We are all aware of the drastic global impact of Covid-19. We all lived during a major global pandemic which cost millions of lives, altered how we worked and learned, and impacted healthcare. Researchers, doctors, midwives, and global health organizations are scrambling to grasp if Covid-19 responsible for pregnancy complications.
During the initial and ongoing pandemic, statistics shows a noticeable jump in pregnancy complications. Multiple initial theories existed, but now science is not so sure of the impact of Covid-19 on pregnancy.
Is Covid-19 Responsible For Pregnancy Complications?
Ilhem Messaoudi, a professor of immunology at the University of Kentucky, said she and many of her colleagues have been surprised by the extent the pandemic has had on pregnancy complications. Being that Covid-19 was thought to be primarily a respiratory infection, the healthcare field did not expect reproductive organs and the placenta to be impacted.
However, pregnancy experts spent the last few years trying to understand the spikes in maternal complications. Initially, these complications were reported anecdotally, however they have since been verified in several large studies. There’s an extremely small, but still alarming, group of unusual stillbirths.
“I was naive,” Messaoudi reflected. “Now I wonder, ‘What else have we been missing?’”
The difficult part, it will take nearly a decade or more to truly be able to study and understand what impact Covid-19 truly had and may continue to have on pregnancy outcomes.
Initial Theories
There are some who felt immediate shifts in outcomes could be related to changes in care. Some routine tests were delayed in the beginning of the pandemic. Long hospital waits, staffing issues, etc., could have led to delays in care which otherwise would not have occurred.
However, with several studies complete, it appears there is an actual physiological impact of Covid-19. Yet it will still take time to know for sure.
Covid-19 is not the first viral threat to pregnancy. During the 1918 flu, there was also an increase in pregnancy complications and stillbirth. In 2015, Brazil and several other countries experienced complications from the Zika virus which increased the risk of stillbirth and congenital birth defects.
There are some encouraging findings, such as no evidenced of impact on male or female fertility. Neither the infection nor the vaccine is associated with any changes in fertility. While there may be a shift in one menstrual cycle, there are no ongoing fertility complications.
Covid-19 Pregnancy Complications
While the fertility news is great. Unfortunately, there is still a concern with pregnancy itself. While most people infected experience no complications, there are documented increased risks of:
- Preeclampsia
- Very small risk of stillbirth
- Hypertension
- Other complications.
Research remains unclear, but they believe the risks likely begin with changes in the blood and immune system of pregnancy people. While pregnancy can be magical, it is also a time of brutal physiological changes. There is an increased risk of stress on the heart and circulatory system. In fact, pregnancy people have a blood volume increase of 30-50%.
It turns out that Covid-19 can have a drastic impact on the immune system and cardiovascular systems. Covid-10 attaches to ACE2 receptors which are involved in regulating inflammation and blood pressure. Doctors found in some patients, the virus can lead to hundreds of microclots which can impact a pregnant person and growing baby.
Amy Heerema McKenney, a Cleveland Clinic pathologist, seemed to study the placentas of stillborn babies in rapid succession during the pandemic. While she had seen only 20 placentas in six months of studying them, it still marked a notable increase.
What was most concerning is the obvious differences between typical healthy placentas and those of the stillborn babies during the pandemic. McKenney noted they looked like nothing she had ever seen before: firm, scarred and more of a shade of tan.
“The degree of devastation was unique,” she said. She noted most of the women were in their second trimester, unvaccinated or only partially vaccinated, and infected with the coronavirus within a two-week window before their pregnancies ending.
Other Specialists Saw Similar Complications
Other researchers also noted similar complications.
A report from the Centers for Disease Control and Prevention involving 1,249,634 deliveries from March 2020 to September 2021 saw a similar link “Although stillbirth was a rare outcome overall, a covid-19 diagnosis documented during the delivery hospitalization was associated with an increased risk for stillbirth in the United States, with a stronger association during the period of delta variant predominance,” researchers wrote.
Researchers suspect Covid-19 impacted blood flow to the placenta in some way. It may also trigger clots, impact hypertension, and thus impact stillbirth and preeclampsia rates.
Unfortunately, it will take years to fully understand the impact. While current research does not suggest delaying pregnancy, like we saw with Zika recommendations, it is likely most recommend taking precautions to reduce the risk of contracting Covid-19 during pregnancy.
As doulas, it is important we provide evidenced-based information, share current recommendations, and do our best to help our clients get adequate care during pregnancy.
Author: Aliza Juliette Bancoff
Aliza Juliette Bancoff is a well-known doula and doula trainer who has been providing doula services to families for over a decade. She is the founder of Main Line Doulas, a doula group providing doula support in the great Philadelphia area for the last decade, the International Doula Institute, which provides online doula training and lactation training and certification programs and the International Breastfeeding Institute which provides lactation training and certification. She is the co-founder of United Birth, a company devoted to increasing access to doulas across the country to make the perinatal time safer both physically and emotionally. “Every birthing person deserves access to quality doula support. And we are working to make that a reality across the country. The work we are doing to get doulas to every birthing person will decrease the black infant and maternal mortality rate significantly by 2030.” Says Bancoff. Aliza is known for her compassionate and empowering approach to doula work, and she has been featured in numerous media outlets, including United Nations Maternal Health Report, Parent Magazine, CafeMom, theBump and many more. Aliza's journey into doula work began when she gave birth to her first child and felt a strong calling...