Lehigh County Health & Medicine Fall/Winter 2020 - 13

L C M E D S O C .O R G

our elder relatives to protect them from those
who are younger and likely asymptomatic all
play a role in the heightened anxiety experienced
by many since this past March.
With regard to COVID-19 and pregnancy,
like every aspect of the medical field, we are
being bombarded with snippets of information
and headlines. Only recently has the data begun
to be collated and analyzed so that we can start
to synthesize information in meaningful ways.
Below we have summarized salient points
gleaned from scientific journals and literature
in the past 6 months.

fatality rates (CFR) than their non-pregnant
counterparts (5.3-12.9% vs 34.5%)4,8. While
the risk of contracting COVID-19 appears to
be the same, the risk of getting markedly ill with
the disease still falls to our brothers, fathers, sons
and husbands. Despite their propensity for better
outcomes, nearly 25% of COVID-19 positive
pregnant women admitted have required oxygen
support, which included noninvasive oxygen via
nasal cannula, high-flow oxygen and mechanical
intubation7. Women with additional risk factors
such as maternal age over 35 and obesity were
at higher risk for utilization of interventions
and poorer outcomes7. Thus the seriousness of
COVID-19 must be acknowledged even in this
relatively low risk population.

Though more concrete information has
trickled into the milieu of obstetrics, what we
know remains limited given the exclusion of
Not all aspects of maternal morbidity and
pregnant women from many gold-standard mortality secondary to COVID-19 fall just
investigations of novel treatments and potential on the mother. The growing fetus is at risk for
vaccines1. However, it is clear that the possibility consequences of COVID as well. Literature has
of maternal morbidity and mortality secondary to shown a high likelihood of preterm delivery and
COVID-19 is a substantial risk. We learned from delivery by Cesarean section, both of which come
studies of the first four weeks of the pandemic in with their own set of risks for mom and baby5,7.
New York that women overall, are more apt to be Prior to delivery, vertical transmission from mother
asymptomatic and incidentally test positive at the to neonate appears to occur at a rate of 2-3%3.
time of admission for active labor. Reassuringly, Though this is at a rate similar to other pathogens
this population is much less likely to be admitted that cause congenital infections, prevention and
for complications associated with COVID-19 safety education for expectant mothers is a critical
than their non-pregnant counterparts8. The part of our job as obstetricians. Despite the risk
likelihood of being an asymptomatic carrier for passage of the virus from mom to baby, we
was echoed in a retrospective cohort study from do know that there has been no increased risk
September that revealed women presenting of micarriage above baseline for those women
for gynecologic and/or obstetric procedures, who have tested positive early in pregnancy9.
including labor, were at significantly higher risk We do not yet know, nor is there enough data
for asymptomatic COVID-19 than patients to say, if neonates delivered by women who were
presenting for elective general surgery procedures infected with the virus early in pregnancy will face
after adjusting for age and sex. Pre-procedural unsuspected manifestations of the virus. What
asymptomatic infection rates in obstetrics have we do know is that COVID-19 does not seem
been reported as high as 14%2. We cannot delay to be as congenitally devastating as other viruses
or reschedule labor. Babies ultimately choose such as Zika, rubella, varicella, or cytomegalovirus.
when they decide to come. The safety of our If we can keep mothers and families healthy, the
health care workers, especially those working newborns seem to do well.
on the labor and delivery units, the majority of
whom are young women of child bearing age,
Finally, we know that the COVID-19
raises the question of whether we should test every pandemic has had a striking impact on the
person admitted to our labor and delivery suite. psychological well-being of our pregnant patients.
It is likely that over 50% of expectant mothers
Among those in the community at large, have suffered severe psychological impacts,
women are faring better. Overall, pregnant with one survey revealing that nearly 66% of
patients have lower hospital admission rates and respondents reported severe anxiety. Many cite
critically ill pregnant patients have lower case concerns regarding potential for transmission

