; Andrea George, MPH20; Melanie Spencer, MPH20; Sascha Ellington, PhD1; Romeo R. Galang, MD1; Suzanne M. Gilboa, PhD1; Van T. Tong, MPH1; Alexandra Piasecki, MPH1,21; Lynnette Brammer, MPH1; Alicia M. Fry, MD1; Aron J. Hall, DVM1; Jonathan M. Wortham, MD1; Lindsay Kim, MD1; Shikha Garg, MD1; COVID-NET Surveillance Team (View author affiliations)
Summary
What is already known about this topic?

Information on the clinical characteristics and birth outcomes of hospitalized U.S. pregnant women with COVID-19 is limited.

What is added by this report?

Among 598 hospitalized pregnant women with COVID-19, 55% were asymptomatic at admission. Severe illness occurred among symptomatic pregnant women, including intensive care unit admissions (16%), mechanical ventilation (8%), and death (1%). Pregnancy losses occurred for 2% of pregnancies completed during COVID-19-associated hospitalizations and were experienced by both symptomatic and asymptomatic women.

What are the implications for public health practice?

Pregnant women and health care providers should be aware of potential risks for severe COVID-19, including adverse pregnancy outcomes. Identifying COVID-19 during birth hospitalizations is important to guide preventive measures to protect pregnant women, parents, newborns, other patients, and hospital personnel.


The CDC's `living document' Evidence used to update the list of underlying medical conditions that increase a person’s risk of severe illness from COVID-19, continues to list pregnancy as a 2nd tier (mixed evidence) risk group for severe illness due to COVID-19.  But their guidance for People with Certain Medical Conditions advises:
Pregnancy

Based on what we know at this time, pregnant people might be at an increased risk for severe illness from COVID-19 compared to non-pregnant people. Additionally, there may be an increased risk of adverse pregnancy outcomes, such as preterm birth, among pregnant people with COVID-19.

Actions to take
  • Do not skip your prenatal care appointments.
  • Make sure that you have at least a 30-day supply of your medicines.
  • Talk to your healthcare provider about how to stay healthy and take care of yourself during the COVID-19 pandemic.
  • If you don’t have a healthcare provider, contact your nearest community health centerexternal icon or health department.
  • Call your healthcare provider if you have any questions related to your health.
  • Seek care immediately if you have a medical emergency.
  • You may feel increased stress during this pandemic. Fear and anxiety can be overwhelming and cause strong emotions. Learn about stress and coping.

A decade after the last influenza pandemic (2009), our understanding of long-term impacts of maternal influenza infection on the unborn child remains limited (see Study: Outcomes Of Infants Born To Women With Influenza A(H1N1)pdm09), and it will likely take years to fully assess and appreciate the impact of COVID-19.

Practically every day we learn about more non-trivial complications from SARS-CoV-2 infection (see PAHO Epi Alert: Complications & Sequelae Of COVID-19), and that until we know a lot more, avoiding infection if you can - particularly if you are in a high risk group - just makes sense.

For now, you'll find the latest pregnancy-related guidance from the CDC below.

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