New research shows pregnant women face higher risks and increased susceptibility to long-term COVID, with potential in-utero effects.
Long COVID, a condition that lingers for at least three months following a SARS-CoV-2 infection, affects individuals of all ages and across various degrees of initial disease severity. Predominantly diagnosed in adults aged 36 to 50, the majority of long COVID cases occur in non-hospitalized individuals who experienced only mild symptoms during the acute phase. Symptoms of long COVID may manifest singly or in various combinations, presenting intermittently, worsening over time, or fluctuating between improvement and deterioration. In this article, we uncover new research on the impact of long COVID on pregnant women and how this population is actually more vulnerable to it than previously thought.
Prevalence: Long COVID Through the Pandemic
Initially, the prevalence of long COVID was estimated at 65 million, assuming a 10% incidence rate. However, research published in the New England Journal of Medicine has indicated that incidences have dropped significantly from earlier variants to the Omicron era. Unvaccinated persons saw a decrease from 10.42 events per 100 in the pre-Delta era to 7.76 in the Omicron era. In comparison, vaccinated individuals reported even lower rates, from 5.34 events per 100 during Delta to 3.50 in the Omicron era.
Long COVID in Pregnant Women
Pregnant women with long COVID are an understudied patient population. Understanding how often long COVID affects pregnant women and the implications for both maternal and child health is vital.
Previous research from Ecuador involving 457 survey responders found that 54.1% reported long-term symptoms after SARS-CoV-2 infection. Notably, these symptoms predominantly affected non-pregnant women (94.0%), suggesting that while pregnant women do experience long COVID, their numbers are not significantly different from the general population.
New Findings on Long COVID and Pregnancy
On the contrary, in the recently published study in Obstetrics & Gynecology, they found that pregnant women are diagnosed with long COVID in higher numbers than the general public, and their symptoms are often misinterpreted for the normal signs of pregnancy.
A multicenter cohort study (NIH RECOVER [Researching COVID to Enhance Recovery]-Pregnancy Cohort) enrolled 1,502 pregnant individuals during their first SARS-CoV-2 infection across the United States. 61.1% had their first infection during the Omicron variant dominance (post-December 1, 2021), and 51.4% were fully vaccinated before their infection. The study found that 9.3% of participants developed long COVID, with a median follow-up of 10.3 months, which is vastly different from the 3.5% published in the New England Journal of Medicine study. The most common symptoms among the pregnant women with long COVID were post-exertional malaise (77.7%), fatigue (76.3%), and gastrointestinal symptoms (61.2%). They also found that the risk factors in pregnant women associated with long COVID are obesity, mental health conditions, economic hardship, and oxygen treatment.
Additional Health Concerns for Pregnant Women with Long COVID
In addition to the increased risk of long COVID, other studies have also shown that contracting COVID-19 during pregnancy increases the likelihood of several complications, such as preterm birth and developmental issues in newborns, compared to pregnant women without the virus. One research from China and highlighted in Scientific Reports suggests that those suffering from long COVID while pregnant are more prone to developing conditions like gestational hypertension and diabetes, as well as foetal intrauterine growth restriction.
The Next Generation: Long COVID’s Impact on In-Utero Exposed Children
The long-term effects of COVID-19 extend beyond those directly infected; researchers are now examining the potential impact on children whose mothers had the virus during pregnancy. The National Institutes of Health’s long COVID RECOVER Initiative is set to include children infected with COVID-19 and those whose mothers suffered from the virus while pregnant. Both groups of children, whether exposed in utero or not, will undergo neurodevelopmental assessments at multiple stages: 12, 18, 24, 36, and 48 months old. This research aims to understand the broader implications of maternal COVID-19 infections, including the risk of preterm birth and pregnancy complications associated with long COVID, on child development.
Guidance for Healthcare Professionals on Advising Pregnant Women Regarding Long COVID
When attending to pregnant women, healthcare professionals need to be vigilant in identifying potential long COVID symptoms, distinguishing them from typical pregnancy-related symptoms. One key indicator of long COVID is the persistence of symptoms like fatigue and post-exertional malaise, which do not alleviate over time like typical pregnancy symptoms do.
The treatment of long COVID also primarily focuses on symptom management, and it is crucial that healthcare professionals avoid generalising the safety of these treatments when treating pregnant women or breastfeeding mothers. Any medications prescribed to pregnant women must be safe for their developing child.
Healthcare professionals should advise pregnant patients to take similar precautions to prevent infection as the general public, including mask wearing, getting vaccinated, practising good hygiene, and practising safe physical distancing.
Conclusion
In conclusion, long COVID presents a significant and persistent health challenge, particularly for pregnant women and potentially affecting their children’s long-term health. This article has explored the significant risks associated with contracting COVID-19 during pregnancy, including an increased likelihood of developing long COVID, and the crucial role of healthcare professionals in managing these complexities. As research progresses, experts must refine targeted preventive measures and treatments to protect vulnerable populations and mitigate the broader impacts of this enduring condition.
References
- Davis, H. E., McCorkell, L., Vogel, J. M., & Topol, E. J. (2023). Long COVID: Major findings, mechanisms and recommendations. Nature Reviews Microbiology, 21(2), 133–146. https://doi.org/10.1038/s41579-022-00846-2
- Xie, Y., Choi, T., & Al-Aly, Z. (2024). Postacute sequelae of SARS-CoV-2 infection in the pre-delta, delta, and omicron eras. New England Journal of Medicine, 391(6), 515-525. https://doi.org/10.1056/NEJMoa2403211
- Metz, T. D., Reeder, H. T., Clifton, R. G., Flaherman, V., Aragon, L. V., Baucom, L. C. et. al. (2024). Post–acute sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) after infection during pregnancy. Obstetrics & Gynecology. Advance online publication. https://doi.org/10.1097/AOG.0000000000005670
- Yao, Y., Sun, L., Luo, J., & Zhang, J. (2024). The effect of long-term COVID-19 infection on maternal and fetal complications: A retrospective cohort study conducted at a single center in China. Scientific Reports, 14, 17273. https://doi.org/10.1038/s41598-024-68184-2
- Vásconez-González, J., Fernandez-Naranjo, R., Izquierdo-Condoy, J. S., Delgado-Moreira, K., Cordovez, S., Tello-De-la-Torre, A., Paz, C., Castillo, D., Izquierdo-Condoy, N., Carrington, S. J., & Ortiz-Prado, E. (2023). Comparative analysis of long-term self-reported COVID-19 symptoms among pregnant women. Journal of Infection and Public Health, 16(3), 430-440. https://doi.org/10.1016/j.jiph.2023.01.012
