Danielle Barron outlines a number of research projects seeking to determine the impact of the new coronavirus on pregnancy and infant outcomes.
One of the goals of Safe Motherhood Week 2020 is to highlight the challenges that the coronavirus pandemic presents for maternal and neonatal care.
Pregnancy can be a worrying and anxious time, even in the absence of a global pandemic. The impact of the new coronavirus on pregnancy and birth outcomes is still being determined but the data filtering through so far highlights the need for pregnant women and recently pregnant women to take all precautions to avoid COVID-19 disease, in particular, if they have underlying conditions.
A recent study from the US Center for Disease Control (CDC) COVID-19 Response Pregnancy and Infant Linked Outcomes Team suggested that pregnant women with COVID-19 are more likely to be hospitalized and are at increased risk for intensive care unit (ICU) admission and receipt of mechanical ventilation than nonpregnant women.
Meanwhile, a paper by the PregCOV-19 Living Systematic Review Consortium published in the BMJ in September determined that pregnant and recently pregnant women are less likely to manifest Covid-19 related symptoms of fever and myalgia than non-pregnant women of reproductive age and also found they are potentially more likely to need intensive care treatment for Covid-19. Pre-existing comorbidities, high maternal age, and high body mass index seem to be risk factors for severe Covid-19. The researchers also noted that preterm birth rates are higher in pregnant women infected with the virus than in pregnant women without the disease.
Consequences of infection with SARS-CoV-2 for pregnant women are uncertain, as epidemiological and clinical information is missing so far in this population. As part of efforts to develop a body of robust evidence, Alice Panchaud and Professor David Baud (both ConcePTION members) were involved in the establishment of COVI-Preg, an international registry for pregnant women exposed to SARS-CoV-2 as well as future emergent pathogens. By using their highly-developed network of 198 antenatal clinics from 23 countries in Africa, Asia, Europe, Oceania, and the Americas, they are using the vast experience they gained investigating the impact of the Zika virus on pregnant women and their infants to gain insight into how Covid-19 affects pregnancies and birth outcomes.
Pregnant women require particular attention in terms of emerging infectious diseases due to their relative immunosuppression, reduced respiratory capacity and the possibility of vertical transmission, explains Panchaud, who is a clinical pharmacist with a special interest in the safety and effectiveness of drugs during pregnancy and lactation based in Lausanne, Switzerland.
She says that maternal morbidity, pregnancy complications and adverse neonatal outcomes have been associated with previous pathogens such as H1N1 Influenza A, Dengue, Zika and Chikungunya viruses.
The coronavirus has only been around for nine months, the length of a typical pregnancy. While the impact of a third trimester infection, including its association with a higher rate of peripartum maternal complications, is becoming better understood, data regarding fetal/neonatal outcomes after maternal infection during the first and second trimester of pregnancy is only just emerging.“Moreover, growing evidence suggests that vertical transmission of SARS-CoV-2 cannot be ruled out, with its fetal impact yet to be determined,” notes Panchaud.
It is critical that emerging evidence on pregnancy and Covid-19 is collected in a rigorous, scientifically meaningful fashion, she adds.
“Reliable risk estimates, effectiveness and safety of treatments or vaccination, prevention strategy effectiveness, the impact of routine pregnancy follow-up examination, non-compliance and the understanding of basic physiopathology are currently lacking in the global perspective of the consequences of COVID-19 for mother-infant pairs,” says Panchaud.
A rigorous collection of meaningful data is the only way to provide the reliable information necessary to develop intervention strategies and allow for the tailoring of information for the relevant stakeholders, such as policy makers, healthcare providers and of course pregnant women.
With many parties keen to learn, it is vital that research efforts must aligned on this topic.
“A lot of the outcomes studied in pregnancy are not very frequent although associated with lifelong implications, and thus require very large datasets to be studied,” Panchaud explains.
“This is only possible at a multinational level with researchers collecting information in a way that allows the data to be merged before harnessing them to assess these risks.”
COVI-Preg has thus been designed to allow multinational structured data collection. “It is a free tool that can be used by researchers to gather and harness their data at a local or national level, while participating in a more global effort,” says Panchaud, who notes that thousands of pregnancies across the world are now enrolled.
COVI-Preg is part of another large scale effort, the CONSIGN (Covid-19 infectiOn aNd medicineS In preGNancy), which is looking at the impact of COVID-19 infection and medicines in pregnancy. This itself is part of efforts led by the European Medicines Agency (EMA) to support the monitoring of the efficacy and safety of COVID-19 treatments and vaccines when used in day-to-day clinical practice.
The goal of CONSIGN is to help guide decision-making about vaccine indication, vaccination policies and treatment options for COVID-19 in pregnant women by gathering real world evidence as the pandemic progresses. Members of the project will analyse existing data sources (e.g. electronic health records, hospital data) and cohorts of pregnant women to provide information on the effect of infection and its treatments in different trimesters of pregnancy, as well as on newborns.
The project is a collaboration with the ConcePTION consortium, which was established under the EU’s Innovative Medicines Initiative. A unique public-private partnership, ConcePTION aims to create a paradigm shift in how evidence on the effects of medication in pregnancy is generated and disseminated by connecting existing data sources in a way that delivers better and more timely evidence.
The COVI-PREG project and the International Network of Obstetric Survey Systems (INOSS) network complete the trio of collaborators.