When pregnant women contract COVID-19, one in 10 will have moderate, severe or even critical symptoms, a new study finds.

So it’s important they get their COVID vaccines, experts say.

“Given that patients in all trimesters of pregnancy are susceptible to infection and severe respiratory illness from COVID-19, these findings add urgency to the need for vaccination of all pregnant individuals,” said study co-author Dr. Rachel Schell. She’s an assistant instructor in obstetrics and gynecology at UT Southwestern in Dallas.

An estimated 182,000 pregnant women have been diagnosed with COVID-19 in the United States during the pandemic to this point. Past research has shown they have an increased risk of severe and critical disease compared to people who are not pregnant.

For this study, researchers collected data on just over 1,300 patients who had tested positive at some point during their pregnancy and then delivered babies between March 2020 and September 2021 at Parkland Health in Dallas.

About 8% of these women tested positive while in their first trimesters, 27% in the second and 65% during the third trimester.

About 10% of the patients who had been asymptomatic developed symptoms, and 10% of those infected had moderate, severe or critical symptoms.

There was no statistically significant difference in symptoms related to the stage of pregnancy, the researchers said.

“In the rapidly evolving landscape of the COVID-19 pandemic, this study provides information regarding the natural course of COVID-19 infection in pregnancy,” Schell said in a university news release. “This may be useful for clinicians to effectively counsel patients and direct care.”

The study found no increased risk of adverse outcomes, such as stillbirths, among babies or their mothers who were infected with COVID. The researchers in this study could not analyze potential associations between outcomes and severity of COVID-19 symptoms.

The findings were published Nov. 22 in the American Journal of Obstetrics and Gynecology MFM.

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Victoria Male, a digestion and metabolism professor at Imperial College London, has published a Perspectives piece in the journal Science addressing reports of COVID-19 vaccines having various impacts on menstruation. In her article, she notes that thus far, research has shown that such vaccines can cause small, temporary changes in menstruation.

Shortly after vaccinations were introduced to protect people against COVID-19, women around the world began reporting changes to their periods after being vaccinated—some noticed longer cycles and others heavier bleeding. Because the reports did not suggest problems serious enough to investigate, the makers of the vaccines did not include testing for menstrual impact during their trials.

Male suggests that the result was hesitancy on the part of some women to be vaccinated, fearing that doing so could lead to other unknown problems, such as fertility issues. And this, she adds, added fuel to the fire of misinformation campaigns aimed at COVID-19 vaccines.

In her paper, Male notes that other researchers have since looked into the matter by conducting studies and in so doing have found evidence showing that some COVID-19 vaccines do indeed have an impact on the menstrual cycle—though, she notes, such impacts have been found to be both small and temporary. She also points out that it is still not known why this happens.

She suggests it might have something to do with the cytokines that are produced after inoculation and their impact on the signaling that occurs between the pituitary gland, the hypothalamus and the ovaries. Another possibility, she suggests, is that the vaccines have an as yet unknown impact on immune cells that are involved in tissue repair of the lining of the uterus after it is shed during menstruation. She notes also that it is still not known if being infected with COVID-19 has any impact on the menstruation cycle.

Male observes that testing of new drugs in general typically does not include measures taken to ascertain whether they impact the menstrual cycle—a situation that she suggests the medical community should consider. Such efforts, she notes, even if nothing is found, would go a long way toward reassuring women that gender issues are being taken seriously.

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Many females receive human papillomavirus (HPV) vaccination after the recommended ages, often after sexual debut, according to a research letter published online Oct. 21 in JAMA Network Open.

Didem Egemen, Ph.D., from the National Institutes of Health in Bethesda, Maryland, and colleagues used data from the National Health and Nutrition Examination Survey to estimate the proportion of females who were vaccinated before sexual debut and examined the association of delayed vaccination with the prevalence of HPV-16/18.

The researchers found that the prevalence of cervical HPV-16/18 decreased from 6 percent in the unvaccinated group to 3 percent in the postdebut group and

“This study highlights the importance of timely vaccination against HPV, particularly before sexual debut, ” the authors write.

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Stillbirth is a recognized complication of COVID-19 in pregnant women caused by harmful changes to the placenta induced by the virus. Termed SARS-CoV-2 placentitis, it can render the placenta incapable of providing oxygen to the fetus, leading to stillbirth and neonatal death. Researchers now suggest that pregnant women who get the COVID-19 vaccine may be protected from SARS-CoV-2 placentitis and stillbirth. In a new article published in the American Journal of Obstetrics & Gynecology, researchers conclude that the vaccine not only protects pregnant women but may also be lifesaving for their unborn children.

The extensive examination of published literature involved reviewing nearly 100 papers looking at COVID-19’s impacts on pregnant women and the effects on the placenta and pregnancy outcome. Sarah Mulkey, M.D., Ph.D., a prenatal-neonatal neurologist in the Division of Prenatal Pediatrics at Children’s National Hospital and co-author of the article, says the findings make a strong case for vaccination.

“The COVID-19 virus fortunately does not cause birth defects like other viruses such Zika, but it can cause severe injury to the placenta that can result in stillbirth and other pregnancy complications,” says Dr. Mulkey. “I hope patients who are pregnant or planning to become pregnant can learn how the COVID vaccine may help keep them and their baby healthy throughout pregnancy from some of the worst effects of this virus.”

While stillbirths can have many causes, the data analyzed supports that the COVID-19 vaccine is beneficial for pregnancies and for reducing the risk of stillbirth by reducing the risk of the virus impacting the placenta.

“In the multiple reports of SARS-CoV-2 placentitis that have been associated with stillbirths and neonatal deaths, none of the mothers had received COVID-19 vaccinations,” says David Schwartz, M.D., lead author, epidemiologist and perinatal pathologist. “And although not constituting proof, we’re not aware, either personally, via collegial networks, or in the published literature, of any cases of SARS-CoV-2 placentitis causing stillbirths among pregnant women having received the COVID-19 vaccine.”

Earlier in 2022, Dr. Schwartz led a team from 12 countries that found SARS-CoV-2 placentitis destroyed an average of 77.7% of placental tissue, resulting in placental insufficiency and fetal death, all occurring in unvaccinated mothers.

Fortunately, the large majority of pregnancies affected by a COVID-19 infection do not result in stillbirth. The development of SARS-CoV-2 placentitis is complex and likely involves both viral and immunological factors. The characteristics of a SARS-CoV-2 variant may also affect risk.

“Placental pathology is an important component in understanding the pathophysiology of SARS-CoV-2 infection during pregnancy,” says Dr. Mulkey

As part of the Congenital Infection Program at Children’s National, Dr. Mulkey has been following infants born to mothers who had SARS-CoV-2 infection during pregnancy since the beginning of the pandemic. She will present the results of the early neurodevelopment of these infants at ID Week in Washington, D.C., on Oct. 22, 2022. Dr. Mulkey will also lead the neurodevelopmental follow-up of a large cohort of infants born to mothers with SARS-CoV-2 infection during pregnancy to better understand any long-term neurological effects to offspring.

The study builds upon Dr. Mulkey’s longitudinal studies on Zika virus infection in pregnancy and long-term impacts on the child.

Children’s National Hospital

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