Research on the effects of COVID19 in pregnancy is still a priority

The COVID19 pandemic seems to be tampering down with both infection rates and death rates falling in many countries. Therefore, restrictions put in place to reduce the impact on national health systems are gradually being lifted across the world. One of the highlights for infertility patients is the reopening of fertility clinics in many countries.

Now the European Society for Human Reproduction and Embryology (ESHRE), American Society for Reproductive Medicine (ASRM) and International Federation of Fertility Societies (IFFS) have issued a joint statement. This explains their support for the resumption of routine fertility treatment. Based on scientific evidence, they feel the continuity of care is important for personal well-being and international fertility rates. They stand behind a gradual and judicial return to the full resumption of treatments.

What happened?

In mid-March, as the infection took off around the world, both ESHRE and ASRM advised the closure of fertility clinics. This was because the effect of COVID19 on pregnant women was unknown. This was a sensible decision based on what we know about some diseases affecting pregnancy. There was also a secondary reason, to consolidate resources of medical personnel to combat the epidemic. It was all hands-on deck, so elective procedures deemed non-essential were cancelled. Unfortunately, fertility services fell into that category.

Happily, this state of affairs didn’t last long. By mid-April the societies were able to begin considering the resumption of services and compiled new guidelines. These new recommendations included:

  • Staff and patient safety
  • Emergency planning for COVID secure units
  • Effective use of limited resources

What do we know about the effects of COVID19 on pregnancy?

Firstly, knowledge of how the virus affects reproductive cells, pregnancy and newborns remains limited.

But there have been some initial studies:

  • An early review in China of 9 pregnant COVID19-positive women concluded that their clinical picture was the same as non-pregnant women. There was no evidence of transmission of COVID19 to the newborn babies
  • The World Health Organisation (WHO) also reported no difference between the clinical picture of pregnant women compared to non-pregnant women
  • A more extensive review of 108 COVID-19-confirmed pregnancies in studies and case reports, mostly from China published up to 1 April. This found that most mothers were discharged after delivery without any major complications. Even though some mothers had severe COVID19 symptoms.

–  The women studied had usually come to hospital with a fever at and persistent dry cough

–  There was a high rate (91%) of cesarean delivery

–  Only one of 75 newborns tested positive for COVID-19. Mother to baby transmission can’t be ruled out.

Largest study

The largest study to date would appear to be from the UK’s Obstetric Surveillance System, which provides data on 243 COVID-19-confirmed births.

– In this study about one in 10 of those admitted required respiratory support and 12% were delivered preterm solely because of the mother having breathing problems.

–  243 women who gave birth, 74% did so at term

–  59% gave birth by cesarean section

–  Most women had good outcomes

–  The health of the newborns was largely reassuring

–  2% of babies tested positive for viral RNA, suggesting that transmission had occurred between mother and baby.

–  A study of 215 pregnant women at a single New York hospital found that 29 of the 33 patients who were positive for COVID19 at admission had no symptoms.

The initial evidence appears to suggest:

  1. That the majority of COVID19-positive pregnant mothers do not have severe illness
  2. Transmission of infection to infants from their mothers may occur but is uncommon.

While the current picture is somewhat reassuring, we should not be complacent. This is why there is an ongoing effort by the three societies. They continue to collect and assess data on pregnancy and birth as we come out of lockdown.

Ongoing research

  • US research: ASPIRE (Assessing the Safety of Pregnancy in the Coronavirus Pandemic study by the University of California, San Francisco monitors the effects of COVID-19 during pregnancy in US hospitals, particularly during the first trimester
  • European research: ESHRE has put in place a survey among its members to collect data and monitor pregnancy in COVID-19 positive women

Other research is also taking place in other regions of the world and the scientific community, together with the WHO, is also keeping a careful eye on developments.

With any new disease, it’s like a ship navigating an uncharted arctic sea! It’s wise to proceed slowly and carefully. We must rely on the good eyes of the lookouts to warn of icebergs. And in ESHRE, ASRM, IFFS, the WHO and the scientific community we have some excellent lookouts.