How Does COVID Affect Pregnant Women And Their Unborn Babies?

My investigation today is the impact of COVID-19 on pregnant women. To be more specific, I am wondering what studies show on the impact of severe COVID on pregnant women and their unborn infants. 

Severe COVID runs a good chance of causing hypoxia. And if the mother is hypoxic, there is a good chance the fetus will be affected by this. So, extra efforts are being made to prevent fetal hypoxia. And this starts with maintaining a maternal oxygen saturation of 94% or above. What evidence supports this recommendation? 

About 40% of COVID patients develop ARDS. And about 20% of ARDS cases become severe. And those with severe COVID will require hospitalization. Pregnant women are at an increased risk of developing severe COVID and require hospitalization than the general population. (1-3)

Most hospitals have guidelines for how best to treat pregnant mothers. As respiratory therapists, our main concern is oxygenation. For those who develop COVID pneumonia and result in severe COVID, hypoxia is the main concern. For most COVID patients, our hospital has a guideline of maintaining sats of 88% or better. But, for pregnant mothers, the goal is to maintain sats of 94% or better. So, is it necessary to maintain a higher sat in pregnant moms? I will attempt to answer this question. 

To better understand this topic, I read various articles on the Internet. And I reviewed various studies. Here is what I learned. 

The following are true about COVID and pregnancy: (4-5)

• COVID may increase the risk of maternal and neonatal morbidities. 
• Pregnant women admitted with COVID are at an increased risk of requiring a stay in a critical care unit. 
• Pregnant women with COVID are more likely to experience pre-term birth compared to those without COVID
• Pregnant women with COVID are more likely to require a C-Section, compared to those without COVID.
• Pregnant women are twice as likely to require a stay in critical care, compared to non-pregnant women. They also have a 70 percent greater risk of death. 
• The newborns of women with COVID are more likely to require a stay in a neonatal intensive care unit, compared to newborns of women without COVID. 
• Pregnant women with COVID have an increased risk of having a stillborn child, compared to women without COVID

How does COVID affect the fetus? (6)

• The percentage of neonates who develop COVID is "unlikely." Only 2.8% of neonates were born and diagnosed with COVID.  
• Due to COVID, there is an increased risk for placental insufficiency. 
• Twenty percent of COVID-positive mothers were diagnosed with intrauterine hypoxia with placental abnormalities. This results in placental insufficiency that may impact the fetus. 
• Placental damage may cause fetal hypoxia. In other words, lack of oxygen to the placenta may cause placental infarctions leading to fetal hypoxia. 
• Sixty-four percent of mothers with an abnormal placenta had placental infarctions

This is just some of the evidence regarding COVID-positive moms and the impact of COVID on their fetuses and newborns. There is still much more to be learned. Although, we can clearly see a picture where severe COVID

References:

1. Rai, et al., "Post COVID pulmonary fibrosis: Is it a real threat?" Indian Journal of Tuberculosis," 2021, July, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7654356/, accessed 12/5/2021
2. Alhiyari, et al, "Post COVID-19 fibrosis, an emerging complication of SARS-CoV-2 infection," ID Cases -- Journals, 2020, December 31, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7785952/, accessed 12/5/2020
3. "Risk for Stillbirth Among Women With and Without COVID-19 at Delivery Hospitalization — United States, March 2020–September 2021," CDC, 2021, November 26, https://www.cdc.gov/mmwr/volumes/70/wr/mm7047e1.htm, accessed 12/17/2021
4. Epelboin, et al., "Obstetrical outcomes and maternal morbidities associated with COVID-19 in pregnant women in France: A national retrospective cohort study," PLOS Medicine, https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003857, accessed 12/16/2021
5. "CDC Statement on Pregnancy Health Advisory," CDC, 2021, September 29, https://www.cdc.gov/media/releases/2021/s0929-pregnancy-health-advisory.html, accessed 12/17/2021
6. Abdelmasseh, et al., "COVID-19 during pregnancy should we really worry from vertical transmission or rather from fetal hypoxia and placental insufficiency? A systematic review," Egyptian Pediatrician Association Gazzette, 2021, April 12, https://epag.springeropen.com/articles/10.1186/s43054-021-00056-0, accessed 12/17/2021