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Dr. Jones: If you or someone you love is pregnant or considering getting pregnant during the COVID-19 epidemic, what do we know about this virus and its effects on pregnancy?

Viruses are not all the same. And when it comes to pregnancy, some viruses like the measles virus can cause birth defects in the fetus and some like the chickenpox virus can make pregnant moms really sick, which is bad for the baby, and some like the common cold are just a nuisance. Imagine sneezing when you have a big baby's head on your bladder. Well, what do we know about the COVID-19 virus in pregnancy? Of course, we can't take a bunch of women who are pregnant and randomize them to getting the virus or not and see what happens. So how do we find out? With us today is

Dr. Torri Metz, a specialist in high-risk pregnancy, a perinatologist, and chief of the division of OB-GYN research at the University of Utah. And thanks so much for taking some time for us in this very complicated time. Dr. Metz.

Dr. Metz: Oh, thank you so much for having me. I appreciate it.

Dr. Jones: So how did you find out about the effects of COVID-19 in pregnancy? Ask one lady in your clinic or sure it was a big deal?

Dr. Metz: We actually just completed the first phase of a large multi-center study looking at the effects of COVID in pregnancy. For the study, we ran it through the NICHD Maternal-Fetal Medicine Units Network, which is funded by the National Institutes of Health. And as part of that network, we have 14 states that are represented with 33 different sites. And from those sites, we did an observational study where we collected all of the women who were pregnant with a positive test for SARS-CoV-2 which is the virus that causes COVID-19 in both the inpatient and the outpatient setting, and then we abstracted detailed information from their medical records to look at how COVID affects pregnancy and how different disease severity with COVID-19 affects pregnancy outcomes.

Dr. Jones: So these were women from all over the country, right?

Dr. Metz: Yes. Yep.

Dr. Jones: And different racial and ethnic groups and levels of income and education and everything.

Dr. Metz: Yes. The MFMU really does have representation across all of those different groups. And I think that's one of the nice things about this study is that it gives us information for women across the United States and not just in one place.

Dr. Jones: Okay. Well, how did COVID-19 infection affect the pregnant women, the women themselves?

Dr. Metz: Yeah. So that's an excellent question. You know, we found that when we broke patients down by disease severity that about 12% of these pregnant women who tested positive for the virus had either severe or critical COVID-19. Meaning that in those cases, patients typically require hospitalization because they're requiring things like oxygen support. And so, we were surprised that the proportion was that high that would require hospitalization because they became that ill.

Dr. Jones: Right. And so if you age control, so for women who aren't pregnant of the same age, the rate of severe or critical illness, is it 5%? What is it in the general population of women who aren't pregnant?

Dr. Metz: Yeah, it's a little bit hard to compare these data just because we actually used NIH classifications for disease severity, which have not been used in all of the studies, but we do know that pregnant women are at higher risk of needing things like going ICU admission, requiring a ventilator to help them breathe, and of death. And so, you know, we were expecting that it would be a little bit higher, but 12% is a decent proportion that required hospitalization and is higher than that, which is estimated in the general population.

Dr. Jones: Yeah. No, that's critical. And when I think about the moms and, you know, especially this later in pregnancy was where you got a lot of this information for women who were far along, it's hard to breathe when there's so much baby in there.

Dr. Metz: Yes, that's definitely true.

Dr. Jones: Well, so then how did COVID-19 affect the fetus?

Dr. Metz: So we think that really did have effects on both moms and babies. And really though those effects were mostly isolated to the patients who develop severe or critical illness and we really didn't see the same adverse effects in patients who had mild to moderate illness or those patients who maybe had a cough or runny nose and got tested and had SARS-CoV-2 virus, but didn't get ill.

Dr. Jones: Okay.

Dr. Metz: And those women who got more sick who did have severe or critical illness and needed to be hospitalized, the rates of them having complications were very high. And so, very often, they needed a cesarean delivery that happened about 60% of the time, and those patients that had severe or critical illness, they also developed more frequently high blood pressure in pregnancy that happened about 40% of the time in those patients. And then in terms of the babies, about 40% of them were delivered prematurely and required neonatal ICU admission.

Dr. Jones: It wasn't so much that the virus made the baby sick or cause birth defects. It was that the fetus was growing in a critically ill mom. And so that made the baby have to be prematurely born or had fetal distress. Do I get that right?

Dr. Metz: Yes. That's all right. You know, these patients, really the majority of them that we studied were in their third trimester of pregnancy because we wanted to study birth outcomes. And so they needed to have delivered by the end of July to be included in the study. And so, really at that point, it was really only women who were late in pregnancy that had contracted SARS-CoV-2 and would have delivered by that time. We still don't really have information about things like birth defects because we have not yet been able to follow enough women who would have had an infection in the first trimester all the way through delivery to be able to look at that.

Dr. Jones: Okay. Well, so now what are your recommendations to women who are pregnant as we're still in the middle of this pandemic? Now you have this information and in your own clinic or when you talk to your colleagues, what are you recommending to women who are pregnant?

Dr. Metz: I think this comes up in a couple of different settings. One is, you know, when patients do develop COVID-19 infections during pregnancy or acquire COVID-19 infections, they have questions about anticipated outcomes. And I think that we can tell patients who have mild illness that we aren't seeing a signal for adverse outcomes in those pregnancies, but I think that we still need to really be telling pregnant patients that they need to do all they can to avoid contracting the virus during pregnancy because a substantial portion of them will go on to get severe and critical illness. And those patients definitely do have increased risk of adverse pregnancy outcomes. And so, encouraging patients still wearing a mask at all times when they're outside, really trying to keep that bubble around them small, and practicing really good hand hygiene.

Dr. Jones: Now, this is more personal, Dr. Metz, but you've been actively caring for women during this pandemic in clinic and you've been on labor and delivery and you're in our own home institution. And how are you and your family doing and staying safe during this time? You come and go, you see people who are pretty sick.

Dr. Metz: Yeah, absolutely. I mean, honestly, it's just about following those same practices that we recommend to everyone in the public. I mean, as healthcare providers, you know, there are sometimes special precautions that we take especially when we're taking care of somebody that we know has an active infection, but outside of that, it's doing all the things that we're asking everyone else to do, wearing a mask at all times and washing my hands many, many times a day, and having my family do the same in our interactions with each other. I think it's a hard time for everybody, but we have good information now about how this virus is transmitted and know ways to help stop transmission.

Dr. Jones: Well, thank you. That's really helpful because people who are making decisions about whether they're going to go out into the world or whether they're going to want people not to come in without a mask or not have people come in who are outside their family, these are important things that we can use to help women make those decisions and maybe even it might help inform them if they are deciding to be vaccinated or not.

Dr. Metz: That absolutely has come up as well. I think as people are starting to think about vaccination and pregnancy, a lot of patients have questions about that and this is another piece of that puzzle and counseling that we can give patients about the frequency of increased disease severity and what we expect in terms of pregnancy outcomes with this virus. So I think it can weigh into those conversations as well for sure.

Dr. Jones: Yeah. Those are critical conversations I'm sure that you do many times a day as well. Thank you. Now, for those of your listening for you and your doctor, knowing about the risks of COVID-19 in pregnancy gives you the information that can help you and those around you be more careful about exposures and can help you to seek testing and care early if you have symptoms. So thanks to Dr. Metz for her time. And for those of you listening, stay safe out there, and thanks for joining us on The Scope.