Pregnant Women Not More Susceptible To COVID-19, Current Data Suggests

Like many pregnant women during the COVID-19 pandemic, Kaleah Metz worries about becoming infected with the virus and potentially putting her pregnancy at risk.




"I am being exposed to COVID every week at this point, when I visit my doctor in the hospital," said Metz, a recently married health auditor in her third trimester and expecting her first child.

As a 35-year-old African American woman, Metz knows she has a higher risk of something going wrong in her pregnancy.

"Black maternity mortality rates are already high," she said. "I am having a C-section which already has complications, add my age, add my ethnicity on top of that -- a lot is working against me, and then the uncertainty of what exactly COVID is doing to me."

Also frustrating, said Metz, is the lack of concrete answers about the risk pregnant women face when becoming exposed to COVID-19.

Thankfully, a newly published JAMA review found no evidence that pregnant women have a higher risk of contracting the novel coronavirus. That means that unlike high blood pressure, diabetes and lung disease, being pregnant doesn't necessarily put women at a higher risk for infection.

"As of now, we do not have evidence that pregnant women are more likely to get COVID-19, nor that they are more severely affected by COVID-19," said Dr. Denise Jamieson, The James Robert McCord professor and chair of the Department of Gynecology and Obstetrics at Emory University School of Medicine.

Dr. Jamieson is also the co-author of the JAMA study, which reviewed currently available medical literature on COVID-19 and pregnancy.

While there's no evidence, as of yet, that suggests pregnant women are more at risk of getting sick with COVID-19, Jamieson and her colleagues pointed out an alarming dearth of data on pregnancy and COVID-19, noting that no news is not necessarily good news.

Still, many questions remain unanswered. Are infants born to moms with COVID-19 during pregnancy at an increased risk of adverse outcomes? Can moms can pass COVID-19 through the placenta to their baby during pregnancy or during delivery? Can the virus can be transmitted through breast milk?

This lack of pregnancy-related data -- paired with a woeful lack of COVID-19 data broken down by race and ethnicity in the United States -- has some researchers worried that, like many other epidemics, the COVID-19 crisis could hit pregnant women of color harder than other groups.

But there is so little data on pregnancy and COVID-19 broken down by race or ethnicity that this information was not even included in the recent JAMA literature review.

"Very limited information is available in the literature on how African American women who are pregnant are affected by COVID-19, so we were unable to address this question in our review," said Dr. Sonja Rasmussen, a co-author of the JAMA article and a professor in the Departments of Pediatrics and Epidemiology at the College of Medicine, the College of Public Health and Health Professions at the University of Florida.

The concern for pregnant minority women remains high, as a new study from the United Kingdom published in the BMJ found that out of 427 pregnant women admitted to the hospital with confirmed SARS- CoV-2 infection, between March 1 and April 14, 56% were black or from other ethnic minority groups.

Dr. Monique Rainford, chief of obstetrics and gynecology At Yale Health, who was not involved in the research, also emphasized the need to include ethnic background in mounting research and in clinical scrutiny.

"The available U.S. data does not include race or ethnicity in the demographics of the pregnant women who are being infected or of those with more severe disease or who have died," Rainford said. "Given the known maternal health disparities in African American women and the health disparities seen in the COVID-19 pandemic, it is perhaps not unreasonable to consider African American pregnant women at higher risk until proven otherwise. Hopefully, this would enhance the care and attention that they receive."

Rasmussen and Jamieson synthesized guidelines from the CDC and other professional organizations, including American College of Obstetricians and Gynecologists (ACOG) for pregnant women, recommending them to follow the public health guidelines to minimize their risk of becoming infected during pregnancy -- including maintaining physical distancing greater than 6 feet, washing hands many times a day and wearing a face mask.

Although current literature suggests that pregnant women do not have a different risk of becoming infected with COVID-19, the biggest unanswered question is if pregnant women are more severely affected by COVID-19 compared to non-pregnant women.

"Given that SARS-CoV-2 has only been spreading in the U.S. for less than six months, it is not surprising that we still have many unanswered questions," Jamieson said. "But I am concerned that as we learn more every day about this virus, our knowledge about this virus specifically in pregnancy may not be keeping up. We need to know more so that we can base our recommendations on evidence rather than on expert opinion."

Comprehensive studies are needed to answer these critical questions regarding COVID-19 and pregnancy. As researchers learn more about the virus daily, even more work needs to be conducted and incorporated into care.

"I am very hopeful," said Metz, who is expecting her first child soon. "My husband knows that when we go to this hospital... that we are coming home with the baby, by any means necessary."

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