We are now over  three months into this pandemic and I thought I would share some data that was released 6/26/20 in the CDC’s Morbidity and Mortality Weekly Report. We are seeing more and more Covid at our hospital, even in pregnant women. The data you are seeing in the news is not fake. Yes, there are more tests being done but the percent of tests that are positive are higher and the hospitalizations are increasing.  

I have previously written that there is limited clear information on pregnancy and Covid; however, based on other respiratory viruses it was felt that pregnant women would be at an increased risk of infection. But early data from other parts of the world had not quite proven this to be the case for Covid. It was felt preliminarily that the risks to pregnant women were similar to age and comorbidity matched non pregnant women. There is some newer data to suggest pregnant women may indeed be at a higher risk. Let’s dive into it.

  • Of all the positive tests among women of reproductive age, 9% of them were reported as pregnant. Historically in this same age group, only 5% of women are pregnant at any given time, suggesting more pregnant women are testing positive. Not all women of reproductive age had their pregnancy status on their testing forms and those were not included for comparing the percentages of pregnant and nonpregnant. One could assume that a large majority of those without a pregnancy state listed were in fact not pregnant. This would drive that 9% down. Pregnant women have more frequent health care encounters, thus will be screened more for Covid, which would increase the amount of testing done on pregnant women. For example, many hospitals universally test all pregnant women upon arrival to labor and delivery. (At the time of writing this article, this is not done at WakeMed but that is something that will likely change in the near future with increasing testing capacity.) This would thus inflate the percentage of positive tests attributed to the pregnant patient over the non pregnant patient due to the shear amount of testing.

  • Of the pregnant women with positive Covid tests, 46% were Hispanic, 22% black, and 23% white.  Using birth data from 2019, 24% were Hispanic, 15% black, and 51% white.  This finding suggests that pregnant women who are Hispanic and black might be disproportionately affected by Covid during pregnancy. Race/Ethnicity data was missing from 20% of the pregnant women in this study so with fewer than 10,000 cases this could affect the percentiles. At our hospital we are certainly seeing many more Covid cases in the Hispanic community, including those who are pregnant.  Recent data show that 46% of all positive tests in North Carolina since the beginning of the pandemic have been in Hispanic people.

  • Hospitalizations are significantly higher in pregnant than non pregnant women (31.5% vs 5.8%). There was not a distinction for Covid-related hospitalizations versus pregnancy related hospitalizations. For example, an asymptomatic woman could have a positive test on universal screening when she was coming in for labor at a hospital that screens everyone. These numbers are thus grossly inflated. 

  • Along similar lines chronic lung disease, diabetes, and cardiovascular disease were reported higher in the pregnant patients that were Covid positive. However, there was not a distinction between chronic disease and those related to pregnancy (for example gestational diabetes or gestational hypertension). This again leads to inflated percentages.

  • Unlike hospitalizations (which are clearly skewed as mentioned above), ICU admission and the need for mechanical ventilation are a better representative of how severe illness is for one group versus another. After adjusting for age, underlying condition, and race/ethnicity, the risks for both ICU admission and mechanical ventilation were significantly higher among pregnant women than nonpregnant women. There does not seem to be, at this time, an increased risk of death.

The take home point is that, what we felt may be the case all along, is true. Pregnant women can get sicker from a viral infection than nonpregnant women, and this seems to be holding true for Covid. So please be smart and wear your mask in public and wash your hands frequently. Of those who have had Covid in our practice, they almost all were able to identify a family member or friend (whether symptomatic or not) from who they acquired the infection. Make sure you know where the friends and family with whom you fraternize are hanging out and if they are taking appropriate precautions. If they are not,do not socialize with them. This holds true for all of our patients, and, by the aforementioned CDC study, is a particular concern currently for our Hispanic and black patients.

Be safe everyone.

Dr. B