Pregnant women who develop Covid-19 symptoms risk emergency complications and other problems with their pregnancies, according to two new studies. The disease also puts their children at risk.

The first study showed that pregnant women with symptomatic Covid-19 had a higher percentage of emergency complications when compared to those who tested positive but didn't have symptoms. This research was part of a presentation given to the Anesthesiology 2021 Annual meeting over the weekend.

Of the 100 Covid-positive mothers who delivered babies between March and September of last year at one hospital in Texas, 58% of those with symptomatic infections delivered in emergency circumstances, the study, which has yet to be peer reviewed, found. For those with an asymptomatic case, 46% did.

The mothers with symptoms were more likely have emergency complications that were a danger to the baby. More babies were born breech, there was more likely to be decreased fetal movement, and some had too little amniotic fluid.

The study also found that babies born to these symptomatic mothers were much more likely to need oxygen support and more likely to be admitted to the intensive care unit.

Plus, babies born to these symptomatic mothers were much more likely to need oxygen support and more likely to be admitted to the intensive care unit.

"COVID-19 has severe systemic effects on the body, especially symptomatic patients," said Kristine Lane, a medical student at the University of Texas Medical Branch, in Galveston, Texas, who helped lead the study. "It is possible that these effects are amplified in pregnant mothers, who have increased fetal and maternal oxygen demands."

There's also a possibility, she said, that the doctors caring for the symptomatic patients were being cautious because of the virus and proactively recommend a cesarean delivery.

Dr. Gil Mor, a reproductive immunologist who did not work on the study but reviewed the work, said it's also possible that the problems could be related to chronic inflammation caused by Covid-19.

"Inflammation is extremely dangerous for both the mother and the development of the fetus. A chronic inflammation is now a fight for the survival of the mother and the fetus, and in every fight, they pay they pay a price," said Mor, who leads a research lab at Wayne State University that studies the immune system during pregnancy and the impact of pathogens. "We need to do everything in our hands in order to prevent the chronic inflammation."

The other study was peer reviewed and was published Sunday in The Journal of Maternal-Fetal & Neonatal Medicine. This research looked at the impact Covid-19 had on women in the third trimester of their pregnancies.

Scientists looked at the records for more than 2,400 women at one hospital in Israel between March and September of last year and saw significant health differences between the women who had Covid-19 and those who did not. Of the Covid-19 positive patients, 67% were asymptomatic.

The women who had symptomatic Covid-19 had the most trouble, Dr. Elior Eliasi of the Mayanei Hayeshua Medical Center and colleagues found. They had higher rates of gestational diabetes, a lower white blood cell count, and experienced heavier bleeding during their delivery. Their babies also experienced more breathing problems.

The increased risk of problems was nearly 20% higher for women who had Covid-19 symptoms, and 14% higher for people with asymptomatic Covid-19.

Unlike the other research, this study did not find symptomatic women were significantly more likely to deliver early.
The study has limitations as it only looked at women in one hospital, so its findings may not be true for all people who are pregnant.

These new studies add to a growing body of evidence that Covid-19, particularly symptomatic Covid-19, is a real threat to people who are pregnant and provides more evidence that the risks of Covid-19 far outweigh the risks to pregnant women of getting vaccinated, said Dr. Denise Jamieson, who did not work on this study.

Only a third of people who are pregnant are fully vaccinated against Covid-19, according to the US Centers for Disease Control and Prevention.
Vaccines can protect pregnant women from getting Covid-19 and if they have a breakthrough case, a vaccinated person is much more likely to have mild symptoms, if any at all. The protection that comes from a vaccine is also passed along to the newborn.

"These studies fit into an overall emerging pattern of what we have seen with other research," said Jamieson, chair of the department of gynecology and obstetrics at the Emory University School of Medicine and a member of the American College of Obstetrics and Gynecology's Covid-19 expert group. "Covid impacts pregnancies and can cause severe illness in pregnant persons and their babies, this is clear."

Jamieson said it is important for doctors to urge their pregnant patients to get the Covid-19 vaccine as soon as possible. Initially the CDC guidance said that women could get the vaccine but it did not recommend it. That's because the initial vaccine studies did not intentionally include pregnant women, although there were woman who became pregnant during the studies. After more research, the CDC sent out an urgent plea in September that strongly recommended pregnant women get vaccinated right away.

"I know pregnant persons can be reluctant to take medications or receive vaccines during their pregnancy and they really want to do everything possible to protect their baby, and they make sacrifices in pregnancies, but I think it has to be balanced with the risks of not getting vaccinated," Jamieson said. "It's important for all persons to get vaccinated, but in particular for pregnant persons to get vaccinated in order to protect themselves and to protect their babies."