As the impact of the coronavirus (COVID-19) pandemic continues to escalate, the Society for Maternal-Fetal Medicine (SMFM) has released guidance on the maternal, fetal and neonatal implications of the disease. The guidance complements the Practice Advisory recently released by the American College of Obstetricians and Gynecologists (ACOG) and the evolving guidance from the Centers for Disease Control and Prevention (CDC).
Information about the effect of COVID-19 on pregnancy is limited, but there have been several small reports which may offer insight into how the disease may impact gestation. SMFM cautions that the outcomes of these studies must be interpreted with caution due to their small numbers of participants.
- In two case studies on COVID-19 infection in pregnancy, totaling 18 women, only one suffered severe reparatory morbidity requiring intensive care unit admission and mechanical ventilation.
- Early data from a series of hospitalized nonpregnant patients in China found that up 32% of individuals developed severe pneumonia, and 19% of all infected hospitalized patients progressed to acute respiratory distress syndrome (ARDS). Mortality ranged from 1.4% to 4.3%, depending on region and testing strategies.
- A small study found no evidence of COVID-19 in the amniotic fluid or cord blood of six infants from infected women.
Risk of PTB
One question that has arisen is whether women infected with COVID-19 are at increased risk of preterm birth (PTB). Although a link may exist, it now appears that some cases were iatrogenic and not due to spontaneous PTB. It is not clear whether these outcomes were related to maternal infection. All of the infants in this single report were clinically well and no neonatal mortality was reported. When looking at other viral infections during pregnancy, such as influenza, PTB and low birth weight have occurred, though this is generally thought to be due to severe maternal illness.
Women with acute illness should receive fetal management similar to the care provided to any critically ill woman. Continuous fetal monitoring in the setting of severe illness should only be considered with delivery when it would not compromise maternal health. At this point, very little is known about the natural history of pregnancy after a patient recovers from COVID-19.