Review: In women of reproductive age with COVID-19, pregnancy confers worse CV outcomes – Healio

August 10, 2022

2 min read

Disclosures: Briller reports serving on the steering committee and as a site investigator for the REBIRTH trial. Please see the review for all other authors’ relevant financial disclosures.

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In women of reproductive age who have COVID-19, those who are pregnant are more likely to have poor CV outcomes than those who are not, according to a review published in JACC: Advances.

“Data suggest increased risk of adverse outcomes in pregnant compared with nonpregnant women of reproductive age with COVID-19 infection, including need for intensive care unit admission, mechanical ventilation and extracorporeal membrane oxygenation utilization,” the researchers wrote.

pregnant woman
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The CV complications of COVID-19 that may be seen in this population include MI, arrhythmias, HF and long-haul symptoms that mimic CV complications of pregnancy, the researchers wrote.

“Pregnant people need to know that they are increased risk of a severe COVID-19 infection, including ICU admissions, cardiac complications, need for critical care and death for the patient or fetus. Unfortunately, pregnant women have lagged behind other groups getting vaccinated,” Joan Briller, MD, a cardiologist and professor of clinical obstetrics and gynecology at the University of Illinois at Chicago, said in a press release. “Available data support vaccination in pregnancy with good safety profile and protective transfer to neonates. The CDC, American College of Obstetrics and Gynecologists, and Society of Maternal-Fetal Medicine, among others, recommend vaccination in pregnancy. I believe we should support this recommendation with our patients.”

Previous statements addressing CV complications of COVID-19 did not include those which appear similar to CV complications of pregnancy, including peripartum cardiomyopathy, spontaneous coronary artery dissection and preeclampsia, the authors wrote, noting that such complications can lead to early delivery and other modifications of management of pregnancy.

Management strategies for cardiac complications in pregnancy can be adapted for pregnant patients with COVID-19, including the assembly of a Pregnancy Heart Team, which should comprise “providers comfortable with high-risk pregnancy, obstetric anesthesia, cardiology, critical care and neonatal care, depending on the nature of the complication, stage of pregnancy and severity of disease,” the authors wrote.

If a pregnant patient has myocardial injury due to COVID-19, medications should be adjusted to avoid teratogenicity and a multidisciplinary team should be convened to discuss timing of delivery and how best to stabilize the cardiac symptoms, Briller and colleagues wrote.

COVID-19 is known to elevate rates of preeclampsia in pregnant women, and women with COVID-19 in preeclampsia should be treated the same as women with preeclampsia but without COVID-19, they wrote.

“Most cardiac complications described outside of pregnancy such as arrhythmias, myocardial injury, thromboembolic complications, and long-haul symptoms are reported in women during pregnancy,” the authors wrote. “Additional concerns include increased risk of preterm labor and delivery and development of preeclampsia. Cardiologists should be vigilant in assessing women with COVID-19 for cardiac complications.”