Living in the time of the pandemic was a test. Difficult for everyone, but even more so for women who were going through a unique and special period like pregnancy. It is now internationally agreed that contracting Sars-CoV-2 during gestation places women at greater risk for Covid disease and Long Covid complications. But what was not yet known is how the pandemic context – studded with lockdowns, movement restrictions, cloistered anxiety and controls lost for fear of infections in the hospital – affected the health of pregnant women, and reverberated on possible adverse outcomes in pregnancy.
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To shed light on these aspects is now a study carried out by the Department of Environmental Health at Boston University, published in Jama Network Open, which analyzed data on almost 153,000 births in the United States during the first and second pandemic waves, from the beginning of March to the end of December 2020 (the information was obtained from a database that collects requests for coverage of expenses medical services addressed to commercial health insurance companies which in the US are the cornerstone of the welfare system).
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The researchers investigated the complications that occurred during the Covid-era births, comparing them to those recorded the year before the pandemic, in the same time interval (for the reference period, over 172,000 births were evaluated from March to December 2019). And they found that in the pandemic waves the risk of gestational diabetes increased (+ 12.5% of the number of births examined), followed by that of gestational hypertension (+ 7.3%), of low fetal weight (+6.9 %) and preeclampsia (+ 4%), a potentially dangerous complication for both mother and baby, which is associated with high blood pressure and the presence of protein in the urine. On the other hand, no variance in risk was found for stillbirths and only modest evidence of a lower risk of preterm birth was identified.
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The study is the largest and most comprehensive study carried out so far on the impact of Covid-19 on complications in pregnancy, and also assessed the overall results of the almost 325,000 births in the two periods 2019 and 2020 considered cumulatively, highlighting the complications premature rupture of membranes (10.3% of all births analyzed), gestational diabetes (9.3%) and gestational hypertension (8.5%) are more common than pregnancy.
There are, however, intrinsic limits to the investigation, as the researchers themselves report, because there is a lack of specifics on the age of pregnant women, for example, only insurance coverage codes are relied on to check for complications and the incidence is not known. of Sars-CoV-2 infection on pregnant women examined.
“Even with all these limitations, the study is interesting because it photographs two historical series putting large numbers in a row – he comments Elsa Viora, gynecologist and president of the Italian Hospital Obstetricians and Gynecologists Association (AOGOI) – and reminds us how the prevention of pregnancy complications is linked to many aspects, from nutrition to lifestyles, without forgetting visits and checks along the of gestation “. Attention that the pandemic disorientation has cracked, if you think of the reduced possibility of access to care, but also of the generous licenses – starting with food – that we granted during the home confinement.” Diabetes, for example , is emblematic of the lifestyle of the expectant mother, and the first thing that comes to think when reading the data of the study is that women have been poorly followed, not catching those alarm bells such as weight gain or lack of activity physics that should not be neglected in pregnancy, a period in which the woman must not “eat for two” or more, but better – Viora emphasizes – so the low fetal weight, which correlates even with the condition of arterial hypertension of the future mother (it is no coincidence that these two complications report a similar percentage of risk in the study), and again preeclampsia, the most serious complication, but whose incidence decreases thanks to the controls that allow you to follow the woman with all the attention “.
With regard to psychological distress, a study published in theAmerican Journal of Obstetrics & Gynecology confirmed that external and traumatic events such as the Coronavirus pandemic can raise the level of stress, which affects neuroendocrine interactions between mother and unborn child, as well as the immune response, and can be associated with pregnancy complications.
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Covid has triggered profound changes in lifestyles, physical and mental health, supply and access to health services, highlights the Boston University survey, and their impact can be read in watermark right in the numbers of the complications of the births. With a caveat: these conclusions cannot be generalized outside the United States. In Italy, for example, the clinics and counseling centers were largely closed in March 2020, but from the following month the birth and assistance services for pregnant women were reopened in compliance with the regulations. Despite this, as some studies on small numbers document, during the pandemic period there was less possibility of access to treatment by pregnant women.
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“It is difficult to make comparisons between two different worlds, but there remains a powerful alert that this study transmits to us: be careful not to take anything for granted – explains Viora – The birth path, which guarantees visits and assistance to all women, has a role indispensable to ensure the reduction of complications and the well-being of women, as is the case today. But if we withdraw even a little in guaranteeing access to treatment, the goals we have achieved risk being lost much more quickly than one can imagine “.
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