Pregnancy outcomes better in Pakistan: AKU and Oxford University study
Pregnant women who contract COVID-19 are 22 times more likely to die, and 50% more likely to experience pregnancy-related complications than pregnant women without COVID-19, according to a global study.
The study, called INTERCOVID, was carried out on over 2,100 pregnant women across 18 countries, including Pakistan and was published in JAMA Paediatrics.
They found that women with COVID-19 during pregnancy were at increased risk of pregnancy-related complications such as premature birth, pre-eclampsia (high blood pressure that can cause organ damage), admission to intensive care and death.
Newborns of infected women were also nearly three times more at risk of severe medical complications, such as admission to a neonatal intensive care unit, mostly due to premature birth.
Around one in 10 babies of mothers who tested COVID-19 positive during pregnancy also tested positive for the virus during the first few days after birth.
“Importantly, breastfeeding does not seem to be related to this increase. Delivery by caesarean section, however, may be associated with an increased risk of having an infected newborn,” said José Villar, professor of perinatal medicine at the University of Oxford, who co-led the study.
Researchers said that current evidence shows that breastfeeding is safe, even if mothers have COVID-19, and its benefits outweigh the potential risk of transmission.
Breastfeeding should continue to be promoted with mothers being encouraged to take preventive measures such as washing their hands and wearing face masks while nursing, they added.
The study, led by the University of Oxford, involved 43 maternity hospitals from low-, middle- and high-income countries.
The Aga Khan University, who conducted the study in Pakistan, recruited over 300 pregnant women for the global study. They said that women with COVID-19 and babies in Pakistan had better outcomes than the rest of the world, with lower preterm births, intensive care unit admissions, neonatal oxygen requirements and length of hospital stay.
“Our findings merit further exploration as to why Pakistani mothers and newborns fared better than the rest of the world,” said AKU’s Dr Shabina Ariff, primary investigator of the study in Pakistan.
“A possible explanation may be that we have had fewer and less virulent COVID-19 variants in Pakistan. Inherent immunity and differences in the level of care received at the hospital may also have played a role. Future studies will be needed to substantiate these points.”
In the Pakistan cohort, only two babies, born to mothers with COVID-19, tested positive for the virus. While both were born preterm and required admission to the neonatal intensive care unit for respiratory distress, they did not require invasive support such as ventilators.
This research is one of the first detailed studies into the effects of the coronavirus on outcomes for mothers and babies during the pandemic. The study is unique because each woman affected by COVID-19 was compared to two non-infected pregnant women giving birth at the same time in the same hospital.
“We now know that the risks to mothers and babies are greater than we assumed at the start of the pandemic and that known health measures when implemented must include pregnant women,” said Stephen Kennedy, professor of reproductive medicine at the University of Oxford, who co-led the study.
“The information should help families, as the need to do all one can to avoid becoming infected is now clear. It also strengthens the case for offering vaccination to pregnant women.”