Over a year ago, we wrote our first post on COVID-19, and it is hard to believe that we are still very much in the midst of a pandemic.  Since that time, we have learned a lot more about the virus, how to prevent and manage COVID-19 infection, and vaccines are rolling out across the globe.  We have also learned about how COVID-19 affects maternal and newborn health.  

A recent systematic review and meta-analysis in the Canadian Medical Association Journal pulls together the data accumulated over the last year with regard to pregnancy outcomes, focusing primarily on risk for preeclampsia, preterm birth, stillbirth, and gestational diabetes.  

The review analyzed data from 42 studies including a total of 438,548 pregnant individuals. Compared to pregnancies without SARS-CoV-2 infection during pregnancy, pregnancies complicated by COVID-19 were associated with an increased risk of preeclampsia (OR 1.33, 95% CI 1.03 to 1.73), preterm birth (OR 1.82, 95% CI 1.38 to 2.39) and stillbirth (OR 2.11, 95% CI 1.14 to 3.90). 

Greater severity of COVID-19 infection was associated with worse outcomes. Compared to mild COVID-19, severe COVID-19 was strongly associated with preeclampsia (OR 4.16, 95% CI 1.55 to 11.15), preterm birth (OR 4.29, 95% CI 2.41 to 7.63), gestational diabetes (OR 1.99, 95% CI 1.09 to 3.64) and low birth weight (OR 1.89, 95% CI 1.14 to 3.12).

Pregnancy and COVID-19 Vaccines

While it is important for clinicians to be aware of the potential of these adverse outcomes, the best strategy for avoiding them is preventing COVID-19 infection in the first place.  Masking and social distancing can mitigate risk; however, it is difficult to completely eliminate exposure to COVID-19 in areas where the virus continues to be widespread.  

The vaccines currently available in the United States decrease risk for severe illness and thus would reduce the risk of the adverse outcomes outlined above.  However, these vaccines have not been tested in pregnant women.  Nonetheless, it is believed that the risks associated with COVID-19 infection outweigh the risks associated with receiving  the vaccine.  Although there were initially some inconsistencies regarding COVID-19 vaccination during pregnancy, most professional organizations now recommend that women who are either pregnant or planning to get pregnant should receive a COVID-19 vaccine.  (The World Health Organization initially recommended against vaccination of pregnant women; however, they now state that individuals at higher risk of infection may consider vaccination in consultation with their physician.)

Ruta Nonacs, MD PhD

Wei SQ, Bilodeau-Bertrand M, Liu S, Auger N.  The impact of COVID-19 on pregnancy outcomes: a systematic review and meta-analysis.  CMAJ. 2021 Mar 19.  Free article.

Monitoring COVID-19 Vaccine Safety during Pregnancy (CDC)

Pregnant People:  At increased risk for severe illness from COVID-19 (CDC)

Information about COVID-19 Vaccines for People who Are Pregnant or Breastfeeding (CDC)

Vaccinating Pregnant and Lactating Patients Against COVID-19 (ACOG)

COVID-19 Vaccines and Pregnancy: Conversation Guide for Clinicians (ACOG)

Pregnancy and COVID: what the data say (Nature)

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