Unknowns increase worry for many of us, but unknowns for science are mysteries to be solved. In mid-summer 2020 one of the mysteries of this virus, COVID-19, is how it affects women who are pregnant. If you are a parent or family member of someone expecting a baby, then you likely have a greater concern about the effect of this virus than the gernal population. Let’s outline the key aspects currently under study with links that you can review on your own and even discuss with your doctor or nurse midwife.
Research to Understand
In April 2020, the University of Oxford launched international study to understand the effects of Covid-19 on the mother and the fetus. INTERCOVID is collaborating with 60 institutions in 29 countries and continues to invite more participant organizations. The need for large number of women in various stages of pregnancy, during labor and birth, and assessments of their newborns, will accelerate the knowledge base of how to best manage pregnancy with this virus. High-quality evidence will guide clinical care as well shed light on how pregnancy could affect vaccination when it is available.
The University of California at San Francisco is also conducting a study called ASPIRE. They are enrolling women who are between 4-10 weeks of pregnancy. The focus of this research is the first trimester where all the critical aspects of fetal development are established.
Both of these research efforts are designed to learn as much as possible, quickly. There is a dearth of quality evidence related to how this virus effects the mother or the fetus. What does exist at this point are smaller studies reporting events that have happened – retrospective case reports. These do inform us, but they are not designed to inform protocols of care or treatment.
One such report is from the CDC in late June, MMWR, a weekly publication, points to the limited information on the virus during pregnancy. There are suggestions from states data submitted to CDC that pregnant women may be at increased risk for complications. However, the data was not always complete, especially related to the stage of pregnancy. The CDC also notes it is not clear if the ICU admissions reported were related to COVID-19 or due to pregnancy itself. The CDC data update on pregnancy shows 11,312 women in the U.S. diagnosed with COVID-19 from January 22- July 7th of this year.
Respiration, Heart Function and Immune System
These three interwoven systems in all of our bodies change dramatically when a woman becomes pregnant. Her cardiovascular system carries 50percent more capacity by 16 weeks of pregnancy, respiration adapts to increase oxygen, and the immune system alters to accommodate the growing fetus. This marvel of adaptation within the woman’s body is an intricate balance in a normal pregnancy. How COVID-19 effects this balance is not understood at this point of the pandemic.
Herein lies the need for answers. One large question for the Global Health Network trial, also known as INTERCOVID launched from Oxford University, seeks to understand how the virus effects the immune response in pregnant women that test positive.
Vaccines are designed to support the body’s immune response in order to stop a virus. In pregnancy the immune response is tempered in order to support the growing fetus. The findings from the prospective INTERCOVID research will be critical in clinical decision making on vaccination against COVID-19, once a vaccine is available.
Until More Answers
A husband and wife teamfrom Harvard University have collaboratedto develop a helpful blog, Pregnant and Worried?, for women who are currently pregnant or are planning to get pregnant soon. Their intention is to provide calm response to the many frequently asked questions women have about their safety and that of the unborn child.
Pregnant Women Not at Greater Risk was published in mid May. It provides an overview of a month-long study in the UK. The Mayo Clinic’s Pregnancy and COVID also provides updated information on managing your health in pregnancy. It is especially important, the article emphasizes, that pregnant women follow social distancing and frequently wash hands, as well aswear a mask when areas with others or in enclosed spaces.