to their baby as one source of their heightened
worry. This psychological impact seems to be
most severe in women in the first trimester of
pregnancy6. At times I wonder if some of the
escalation in anxiety for newly pregnant women
is the unsaid question: what will happen to me if
my partner gets sick? Now, more than ever, it is
imperative that we, as a community, work with
our families to educate, reassure, and provide
physical and mental support in the context of
pregnancy and the COVID-19 pandemic.
REFERENCES
1. Hantoushzadeh S, Shamshiraz AA, Aleyasin A, Nouri
B, Nekooghadam SM, and Aagaard K. Maternal death
due to COVID-19. American Journal of Obstetrics and
Gynecology, 223(1). Jul 2020. doi: https://doi.org/10.1016/j.
ajog.2020.04.030.
2. Kelly JC, Raghuraman N, Palanisamy A, Stout MJ, and
Carter EB. Pre-procedural asymptomatic COVID-19 in
obstetric and surgical units. American Journal of Obstetrics
and Gynecology. Sept 2020. doi: https://doi.org/10.1016/j.
ajog.2020.09.023.
3. Kotlyar AM, Grechukhina O, Chen A, Tal O, Taylor HS,
and Tal R. Vertical transmission of coronavirus disease 2019:
a systematic review and meta-analysis. American Journal
of Obstetrics and Gynecology. Jul 2020. doi: https://doi.
org/10.1016/j.ajog.2020.07.049.
4. Nam Hee Kim C, Hutcheon J, van Schalkwyk J, and
Marquette G. Maternal outcome of pregnant women admitted to intensive care units for coronavirus disease of 2019.
American Journal of Obstetrics and Gynecology. Aug 2020.
doi: https://doi.org/10.1016/j.ajog.2020.08.002.
5. Nunzia Della Gatta A, Rizzo R, Pilu G, and Simonazzi
G. Coronavirus disease 2019 during pregnancy: a systematic
review of reported cases. American Journal of Obstetrics and
Gynecology, 223(1). Jul 2020. doi: https://doi.org/10.1016/j.
ajog.2020.04.013.
6. Saccone G, Florio A, Aiello F, Bifulco G, Zullo F, and
Di Spiezio Sardo A. Psychological impact of coronavirus
disease 2019 in pregnant women. American Journal of
Obstetrics and Gynecology, 223(2). Aug 2020. doi: https://doi.
org/10.1016/j.ajog.2020.05.003.
7. Sentilhes L, De Macillac F, Jouffrieau C, Ruch Y, Fafi-Kremer S, and Deruelle P. Coronavirus disease 2019
in pregnancy was associated with maternal morbidity and
preterm birth. American Journal of Obstetrics and Gynecology.
Jun 2020. doi: https://doi.org/10.1016/j.ajog.2020.06.022.
8. Tekbali A, Grunebaum A, Saraya A, McCullough L,
Bornstein E, and Chervenak FA. Pregnant vs nonpregnant
severe acute respiratory syndrome coronavirus 2 and coronavirus disease 2019 hospital admissions: the first 4 weeks in New
York. American Journal of Obstetrics and Gynecology, 223(1).
Apr 2020. doi: https://doi.org/10.1016/j.ajog.2020.04.012.
9. Yan J, Guo J, Fan C, Zhang Y, Poon LC, and Yang H.
Coronavirus disease 2019 in pregnant women: a report
based on 116 cases. American Journal of Obstetrics and
Gynecology, 223(1). Apr 2020. doi: https://doi.org/10.1016/j.
ajog.2020.04.014.

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http://www.LCMEDSOC.ORG https://www.doi.org/10.1016/j.ajog.2020.04.030 https://www.doi.org/10.1016/j.ajog.2020.04.030 https://www.doi.org/10.1016/j.ajog.2020.09.023 https://www.doi.org/10.1016/j.ajog.2020.09.023 https://www.doi.org/10.1016/j.ajog.2020.07.049 https://www.doi.org/10.1016/j.ajog.2020.07.049 https://www.doi.org/10.1016/j.ajog.2020.08.002 https://www.doi.org/10.1016/j.ajog.2020.04.013 https://www.doi.org/10.1016/j.ajog.2020.04.013 https://www.doi.org/10.1016/j.ajog.2020.05.003 https://www.doi.org/10.1016/j.ajog.2020.05.003 https://www.doi.org/10.1016/j.ajog.2020.06.022 https://www.doi.org/10.1016/j.ajog.2020.04.012 https://www.doi.org/10.1016/j.ajog.2020.04.014 https://www.doi.org/10.1016/j.ajog.2020.04.014

Lehigh County Health & Medicine Fall/Winter 2020

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