Paediatric and Perinatal Epidemiology | 2021
SARS‐CoV‐2 infection in pregnancy: Lessons learned from the first pandemic wave
Abstract
Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has infected over 55 million people worldwide and killed more than 1.3 million people since the global pandemic was declared by the World Health Organization (WHO) in March 2020. During the first wave, when clinical care was informed by acutely limited understanding of the virus and constrained by shortages of ventilators and personal protective equipment (PPE), health care systems across the world struggled to combat the disease caused by the virus, coronavirus disease 2019 (COVID-19). Early in the pandemic, pregnant women were considered at increased risk due to physiologic adaptations of pregnancy that make them vulnerable to complications from upper respiratory infections. While early reports of COVID-19 suggested pregnant women had similar outcomes compared with non-pregnant women,1 recent surveillance data from the US Centers for Disease Control found that infected pregnant women were more likely to be admitted to the intensive care unit, receive mechanical ventilation, and die, compared with similarly aged, non-pregnant women.2 Evidence on the epidemiology of COVID-19 in pregnancy, including risk factors for severe disease, has been elucidated,3 but risk factors for SARS-CoV-2 infection remain less clear. As a result of hard earned experience during the initial wave of COVID-19, several interventions emerged that reduce the mortality risk, such as dexamethasone and other glucocorticoids,4 and promising vaccines loom on the horizon.5 The global community is now engaged in a second wave and is better prepared, but we continue to learn from our initial experiences with COVID-19. In this issue of Paediatric and Perinatal Epidemiology, Reale and colleagues 6 prospectively assessed epidemiologic risk factors associated with SARS-CoV-2 infection among a cohort of 2495 pregnant women who delivered during the first wave in four hospitals in Boston, Massachusetts (19 April to 27 June 2020). All pregnant women admitted for delivery had universal SARS-CoV-2 testing by reverse transcription-polymerase chain reaction tests of nasopharyngeal specimens. The authors found that 93 women or 3.2% (95% confidence interval [CI] 2.5, 3.5) were positive for SARS-CoV-2, of whom 86% were asymptomatic. Risk factors for SARS-CoV-2 infection included young age, obesity, Black and Hispanic race/ ethnicity, and public insurance beneficiary, as well as geographic factors, such as living in areas with high per capita infection rates, and occupational risk factors, such as non–health care essential worker occupations. The study provides insight into risk factors for SARS-CoV-2 infection in pregnancy, but also illustrates several salient points about universal testing for SARS-CoV-2 in labour and delivery (L&D) settings, presence of identifiable risk factors, and vulnerability of pregnant non–health care essential workers and racial/ethnic minorities. What follows in this commentary is a discussion of these issues.