Since the COVID-19 pandemic began, the effect of the coronavirus on pregnancy has been a worrisome mystery; with little data available, the Centers for Disease Control and Prevention website had previously said there was no evidence that pregnancy was a risk factor for COVID-19. But last week, the CDC updated its website to include pregnant women, particularly Black and Hispanic women, among those who may be at increased risk of severe illness from COVID-19 — an important finding as the medical profession learns about the virus that has so far infected over 2.8 million in the United States alone and 11.4 million worldwide.
A Morbidity and Mortality Weekly Report released by the CDC on June 16 found that “among women of reproductive age with COVID-19, pregnant women are more likely to be hospitalized and at increased risk for ICU admission and receipt of mechanical ventilation compared with nonpregnant women.”
The reassuring news in the report was that pregnancy did not appear to increase the risk of death from COVID-19.
So far there is no evidence that the coronavirus has a negative effect on the fetus, though the CDC is warning about the possibility of an increased risk of adverse pregnancy outcomes such as preterm birth.
The findings are based on reports of 326,335 women of reproductive age received by the CDC from Jan. 22–June 7, which concluded that 31.5 percent of pregnant women with COVID-19 were hospitalized, compared to 5.8 percent of nonpregnant women. The report cautions that pregnancy status was missing for three quarters of women of reproductive age, and that it’s not clear if the women were hospitalized because of COVID-19 or if they were admitted for something else related to their pregnancy and also happened to have COVID-19. But even before the potential consequences of COVID-19 on pregnant women were revealed, the risk of other respiratory illnesses were well-known.
“It isn’t a surprise that pregnant women would be more at risk for developing severe illness if they developed COVID-19,” says Dr. Uché Blackstock, a Yahoo News medical contributor and CEO of Advancing Health Equity. “Essentially, pregnant women have a relatively depressed immune system, meaning the immune system doesn’t work as strongly as nonpregnant people. And one the reasons why is because if their immune systems did work very strongly, they would reject the growing baby inside of them.”
This weaker immune system is also a reason pregnant women are at increased risk for severe illness from influenza and other diseases.
“Changes in the immune, respiratory and cardiovascular systems that occur during pregnancy put pregnant women at risk of being more severely affected by certain infections, including influenza,” according to the CDC, which is why it’s recommended that pregnant women receive the flu vaccine each year and stay up to date on other routine vaccinations.
“I’m assuming once COVID-19 has a vaccine, we’ll want to make sure they get that vaccination as well,” Blackstock says.
The study also revealed that women who are Black or Hispanic may be disproportionately affected by COVID-19 during pregnancy. Among pregnant women with COVID-19, 46 percent were Hispanic, 22 percent were Black and 23 percent were white, although (based on last year’s figures) white women were a larger share of overall births.
Information on race and ethnicity was missing for 20 percent of pregnant women in the study, but the findings reflect the general racial disparities in COVID-19 cases that were evident early in the pandemic. Black people have an overall infection rate approximately five times that of white people, while Hispanic or Latino people have a rate approximately four times that of white people. The CDC notes “long-standing systemic health and social inequities” have put some members of minority groups at increased risk for COVID-19. Poorer living conditions in densely populated areas, a higher representation among essential workers without paid sick leave, and a higher rate of underlying health conditions with less access to quality health care are all cited as factors contributing to Black people being more affected by the virus.
“I do think that these disproportionate numbers that we’re seeing in terms of Black and Hispanic women being represented among pregnant people being admitted and hospitalized for COVID-19 is a representation of a larger issue of racism,” Blackstock says.
As Blackstock observes, years before the coronavirus pandemic, the maternal mortality crisis among Black women in the U.S. had been gradually receiving more media attention. For expectant mothers over the age of 30, the pregnancy-related mortality rate for Black women is four to five times higher than for white women, according to 2007-2016 national data. And the disparity exists regardless of socioeconomic background; for Black women with at least a college degree, the pregnancy-related mortality rate was 5.2 times that of equally educated white women.
“Even Black women with a professional degree, or from a higher socioeconomic background, we still see that same maternal mortality gap,” Blackstock says.
“So we know this isn’t necessarily about even just having access to health care. It’s about having access to health care environments where Black women are seen and heard.”
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