Credit CDC
#15,532
Historically, pregnant women and their unborn offspring are among the hardest hit during influenza pandemics (see 2009's Pregnancy & Flu: A Bad Combination), and even seasonal flu in known to hit pregnant women harder than non-pregnant women.
From the CDC's Flu Vaccine FAQ:
Flu vaccination helps protect women during and after pregnancy.
- Vaccination reduces the risk of flu-associated acute respiratory infection in pregnant women by about one-half.
- A 2018 study that included influenza seasons from 2010-2016 showed that getting a flu shot reduced a pregnant woman’s risk of being hospitalized with flu by an average of 40 percent.
- A number of studies have shown that in addition to helping to protect pregnant women, a flu vaccine given during pregnancy helps protect the baby from flu for several months after birth, when he or she is not old enough to be vaccinated.
Since the emergence of COVID-19 there have been similar concerns over SARS-CoV-2 infection in pregnant women as well, and while the evidence has been limited, some early studies/reports include:
NFID: The Dangers of Influenza & COVID-19 In Adults With Chronic Health Conditions
MMWR: Two New Reports On Pregnancy & COVID-19
PAHO Epi Alert: COVID-19 During Pregnancy - 13 August 2020
Pregnancy & COVID-19: Still More Questions Than Answers
The CDC maintains a Data on COVID-19 during Pregnancy website, but cautions that:
Because only about a third 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.
While new data continues to emerge, today we've two recent 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.
The first report, based on an analysis of nearly 400,000 symptomatic COVID-19 cases among women of reproductive age found that `. . . pregnant women were significantly more likely than were nonpregnant women to be admitted to an intensive care unit . . .'.
Update: Characteristics of Symptomatic Women of Reproductive Age with Laboratory-Confirmed SARS-CoV-2 Infection by Pregnancy Status — United States, January 22–October 3, 2020
Early Release / November 2, 2020 / 69
Laura D. Zambrano, PhD1,*; Sascha Ellington, PhD1,*; Penelope Strid, MPH1; Romeo R. Galang, MD1; Titilope Oduyebo, MD1; Van T. Tong, MPH1; Kate R. Woodworth, MD1; John F. Nahabedian III, MS1; Eduardo Azziz-Baumgartner, MD1; Suzanne M. Gilboa, PhD1; Dana Meaney-Delman, MD1; CDC COVID-19 Response Pregnancy and Infant Linked Outcomes Team (View author affiliations)
Summary
What is already known about this topic?
Limited information suggests that pregnant women with COVID-19 might be at increased risk for severe illness compared with nonpregnant women.
What is added by this report?
In an analysis of approximately 400,000 women aged 15–44 years with symptomatic COVID-19, intensive care unit admission, invasive ventilation, extracorporeal membrane oxygenation, and death were more likely in pregnant women than in nonpregnant women.
What are the implications for public health practice?
Pregnant women should be counseled about the risk for severe COVID-19–associated illness including death; measures to prevent infection with SARS-CoV-2 should be emphasized for pregnant women and their families. These findings can inform clinical practice, risk communication, and medical countermeasure allocation.
Studies suggest that pregnant women might be at increased risk for severe illness associated with coronavirus disease 2019 (COVID-19) (1,2). This report provides updated information about symptomatic women of reproductive age (15–44 years) with laboratory-confirmed infection with SARS-CoV-2, the virus that causes COVID-19.
During January 22–October 3, CDC received reports through national COVID-19 case surveillance or through the National Notifiable Diseases Surveillance System (NNDSS) of 1,300,938 women aged 15–44 years with laboratory results indicative of acute infection with SARS-CoV-2. Data on pregnancy status were available for 461,825 (35.5%) women with laboratory-confirmed infection, 409,462 (88.7%) of whom were symptomatic. Among symptomatic women, 23,434 (5.7%) were reported to be pregnant.
After adjusting for age, race/ethnicity, and underlying medical conditions, pregnant women were significantly more likely than were nonpregnant women to be admitted to an intensive care unit (ICU) (10.5 versus 3.9 per 1,000 cases; adjusted risk ratio [aRR] = 3.0; 95% confidence interval [CI] = 2.6–3.4), receive invasive ventilation (2.9 versus 1.1 per 1,000 cases; aRR = 2.9; 95% CI = 2.2–3.8), receive extracorporeal membrane oxygenation (ECMO) (0.7 versus 0.3 per 1,000 cases; aRR = 2.4; 95% CI = 1.5–4.0), and die (1.5 versus 1.2 per 1,000 cases; aRR = 1.7; 95% CI = 1.2–2.4).
