Delivering facts: scientists start to birth answers to Covid during pregnancy

When not enough data or research is available, the void is filled with anecdotal evidence. This was the situation in May last year when the story broke of a newborn baby that had died in SA from Covid-19.

It shocked the country, especially as we were rushing headlong into the peak of the first wave.

But like many things related to this virus, which has been in our country for just over a year, it is not easy to separate out factors and say with any certainty what has caused what.

At the time of the baby’s death, the health department released a statement saying the child had also been born prematurely and required ventilation, and that this had made it difficult to say whether the baby died because of the virus.

“The mother had tested positive for Covid-19 and the child subsequently tested positive for Covid-19 as well. It is important to appreciate the complexities of the underlying condition of prematurity,” read the statement.

It has taken a year for the global science community to pin down the risks associated with Covid-19 if a woman is pregnant, but now, for the first time, there seems to be some clarity.

According to a paper published in science journal Nature this week: “Research from groups around the world has shown that pregnant women with Covid-19 are at higher risk of hospitalisation and severe disease than are women of the same age who are not pregnant.”

But it’s not all bad news.

Also reported in Nature, it now appears babies are “mostly spared a severe respiratory infection, and do not often get sick”.

At the height of the HIV pandemic, before ARVs, mother-to-child transmission was one of the biggest tragedies: babies were being born with HIV and many lost their mother, or both parents, shortly thereafter from the disease.

But in the case of Covid-19, according to the journal: “Samples from the placenta, the umbilical cord and blood from mothers and infants indicate that the virus rarely crosses from mother to foetus.”

However, some preliminary data suggest infection with the virus “can damage the placenta, possibly causing injury to the baby”.

Like most Covid-related topics, there are still many blank pages of research that need filling.

Themes needing further research include how widespread Covid-19 infection is among pregnant women overall (and not only those who present at clinics); whether women are more vulnerable to infection or its repercussions in any particular phase of pregnancy or post-partum recovery; and whether it is safe for pregnant women to have a Covid-19 vaccine.

“Following established norms, none of the major vaccine makers enrolled pregnant women in their first trials, although some current and planned trials now include them,” Nature reports.

“As health systems around the world began to churn out shots, regulators have offered conflicting or vague recommendations about whether pregnant women should be offered the jab.”

For many, it’s a balancing act between the data void of vaccine safety in pregnancy and the established dangers of acquiring the virus while pregnant.

Several experts provided commentary to Nature, however, and most said they would recommend pregnant women be offered the vaccine after medical consultation. 

That’s because women’s lungs are already under strain when they’re pregnant: the lungs have to work harder and the uterus pushes against the diaphragm as it grows, reducing lung capacity.

On top of that, the immune system of the mother “dials down so as not to harm the baby”.

For example, Kristina Adams Waldorf, an obstetrician and researcher at the University of Washington in Seattle, said: “Given what we know about the increased risk of hospitalisation, mortality, preterm birth — for me, it’s a no-brainer.”

Vaccine safety is not the only grey area.

“Multiple studies are converging on other risk factors that worsen Covid-19 in pregnancy,” Nature reports, “including obesity, high blood pressure and gestational diabetes.”

Further research and data are needed “to quantify the part each factor plays”.