COVID-19 has been a prevalent and disruptive part of life for over two years. It has taken millions of lives to date and has had unprecedented political and socioeconomic consequences. One of the many questions that have arisen during the pandemic is the effects of COVID-19 on pregnancy, and which maternal and neonatal complications might be anticipated in a COVID-19 positive pregnant patient.
Possible effects of COVID-19 on pregnancy were thought to include preterm labor, hypertensive disorders of pregnancy, perinatal death, fetal growth restriction, placental abnormalities and neurodevelopmental anomalies2. A 2022 article from the UK examined the pregnancy complications of COVID-19 in a multi-ethnic cohort in England when compared with matched controls3. They found a significant increase in preterm births among pregnant patients who were COVID-19 positive and symptomatic, and that this increase was accompanied by increased emergency Caesarean sections and operative preterm births3. This suggests that preterm deliveries in this situation may not have been directly attributed to the virus itself, but rather a lowered threshold for the obstetrician to intervene in a patient who is COVID positive3. However, other outcomes such as incidence of pre-eclampsia and fetal growth restriction were no different between the COVID positive and control groups3. The article interprets these results to mean that COVID-19 likely has no impact on placental development or adverse perinatal outcomes3. Furthermore, it seems as though newborns born by COVID-positive mothers fare similarly to their COVID-negative counterparts, with no differences in neonatal ICU admission rates, lengths of stay, or neonatal acid-base status3. In terms of maternal outcomes, there was also no difference in incidence of postpartum hemorrhage, length of stay or estimated blood loss3.
While these data are reassuring, there is a concern that COVID-19 can cause more delayed adverse outcomes for the children down the road. A 2022 JAMA article looked at the effects of COVID-19 exposure in utero on neonatal neurodevelopment, specifically looking at incidence of neurodevelopmental disorders in the first year of life1. They compared a cohort of 222 neonates born to COVID-19 positive mothers with a cohort of neonates born to 7550 COVID-19 negative mothers1. They found that there was an increased incidence of neurodevelopmental disorders in babies exposed to COVID-19 in utero, and that while there was also an increase in preterm births, that did not fully explain this association1. This paper does not establish a definitive relationship between COVID-19 and poorer neurodevelopmental outcomes, however, because there is no longitudinal data – all the children exposed to the virus are two years old or younger1. There is also the question about whether these delays and disorders are due to the virus, and not the result of being born during with the stressors and social isolation of a pandemic1.
COVID-19 is, and has always been, a developing situation, and continues to raise many clinical questions as time goes on and variants develop. Larger and more longitudinal studies are required to understand the full extent of the consequences of this virus on maternal, neonatal and pediatric outcomes.
References
- Edlow AG, Castro VM, Shook LL, Kaimal AJ, Perlis RH. Neurodevelopmental Outcomes at 1 Year in Infants of Mothers Who Tested Positive for SARS-CoV-2 During Pregnancy. JAMA Netw Open. 2022;5(6):e2215787. https://doi.org/10.1001/jamanetworkopen.2022.15787
- Vergara-Merino, L., Meza, N., Couve-Pérez, C., Carrasco, C., Ortiz-Muñoz, L., Madrid, E., Bohorquez-Blanco, S. and Pérez-Bracchiglione, J. (2021), Maternal and perinatal outcomes related to COVID-19 and pregnancy: An overview of systematic reviews. Acta Obstet Gynecol Scand, 100: 1200-1218. https://doi.org/10.1111/aogs.14118
- Wilkinson, M., Johnstone, E.D., Simcox, L.E. et al. The impact of COVID-19 on pregnancy outcomes in a diverse cohort in England. Sci Rep 12, 942 (2022). https://doi.org/10.1038/s41598-022-04898-5
