Covid-19 and pregnant women: what are the real risks?

In a Press release very recently, dated November 17, 2021, the French National College of Gynecologists and Obstetricians (CNGOF) and the Research Group on Infections During Pregnancy (GRIG) insist on the fact that pregnant women represent a group at risk of developing severe forms of Covid-19 disease. What are the results of the latest publications?

Alarming figures

Several studies have looked at the impact of contamination to Covid-19 during pregnancy. The results are clear:

• an infected pregnant woman is 18 times more likely to be admitted to intensive care than an uncontaminated woman of the same age;
• an infected woman is 2.8 times more likely to lose her baby;
• a child born to an infected woman is 5 times more likely to be admitted to intensive care at birth than a child born to an uncontaminated woman.

The risk is even greater in pregnant women with one or more comorbidities as’obesity, a diabetes type 1 or type 2, a renal failure…

According to one study recently published, an infected pregnant woman is twice as likely to give birth to a stillborn child. the Delta variant, a majority variant today, would further worsen this risk. Unfortunately in this study, the vaccination status of women is not known.

Vaccination protects pregnant women

The vaccination also works in pregnant women. A vaccinated pregnant woman is 3.5 times less likely to contract Covid-19. The vaccines have no harmful effect on the unborn baby; no risk of malformation has been reported. The potential and rare side effects of the vaccine are no greater in pregnant women than in other people eligible for the vaccine.

The third dose is recommended for pregnant women

Vaccination is recommended from the second trimester of pregnancy. It is possible from the first trimester of pregnancy for women who want it. Vaccination is also recommended for women who are not yet pregnant but wanting to have a baby.

The question of 3^e dose occurs in pregnant women whose second injection was more than six months ago. It is commonly accepted today that the vaccine protection drops considerably after six months. In France, the third dose is recommended ” in people at very high risk of severe disease “. This is why the CNGOF and the GRIG recommend a third dose of vaccine in pregnant women or women with the desire to become pregnant, as soon as the second dose dates from more than six months ago.

It is more than ever recommended to be vaccinated. If contamination by the Covid-19 virus occurs in a pregnant woman, the pregnancy will be monitored very closely!

The coronavirus represents a significant risk for pregnant women.

Article by Julie kern, published on 04/27/2021

Pregnant women infected with coronavirus are more likely to have a complicated pregnancy. The immune reaction that is triggered in the placenta could be the cause.

Pregnant women are no more at risk of being infected with the coronavirus, but the disease can have a significant impact on the course of their pregnancy. They are also more prone to severe forms of Covid-19. A statistical study published in Jama Pediatrics estimated the relative risk of developing complications in pregnant women positive for SARS-CoV-2 compared to those that are not infected.

Increased risk of complications for women with Covid-19 and pregnant

For an infected pregnant woman, the scientists compared two uncontaminated pregnant women with a similar profile and at the same stage of pregnancy. In total, 2,130 participants (median age: 30), including 706 infected with the coronavirus, were followed for eight months. Thus, pregnant women have a greater relative risk (RR) of:

• preeclampsia / eclampsia (RR: 1.76);
• get a serious infection (RR: 3.38);
• be admitted to intensive care (RR: 5.04);
• maternal death which refers to the death of a woman within 42 days of her childbirth caused or aggravated by pregnancy (RR: 22.3);
• give birth naturally prematurely (RR: 1.59) or induce medically (RR: 1.97).

A portion (44%) of infected women contracted asymptomatic forms. The symptoms of Covid-19 such as cough or fever also increase the relative risk of complications for the mother (RR: 2.56) and for the newborn (RR: 4.97). Among the group of participants with Covid-19, eleven died, four of them from preeclampsia, five from worsening respiratory distress after childbirth, and two from fever, cough and respiratory problems. Pregnant women positive for SARS-CoV-2 are therefore more vulnerable to complications of pregnancy.

The inflammation responsible?

According to a second study, conducted at Yale University in the United States, it is not the virus itself that damages the placenta and thus threatens the mother and the baby, but the immune reaction which is triggered there at the level of the placenta. This is because the cells of the placenta (trophoblasts) express the ACE2 receptor, especially during the first trimester. In women with Covid-19, the expression of ACE2 in the placenta remains constant throughout pregnancy. However, coronavirus RNA has only been observed in the placenta after pregnancy in very rare cases.

In contrast, scientists observed a robust inflammatory response at the maternal-fetal barrier. The lymphocytes T as well as cells natural killer (NK) are activated, just like genes stimulated by interferons. This situation is a double-edged sword since it allows the body to thwart the infection of the virus, but also weakens the placenta, markers characteristic of preeclampsia.

No causal relationship has been established between the estimates presented in Jama Pediatrics and the observations made by the Yale team, these are two independent studies. But the second offers an interesting mechanism that could help understand the risks faced by women who contract Covid-19 during their pregnancy.