Study Raises Concerns for Pregnant Women With the Coronavirus – The New York Times

Pregnant women infected with the coronavirus are more likely to be hospitalized, admitted to an intensive care unit and put on a ventilator than are infected women who are not pregnant, according to a new government analysis.

Pregnant women are known to be particularly susceptible to other respiratory infections, but the Centers for Disease Control and Prevention has maintained from the start of the pandemic that the virus does not seem to “affect pregnant people differently than others.”

The increased risk for intensive care and mechanical ventilation worried experts. But the new study did not include one pivotal detail: whether pregnant women were hospitalized because of labor and delivery. That may have significantly inflated the numbers, so it is unclear whether the analysis reflects a true increase in risk of hospitalization.

Admissions for childbirth represent 25 percent of all hospitalizations in the United States, counting mother and baby, said Dr. Neel Shah, an assistant professor of obstetrics and gynecology at Harvard University. Even at earlier stages of pregnancy, doctors err on the side of being overly cautious when treating pregnant women — whether they have the coronavirus or not.

“There’s quite clearly a different threshold for hospitalizing pregnant people and nonpregnant people,” he said. “The question is whether it also reflects something about their illness, and that’s something we don’t really know.”

The results are to be published on Thursday by the C.D.C.; government researchers presented the data to a federal immunization committee on Wednesday. (The slides were posted online on Wednesday afternoon but taken down later in the day.)

The analysis, the largest of its type so far, is based on data from women with confirmed infections of the coronavirus as reported to the C.D.C. by 50 states and Washington, from Jan. 22 to June 7.

The report includes information on 8,207 pregnant women between ages 15 to 44, who were compared to 83,205 women in the same age bracket who were not pregnant.

More than 31 percent of the pregnant women were hospitalized, compared with about 6 percent of women who were not pregnant. Pregnant women were more likely to be admitted to the I.C.U. (1.5 percent versus 0.9 percent) and to require mechanical ventilation (0.5 percent versus 0.3 percent).

These proportions are small, Dr. Shah noted, and the 10-fold difference in the number of pregnant and nonpregnant women in the analysis makes it difficult to compare their risks.

In a separate analysis by Covid-Net of women hospitalized with the coronavirus, C.D.C. researchers noted that “the risk of I.C.U. and mechanical ventilation was lower among pregnant compared to nonpregnant women.” Covid-Net analyzes data from hospitalizations in the network’s surveillance area in 14 states.

Despite the ambiguities, some experts said the new data suggests at the very least that pregnant women with the coronavirus should be carefully monitored.

If many of the pregnant women were hospitalized for labor and delivery, the proportion of women who were hospitalized for only coronavirus infection and became severely ill — those advancing to the I.C.U. or ventilation — would be even higher, said Dr. Denise Jamieson, a member of the Covid-19 task force at the American College of Obstetricians and Gynecologists.

“I think the bottom line is this: These findings suggest that compared to nonpregnant women, pregnant women are more likely to have severe Covid,” she said.

Pregnancy transforms the body’s biology, ramping up metabolism, blood flow, lung capacity and heart rate. It also suppresses a woman’s immune system to accommodate the fetus — a circumstance that can increase her susceptibility to respiratory illnesses like influenza.

  • Frequently Asked Questions and Advice

    Updated June 24, 2020

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      A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.

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      The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.

    • What is pandemic paid leave?

      The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.

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      So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.

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      Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.

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      A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.

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      The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.

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      Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.

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      If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)

    • What should I do if I feel sick?

      If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.


Because of this heightened risk, scientists have been closely monitoring pregnancy outcomes in various coronavirus studies. So far, few studies have indicated a significant risk for pregnant women or for their children. Infections in newborns have been exceedingly rare.

Still, as the pandemic has progressed, prenatal care has been severely disrupted, Dr. Shah said, and women are being hospitalized for conditions that might have been caught and treated much earlier.

“Things that might have happened in an office setting are happening in a hospital triage setting,” he said.

Dr. Jamieson pointed to a recent study of pregnant women at New York City hospitals who were asymptomatic at admission. Of the 241 women who tested positive for the coronavirus in that study, 48 did not have symptoms at first but then became severely ill.

The study also found that women with more severe symptoms were more likely to give birth prematurely.

“All this information points to the importance of being vigilant when it comes to monitoring pregnant women,” Dr. Jamieson said. “They’re not at as great a risk as, for example, older people, or people with other underlying medical conditions. But they do seem to be at some increased risk.”

The data suggests that hospitals should aim to test all pregnant women for the coronavirus, regardless of symptoms, she added. The new analysis also has implications for a coronavirus vaccine, whenever one becomes available.

“How strongly are we going to counsel pregnant women about the benefits of vaccines?” Dr. Jamieson wondered.

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