Severe cases of Covid-19 during pregnancy increase risk of preterm delivery

Facing the second year of pandemic caused by Covid-19, it is not new that pregnant women tend to develop more severe cases of the disease when infected during the nine months. However, developments in science have allowed studies to uncover possible long-term consequences for mother and baby after infection, such as increased risk of having a premature birth if there is a severe picture of the infection During pregnancy.

The discovery was achieved through a study conducted by the National Institute for Health Research HS&DR Program and Wellbeing of Women and published in the scientific journal Acta Obstetricia and Gynecologica Scandinavica, in February of this year. The research analyzed 4,436 symptomatic pregnant women who were admitted to 194 hospitals in England between March 1, 2020 and October 31, 2021 and whose cases were registered in the UK Obstetric Surveillance System.

Of these, 13.9% had severe cases of Covid-19 and were associated with a greater chance of giving birth earlier than expected – according to the research, they had a 50 times higher risk of having expedited deliverydelivering the baby by caesarean section, between the ages of 28 (great prematurity) and 32 weeks gestation (very premature).

With delivery ahead of schedule, these mothers had a 12 times higher risk of having their children admitted to neonatal intensive caresince prematurity requires a closer monitoring of the baby and early interventions so that the little one develops as expected.

The survey also profiled those women who had the most severe version of the coronavirus. They were aged 30 or older, of mixed ethnicity, and were overweight or obese, in addition to Gestational Diabetes. As observed with the rest of the population, the last two conditions are perceived as comorbidities that lead people to be disease risk group.

The risks are higher in case of infection in early pregnancy

The scenario observed in the study published in February was already beginning to be designed in another important research, published in The Lancet Digital Health. Published in January 2022, it was conducted by academics who analyzed electronic records from the Providence Health & Services system of 73,666 pregnant women who gave birth between March 5, 2020 and July 4, 2021.

Among them, 882 tested positive for Covid-19 during the nine months: 85 were diagnosed with the disease in the first trimester of pregnancy, 226 in the second and 571 in the third. With this split, the study was able to conclude that women were at a greater risk of having a premature birth regardless of when they were infected, however, the odds seemed more pronounced if the infection had occurred. during the first trimester of pregnancy.

The possible explanation presented in the investigation is that in early pregnancy there is a higher level of the enzyme ACE2 in the placenta, which interacts with the spike protein Sars-Cov-2, facilitating entry of the virus and contamination of the gestational uterus. organ. Consequently, increase the risk of fetal distress and, later, premature birth.

Remember that vertical transmission (from mother to baby, via the placenta), although reported, remains a rare mode of infection.

Thus, the defense of the study is that, in the same way that pregnant women infected with Covid-19 during the last trimester of pregnancy should be closely monitored, the same should be done with those who are infected during the last trimester of pregnancy. early pregnancy. Thus, it is possible to describe the possible long-term consequences for the mother and the baby, and to reinforce the importance of vaccination against pandemic disease still during pregnancy.