Stratifying these analyses by age and race/ethnicity highlighted disparities in risk by subgroup. Although the absolute risks for severe outcomes for women were low, pregnant women were at increased risk for severe COVID-19–associated illness. To reduce the risk for severe illness and death from COVID-19, pregnant women should be counseled about the importance of seeking prompt medical care if they have symptoms and measures to prevent SARS-CoV-2 infection should be strongly emphasized for pregnant women and their families during all medical encounters, including prenatal care visits. Understanding COVID-19–associated risks among pregnant women is important for prevention counseling and clinical care and treatment.
The second report looks at birth outcomes, and while the data available remains extremely limited, there are early indications of increased pre-term births linked to COVID-19. Other potential adverse effects, such as developmental issues, may take years to unravel.
Early Release / November 2, 2020 / 69
Kate R. Woodworth, MD1; Emily O’Malley Olsen, PhD1; Varsha Neelam, MPH1; Elizabeth L. Lewis, MPH1; Romeo R. Galang, MD1; Titilope Oduyebo, MD1; Kathryn Aveni, MPH2; Mahsa M. Yazdy, PhD3; Elizabeth Harvey, PhD4; Nicole D. Longcore, MPH5; Jerusha Barton, MPH6; Chris Fussman, MS7; Samantha Siebman, MPH8; Mamie Lush, MA9; Paul H. Patrick, MPH10; Umme-Aiman Halai, MD11; Miguel Valencia-Prado, MD12; Lauren Orkis, DrPH13; Similoluwa Sowunmi, MPH14; Levi Schlosser, MPH15; Salma Khuwaja, MD16; Jennifer S. Read, MD17; Aron J. Hall, DVM1; Dana Meaney-Delman, MD1; Sascha R. Ellington, PhD1; Suzanne M. Gilboa, PhD1; Van T. Tong, MPH1; CDC COVID-19 Response Pregnancy and Infant Linked Outcomes Team (View author affiliations)
View suggested citation
Summary
What is already known about this topic?
Pregnant women with SARS-CoV-2 infection are at increased risk for severe illness compared with nonpregnant women. Adverse pregnancy outcomes such as preterm birth and pregnancy loss have been reported.
What is added by this report?
Among 3,912 infants with known gestational age born to women with SARS-CoV-2 infection, 12.9% were preterm (<37 weeks), higher than a national estimate of 10.2%. Among 610 (21.3%) infants with testing results, 2.6% had positive SARS-CoV-2 results, primarily those born to women with infection at delivery.
What are the implications for public health practice?
These findings can inform clinical practice, public health practice, and policy. It is important that providers counsel pregnant women on measures to prevent SARS-CoV-2 infection.
Pregnant women with coronavirus disease 2019 (COVID-19) are at increased risk for severe illness and might be at risk for preterm birth (1–3). The full impact of infection with SARS-CoV-2, the virus that causes COVID-19, in pregnancy is unknown.
Public health jurisdictions report information, including pregnancy status, on confirmed and probable COVID-19 cases to CDC through the National Notifiable Diseases Surveillance System.* Through the Surveillance for Emerging Threats to Mothers and Babies Network (SET-NET), 16 jurisdictions collected supplementary information on pregnancy and infant outcomes among 5,252 women with laboratory-confirmed SARS-CoV-2 infection reported during March 29–October 14, 2020.
Among 3,912 live births with known gestational age, 12.9% were preterm (<37 weeks), higher than the reported 10.2% among the general U.S. population in 2019 (4). Among 610 infants (21.3%) with reported SARS-CoV-2 test results, perinatal infection was infrequent (2.6%) and occurred primarily among infants whose mother had SARS-CoV-2 infection identified within 1 week of delivery.
Because the majority of pregnant women with COVID-19 reported thus far experienced infection in the third trimester, ongoing surveillance is needed to assess effects of infections in early pregnancy, as well the longer-term outcomes of exposed infants.
These findings can inform neonatal testing recommendations, clinical practice, and public health action and can be used by health care providers to counsel pregnant women on the risks of SARS-CoV-2 infection, including preterm births. Pregnant women and their household members should follow recommended infection prevention measures, including wearing a mask, social distancing, and frequent handwashing when going out or interacting with others or if there is a person within the household who has had exposure to COVID-19.†
