A study observing over 2,100 pregnant women across 18 countries worldwide has revealed that COVID-19 is associated with a higher risk of severe maternal and newborn complications than previously recognised.

Research that was carried out at Nuffield Dept of Women’s & Reproductive Health at the University of Oxford was later reported in the INTERCOVID Study in the journal JAMA Pediatrics, offering, for the first time, thorough comparative information about the effects of COVID-19 in pregnancy. In the paper, published 23rdApril, they concluded that the risk posed to both babies and mothers is greater than was acknowledged at the beginning of the pandemic; greater to the extent that health priority measures should in fact include pregnant women.

Co-leader of INTERCOVID, Aris Papageorghiou, Professor of Foetal Medicine at the University of Oxford said, “Women with COVID-19 during pregnancy were over 50% more likely to experience pregnancy complications (such as premature birth, pre-eclampsia, admission to intensive care and death) compared to pregnant women unaffected by COVID-19.

“Newborns of infected women were also nearly three times more at risk of severe medical complications, such as admission to a Neonatal Intensive Care Unit – mostly due to premature birth. The good news, however, is that the risks in symptomless infected women and non-infected women were similar.”

The researchers aimed to understand the effects of COVID-19 in pregnancy by amassing robust data on pregnant women with and without a diagnosis of COVID-19. This was a vital step for a number of reasons: to ensure that families understand the risks involved, mothers and babies receive the best possible care, and so that health resources, such as vaccines may be appropriately allocated. Until the release of this paper, the quality of information available has been limited.

The paper expands on the work of over 100 researchers that recently completed the INTERCOVID Study involving over 2,100 pregnant women form 43 maternity hospitals in 18 low, middle and high-income countries worldwide. The study was particularly unique since each woman who tested positive for COVID-19 was analytically compared to two non-infected pregnant women giving birth at the same time in hospital.

Professor Papageorghiou, continued: “Fortunately, there were very few maternal deaths; nevertheless, the risk of dying during pregnancy and in the postnatal period was 22 times higher in women with COVID-19 than in the non-infected pregnant women.”

The study also revealed that close to 10% of newborns from mothers that were test-positive for the virus also tested positive for the virus during the first few postnatal days.

Another co-leader, José Villar, Professor of Perinatal Medicine at the University of Oxford said,: “Importantly, breastfeeding does not seem to be related to this increase. Delivery by Caesarean section, however, may be associated with an increased risk of having an infected newborn”.

The importance of such a study extends beyond its contents. The study demonstrated the importance of collecting large-scale multinational data quickly during a health crisis as this was what enabled the researchers to complete the study in a quick 9 months.

Co-leader Stephen Kennedy, Professor of Reproductive Medicine at the University of Oxford concluded: “We now know that the risks to mothers and babies are greater than we assumed at the start of the pandemic and that known health measures when implemented must include pregnant women. The information should help families, as the need to do all one can to avoid becoming infected is now clear. It also strengthens the case for offering vaccination to all pregnant women”.

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