Study Shows Pregnant Women Are at Increased Risk of Severe Illness and Complications From COVID-19

August 10, 2022—The American College of Cardiology (ACC) announced the publication of a studying showing that COVID-19 infection in pregnant women is associated with increased risk of adverse outcomes compared to women who are not pregnant. Cardiovascular complications include heart attack, arrythmias, heart failure, and long-haul symptoms that may be difficult to distinguish from other cardiac complications of pregnancy and require the cardiovascular care team to be vigilant when assessing pregnant women with COVID-19, noted the findings.

“Cardiovascular Complications of Pregnancy-Associated COVID-19 Infections” by Joan E. Briller, MD, et al on behalf of ACC Cardiovascular Disease in Women Committee is available online and accepted for publication as a State-of-the-Art Review paper in JACC: Advances.

According to the ACC press release, the investigators reported that as COVID-19 cases increased globally, awareness of cardiovascular complications also increased, especially in certain high-risk populations. Heart attacks are estimated in up to 12% of patients.

The Centers for Disease Control and Prevention (CDC) found pregnant women are at increased risk of adverse outcomes with COVID-19, including severe infection (10%), intensive care unit (ICU) admission (4%), mechanical ventilation (3%), and use of extracorporeal membrane oxygenation hemodynamic support (0.2%), compared with nonpregnant women of reproductive age.

Additionally, pregnant patients who were of increased maternal age, had high body mass index, or had other preexisting conditions such as chronic hypertension, preeclampsia, and preexisting diabetes, were at even higher risk for severe infection.

The investigators reported that when compared to pregnant women without COVID-19, pregnant COVID-19 patients were at higher risk for preterm birth and stillbirth. Overall, 33% of infants born to patients with COVID-19 were admitted to the neonatal intensive care unit. No other differences have been found for perinatal outcomes.

A United States-specific study found substantial racial disparities in outcomes for pregnant COVID-19 patients. Non-Hispanic Black women accounted for 14.1% of the study cohort but represented 26.5% of pregnancy-associated deaths. Pregnancy was associated with a 2.4 times risk of death in Hispanic women with COVID-19 and pregnant Asian and Native Hawaiian/Pacific Islanders were among the highest risks of ICU admissions.

According to the investigators, a reason for increased risk of cardiovascular complications is the low vaccination rate in pregnant women compared to other groups. In a recent study of more than 130,000 pregnant women with more than three quarters of those requiring hospital admission, the vast majority of patients who required critical care and all fetal deaths occurred in unvaccinated women compared with vaccinated women.

As noted in the ACC press release, the management of cardiac complications and diagnosis in pregnant COVID-19 patients can be challenging given the overlap of COVID-19 symptoms, cardiovascular disease, and pregnancy.

The investigators stated that imaging findings and the timing of presentation may be helpful in differentiation and determining diagnosis. Clinicians may also need to adjust medical therapy during pregnancy and lactation.

They suggest management of cardiac complications in pregnant COVID-19 patients requires the creation of a “Pregnancy Heart Team” to optimize care, which may include providers comfortable with high-risk pregnancy, obstetric anesthesia, cardiology, critical care, and neonatal care, depending on the nature of the complication, stage of pregnancy, and severity of infection.

“Pregnant people need to know that they are increased risk of a severe COVID-19 infection, including ICU admissions, cardiac complications, need for critical care, and death for the patient or fetus,” commented Dr. Briller in the ACC press release. “Unfortunately, pregnant women have lagged behind other groups getting vaccinated.”

Dr. Briller, who is a cardiologist and professor of clinical obstetrics and gynecology at the University of Illinois at Chicago, continued, “Available data support vaccination in pregnancy with good safety profile and protective transfer to neonates. The CDC, American College of Obstetrics and Gynecology, and Society of Maternal Fetal Medicine among others recommend vaccination in pregnancy. I believe we should support this recommendation with our patients.”

Additionally, Dr. Briller noted, “Recognition of cardiovascular complication is hampered by failure to include pregnant women in clinical trials despite calls for inclusion of pregnant populations. Consequently, women may be undertreated or inadequately treated due to lack studies addressing safety and efficacy of therapies during pregnancy or conversely be exposed to therapies where safety is not known.”