Pregnant women who contract COVID-19 are 22 times more likely to die, and 50 per cent more likely to experience pregnancy-related complications than expecting women unaffected by COVID-19, according to a global study of over 2,100 pregnant women across 18 countries, including Pakistan, published in JAMA Paediatrics.
AKU faculty Professor Zulfiqar A. Bhutta, Dr Shabina Ariff, Dr Ghulam Zainab, Dr Lumaan Shaikh and Dr Khalil Ahmed from the departments of paediatrics and child health, and obstetrics and gynecology contributed to the study which recruited over 300 pregnant women from Pakistan to the global study.
The INTERCOVID study – led by the University of Oxford – involved collaborations with 43 maternity hospitals from low, middle and high-income countries to conduct one of the first detailed comparative studies into the effects of the coronavirus on outcomes for mothers and babies during the pandemic. The study is unique because each woman affected by COVID-19 was compared to two non-infected pregnant women giving birth at the same time in the same hospital.
The researchers sought to understand the effects of COVID-19 in pregnancy by collecting robust data on expecting women with and without a diagnosis of COVID-19, an important step to ensure that families understand the risks involved, mothers and babies receive the best possible care and health resources, such as vaccines, are appropriately allocated.
They found that women with COVID-19 during pregnancy were at increased risk of pregnancy-related complications such as premature birth, pre-eclampsia, admission to intensive care and death. 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.
“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,” said Stephen Kennedy, professor of reproductive medicine at the University of Oxford, who co-led the study. “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 pregnant women.”
Around 1 in 10 babies of mothers who tested COVID-19 positive during pregnancy also tested positive for the virus during the first few days after birth. Explaining the implications of this finding, José Villar, professor of perinatal medicine at the University of Oxford, who co-led the study, 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.”
Researchers stated that current evidence shows that breastfeeding is safe, even if mothers have COVID-19, and its benefits outweigh the potential risk of transmission. Breastfeeding should continue to be promoted with mothers being encouraged to take preventive measures such as washing their hands and wearing face masks while nursing, they added.
AKU faculty recruited over 300 pregnant women in Pakistan to the global study. They noted that women with COVID-19 and babies in Pakistan had better outcomes than the rest of the world, with lower pre-term births, intensive care unit admissions, neonatal oxygen requirements and length of hospital stay.
“Our findings merit further exploration as to why Pakistani mothers and newborns fared better than the rest of world,” said AKU’s Dr Shabina Ariff, primary investigator of the study in Pakistan. “A possible explanation may be that we have had fewer and less virulent COVID-19 variants in Pakistan. Inherent immunity and differences in the level of care received at the hospital may also have played a role. Future studies will be needed to substantiate these points.”
In the Pakistan cohort, only two babies, born to mothers with COVID-19, tested positive for COVID-19. While both were born pre-term and required admission to the neonatal intensive care unit for respiratory distress, they did not require invasive support such as ventilators.
AKU faculty have collaborated with the University of Oxford-led consortium of over 100 researchers around the world on three studies prior to INTERCOVID under the INTERGROWTH-21st Project series of studies into global maternal and child health.
The INTERCOVID study demonstrates the importance of partnerships in collecting large-scale multinational data quickly during a health crisis, as researchers were able to complete the study in only 9 months, using infrastructure that was already in place from previous studies.
Oxford University’s Professor Villar said: “The existing INTERGROWTH-21st infrastructure was critical in enabling researchers worldwide to implement this urgent initiative in record time, and their commitment to the study was remarkable. Examining the long-term effects on mothers and children is the next challenge.”