The PregCOV-19 Living Systematic Review has included 64 000 pregnant woman to date and found that pregnant women do not appear to be any more likely to contract COVID-19 than the rest of the population and the majority of those that do will be asymptomatic (approximately 74%) or only have mild–moderate cold/flu-like symptoms, including cough (41% of symptomatic cases), fever (40%), dyspnoea (21%), myalgia (19%), loss of taste (14%) and diarrhoea (8%).
Compared to pregnant women without COVID-19, symptomatic pregnant women that were hospitalised had worse maternal outcomes, including an increased risk of death, although that risk remains very low (the UK maternal mortality rate from COVID-19 is 2.2 per 100 000 maternities).
The effect of prolonged COVID symptoms or 'long COVID' on pregnant women and their fetuses has not yet been determined but the care for women with this condition has been outlined by NICE.
Severe illness and death
Severe illness is more common in the third trimester or peripartum than in earlier pregnancy. The UKOSS study demostrated that more women were hospitalised in these later stages than in the first or second trimesters, although admission at term to give birth contributed to hospitalisation numbers. In total, 83% of symptomatic women were diagnosed at or beyond 28 weeks, with 52% diagnosed at or beyond 37 weeks, showing symptomatic COVID-19 is also more common later in pregnancy.
In the PregCOV-19 Living Systematic Review Consortium analysis, 73 out of 11 580 COVID-19-infected women died of any cause, and 16 out of 1935 women required extracorporeal membrane oxygenation (ECMO). A large US study compared outcomes for pregnant women with and without COVID-19 and concluded in-hospital maternal death was rare but significantly higher for women with COVID-19 (141 deaths per 100 000 women) than for women without COVID-19 (five deaths per 100 000 women).
Compared with non-pregnant women with COVID-19, pregnant infected woman:
- possibly have an increased risk of severe disease demonstrated by higher rates of intensive care unit admission, although this may reflect a lower threshold for admission (Allotey J et al 2020)
- are at no increased risk of death outside of the USA or Mexico, where a slightly higher risk of death was noted (see aforementioned study).
Allotey J, Stallings E, Bonet M, et al. Clinical manifestations, risk factors, and maternal and 87 perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis. BMJ 2020;370:m3320.
Vousden N, Bunch K, Morris E, et al. The incidence, characteristics and outcomes of pregnant women hospitalized with symptomatic and asymptomatic SARS-CoV-2 infection in the UK from March to September 2020: a national cohort study using the UK Obstetric Surveillance System (UKOSS). MedRxiv doi: https://doi.org/10.1101/2021.01.04.21249195.