The COVID-19 (SARS-CoV-2, Coronavirus 2) pandemic has created a major public health crisis worldwide. At InVia Fertility Specialists, we have been counselling our patients about the possible risks of COVID-19 prior to starting a treatment cycle. The discussions included the fact that we really did not know much about the impact of COVID-19 infection on pregnancy outcomes.
Early data from China suggested that COVID-19 did not cross the placenta and therefore did not affect the baby. Little was known about the risk of miscarriage, preterm birth, still birth, maternal death and other pregnancy complications. A recent publication in the Journal of the American Medical Association by Emily Adhikari and her co-workers from the University of Texas sheds light on some these very important questions.
They studied 3374 pregnant women with and without COVID-19 during pregnancy from March 18 through August 22, 2020, at Parkland Health and Hospital System (Dallas, Texas), Women were included if they were tested for SARS-CoV-2 during pregnancy and delivered. Of these 252 tested positive for COVID-19 and 3122 tested negative. Patients were tested in outpatient, emergency department, and inpatient settings.
Maternal illness at initial presentation was asymptomatic or mild in 239 women (95%), and 6 of those women (3%) developed severe or critical illness. Fourteen women (6%) were hospitalized for COVID-19.
The majority of women (2520, 75%) were Hispanic, 619 Black (18%), and 125 White (4%). There were no differences in age, parity, body mass index, or diabetes among women with or without COVID-19. COVID-19 positivity was more common among Hispanic women (230 [91%] positive vs 2290 [73%] negative).
There was no increase in the incidence of preterm birth, severe preeclampsia or cesarean delivery for abnormal fetal heart rate.
Among all 239 women (95%) with asymptomatic or mild disease at initial presentation, 6 of those women (3%) subsequently developed severe or critical illness. Of the total cohort of 252 women, 13 (5%) presented with or developed severe or critical illness. There were no maternal deaths.
Early neonatal COVID-19 infection occurred in 6 of 188 tested infants (3%), primarily born to asymptomatic or mildly symptomatic women. Transmission from mother to baby was documented in only one woman where the placenta showed severe abnormalities.
The incidence of major fetal malformations (2%) was similar in the two groups.
The authors conclude that COVID-19 infection during pregnancy was not associated with adverse pregnancy outcomes. Transmission of the virus to baby is rare. Still, the long-term outcome in these patients remains unknown.
As more studies are published, it is possible that some of these conclusions could be challenged. However, based on the current data, infertility patients pursuing pregnancy during this pandemic may find these data to be reassuring.
Our Chicago-area fertility clinics continue to provide safe treatment during the coronavirus pandemic in accordance with CDC guidelines. To learn more about how we can help you on your pathway to pregnancy, click below to schedule your appointment at one of our four clinic locations.
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