Trending Clinical Topic: Pregnancy and COVID-19

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New information regarding COVID-19 infection rates and disease severity among pregnant women and those who care for them resulted in this week's top trending clinical topic.

A systematic review of 77 studies found that a significant number of pregnant or recently pregnant patients were diagnosed with COVID-19 from December 1, 2019, to June 26, 2020 (see Infographic). The study was published in BMJ and also found an increased risk for preterm delivery as well as the need for invasive ventilation compared with nonpregnant women with COVID-19, especially those with an underlying medical condition.

Although the findings may help in establishing guidelines, some experts suggest caution in interpreting the results at this point, as many of the studies used in the review were published at the height of the pandemic and did not include routine COVID testing for all pregnant patients. However, the living systematic review will include weekly search updates, with analysis performed every 2-4 weeks. The updated information is likely to further clarify ongoing questions regarding incidence and disease severity.

A separate study examining the incidence of COVID-19 among maternity healthcare staff in London found that 1 in every 6 workers had SARS-CoV-2 antibodies, with one third showing no symptoms. The findings were published in Anaesthesia and comprise the largest report on antibody levels in obstetric healthcare workers to date. Findings suggest that, compared with the general population of the United Kingdom, obstetric healthcare workers had twice the prevalence of seroconversion.

In the United States, disease severity in pregnancy has been a particular concern. In late June, the Centers for Disease Control and Prevention (CDC) released a report which found that pregnant women were 50% more likely to be admitted to intensive care and 70% more likely to be intubated than nonpregnant women in their childbearing years. This was in contrast to initial guidance in May, when the CDC indicated that pregnant women had the same risk for severe COVID-19 as adults who were not pregnant. In terms of birth defects, much remains unknown, as most individuals with COVID-19 during their first trimester have yet to give birth.

As with most clinical information regarding COVID-19, further clarification on key issues involving pregnancy is in high demand. Additional guidance is likely to again drive interest in this particular subject, as it did this week, making it the top trending clinical topic.