Caution is advised for pregnant women during the COVID-19 pandemic
Pregnant women are not more susceptible to COVID-19
Inaccurate as a whole (with reservations)
The headline of an article published on June 18, 2020, in the American media ABC News states that pregnant women are not more susceptible to COVID-19, according to currently available data. This statement is inaccurate with reservations.
A confusing and inaccurate title
First, both the title of the ABC news article and its claims are vague and confusing. Indeed, the title mentions the susceptibility of pregnant women to COVID-19, but of what type? To catch the disease? To be more seriously ill? To pass it on to their babies? A second problem lies with the title that suggests that available data indicates that pregnant women are no more at risk from COVID-19 than the rest of the population.
However, in the body of the ABC News item itself, and in the official sources cited below, it is instead explained that, based on the limited data currently available, there is no evidence that pregnant women are more vulnerable to the disease - unlike people with diabetes, high blood pressure and lung disease. However, considering the vulnerability of pregnant women to respiratory viruses in general, there is reason to believe that the SARS-CoV-2 virus, itself a respiratory virus, would also be more harmful to them. The title therefore poses a risk of misinformation since it could mislead a reader who would limit his or her reading to the title, as is often the case.
No more risk of catching COVID-19: inaccurate with reservations
First, the JAMA study to which the article refers concludes that there is a lack of data, and therefore that there is no reason why women should consider delaying pregnancy during COVID-19. However, despite this lack of data, we do know that the physiological changes that occur in pregnant women make them more vulnerable to respiratory disease. Therefore, and in theory, a weakened defence system in pregnant women could make them more vulnerable to COVID-19 infection - hence our reservation.
Risks of serious illness: more hospitalizations and intensive care admissions
An update from the U.S. Centers for Disease Control and Prevention warns that it is increasingly clear that pregnant women tend to be more likely to be hospitalized and admitted to intensive care than women of childbearing age who are not pregnant. However, the mortality rate does not differ significantly between the two groups and remains low.
This update confirms the concerns of the World Health Organization (WHO) and the Mayo Clinic that pregnant women may be more vulnerable to more severe forms of COVID-19. These fears stem from the well-known changes in the body and immune system of pregnant women that make them more at risk of developing severe forms of other respiratory diseases. However, WHO and the Mayo Clinic do not yet recognize the US CDC update; they may be waiting for more research from other countries so that results from one country are not generalized and projected to the rest of the world.
On the other hand, the guidelines remain the same for WHO, the Mayo Clinic, and Health Canada: pregnant women need to consider that they may be more likely to develop severe forms of the disease than others and therefore need to follow health measures to the letter to protect themselves and their babies.
At this point, we reiterate our verdict that the claim that pregnant women are not more at risk from COVID-19 is deemed inaccurate. Pregnant women tend to be more likely to be hospitalized and admitted to intensive care than women of childbearing age who are not pregnant. We have a reservation because it is still unsubstantiated (but theoretically possible) that pregnant women are at greater risk of contracting COVID-19.
What about transmission to the baby and complications?
Mother-to-child transmission has been observed on rare occasions, but the modes of transmission are still unknown. However, Italian researchers revealed in an online press conference at the 23rd International AIDS Convention that it is highly likely that there were two cases of transmission during pregnancy in one of their studies of 31 pregnant women with COVID-19. More recently it has been proven that the placenta expresses more ACE2 receptors. And a study now shows that the coronavirus enters cells via these ACE2 receptors. This allows a theoretical risk of transmission of the virus between mother and fetus (before birth).
The Canadian Paediatric Society believes that transmission is more likely to occur through breathing droplets and that normal hygiene practices help minimize the risk of transmission.
According to the Mayo Clinic, there is no evidence that COVID-19 can cause complications during childbirth. Only a small number of problems have been identified, such as premature births, but it is impossible to determine the role of COVID-19 in these cases. To date, babies infected with COVID-19 have had only minor symptoms, or no symptoms at all in the majority of cases. However, the organization says that a few limited cases of severe forms of the disease have been noted in newborns.
WHO recommends that new mothers who have contracted COVID-19 breastfeed their newborn(s), as there is no evidence to date that COVID-19 is transmitted through breast milk. WHO also recommends that skin-to-skin contact between mother and child continues.
In July 2020, WHO requested Member States to share information (in anonymous format) on pregnant women or women who gave birth up to 21 days after receiving a positive diagnosis of COVID-19, in order to conduct further studies on the risks of COVID-19 to pregnant women and their newborns.
Visible minorities and COVID-19
While the risks to pregnant women of contracting COVID-19 are not fully substantiated as of the date of publication of this paper, the US CDC notes that visible minorities in the United States are disproportionately affected by COVID-19. African-American women are five times more likely to contract COVID-19 (and Hispanic women four times more likely) than Caucasian women. The CDC justifies this discrepancy by the systemic social inequalities that these populations have long experienced. Therefore, it is reasonable for visible minorities to consider that they are at greater risk of contracting the disease - and therefore to take precautions as much as possible.
A study by the National Perinatal Epidemiology Unit (NPEU) in the United Kingdom, in collaboration with the Royal College of Obstetricians and Gynecologists, the Universities of Leeds and Birmingham, Kings and Imperial Colleges London, echoes the U.S. CDC in stating that pregnant women of black and ethnic minority backgrounds are more likely to be admitted to hospitals in the United Kingdom for COVID-19.
Pregnant women are not more susceptible to COVID-19
July 31, 2020
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