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Morbidity and Mortality Weekly Report

STUDY: Hispanic, Black Pregnant COVID Patients Higher Risk for Hospitalization

A US Centers for Disease Control and Prevention (CDC) study published today in Morbidity and Mortality Weekly Report found that pregnant women with COVID-19 are at increased risk for hospitalization, intensive care unit (ICU) admission, and mechanical ventilation but not death.

Researchers studied the disease surveillance data of 8,207 pregnant women infected with the novel coronavirus and 83,205 nonpregnant women aged 15 to 44 years from Jan 22 to Jun 7 to determine whether the immunologic and physiologic changes of pregnancy put them at risk for more severe outcomes.

About one third (31.5%) of pregnant women infected with SARS-CoV-2, the virus that causes COVID-19, had been hospitalized, versus 5.8% of their infected nonpregnant peers, but the researchers were unable to distinguish between hospitalization for coronavirus-related symptoms versus those for pregnancy-related procedures such as delivery.

After adjustment for age, underlying conditions, and race/ethnicity, pregnant women were 5.4 times more likely to be hospitalized, 1.5 times more likely to need intensive care, and 1.7 times more likely to require mechanical ventilation than nonpregnant women.

Sixteen of 8,207 pregnant women and 208 of 83,205 nonpregnant counterparts died of the novel coronavirus, or 0.2% for both groups.

Hispanic, black pregnant women more affected

When stratified by age, hospitalization, ICU admission, receipt of mechanical ventilation, and death were reported more often by women aged 35 to 44 years than by those aged 15 to 24 years, whether or not they were pregnant. When stratified by race/ethnicity, the rate of ICU admission for pregnant Asian women was 3.5%, compared with 1.5% in all pregnant women.

Overall, 97.1% of pregnant women and 96.9% of nonpregnant women reported COVID-19 symptoms. While both reported similar percentages of cough (more than 50%) and shortness of breath (30%), pregnant women were less likely to report headache, muscle aches, fever, chills, and diarrhea and more likely to have chronic lung disease, diabetes, and heart disease.

Among pregnant women, 46.2% were Hispanic, 23.0% were white, 22.1% were black, and 3.8% were Asian, versus 38.1%, 29.4%, 25.4%, and 3.2%, respectively, of their nonpregnant peers. “Although data on race/ethnicity were missing for 20% of pregnant women in this study, these findings suggest that pregnant women who are Hispanic and black might be disproportionately affected by SARS-CoV-2 infection during pregnancy,” the authors said.

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CDC Issues New Guidance on Zika and Pregnant Women

zika

Yesterday, the Centers for Disease Control and Prevention (CDC) updated its interim guidance on caring for pregnant women who may have been exposed to the Zika virus.  The updated guidance is published online July 24 in Morbidity and Mortality Weekly Report.

“CDC has updated the interim guidance for U.S. health care providers caring for pregnant women with possible Zika virus exposure in response to 1) declining prevalence of Zika virus disease in the World Health Organization’s Region of the Americas (Americas) and 2) emerging evidence indicating prolonged detection of Zika virus immunoglobulin M (IgM) antibodies,” state Titilope Oduyebo, MD, from the Zika Response Team, CDC, and colleagues.

The agency updated the guidance given the fact that it is difficult to accurately interpret the current available tests for Zika, and the fact there is new evidence showing that antibodies to Zika virus can be detected more than 12 weeks after a person is infected.

Ugh!

The CDC kept the definition of possible Zika virus exposure: If a woman has traveled to or is living in an area where mosquitoes carry the virus or is having sex with an individual who has traveled to or lives in such an area.

 All practitioners and medical facilities that see pregnant women should take heed to the following recommendations:
  • Ask all pregnant women in the United States and US territories about possible Zika virus exposure before and during their current pregnancy at every prenatal visit. Providers should also ask about symptoms of Zika (eg, fever, rash, joint pain, conjunctivitis).
  • Pregnant women should not travel to areas at risk for Zika transmission. If their sexual partner lives in such an area, pregnant women should use condoms or abstain from sex during pregnancy.
  • Pregnant women with recent Zika virus exposure and symptoms of Zika should undergo Zika virus nucleic acid test (NAT) of serum and urine and IgM testing as soon as possible, through 12 weeks after symptom onset.
  • For pregnant women without symptoms but with ongoing possible exposure to Zika, IgM testing is no longer routinely recommended; offer Zika NAT testing three times during pregnancy, although optimal timing and frequency of NAT alone are unknown.
  • For asymptomatic pregnant women with recent possible Zika exposure, routine Zika testing is not recommended but can be considered using shared-decision making.
  • Pregnant women with recent possible Zika exposure whose fetus has ultrasound findings suggesting congenital Zika syndrome should undergo maternal testing with NAT and IgM.
  • For nonpregnant women with ongoing Zika exposure, Zika IgM testing is not warranted to establish baseline IgM levels as part of preconception counseling.

The guidance includes an updated comprehensive approach for testing placental and fetal tissues in certain cases, such as in a mother with laboratory-confirmed Zika whose fetus or infant has possible Zika-associated birth defects.