KARACHI: Pregnant women who contract Covid-19 are 22 times more likely to die and 50 per cent more likely to experience pregnancy-related complications than expecting women unaffected by Covid-19, says a global study of over 2,100 pregnant women across 18 countries, including Pakistan, published in JAMA Paediatrics.

AKU faculty Prof Zulfiqar A. Bhutta, Dr Shabina Ariff, Dr Ghulam Zainab, Dr Lumaan Shaikh and Dr Khalil Ahmed from the departments of paediatrics and child health, and obstetrics and gynaecology contributed to the study which recruited over 300 pregnant women from Pakistan to the global study.

The INTERCOVID study — led by the University of Oxford — involved collaborations with 43 maternity hospitals from low, middle and high-income countries to conduct one of the first detailed comparative 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.

The researchers sought to understand the effects of Covid-19 in pregnancy by collecting robust data on expecting women with and without a diagnosis of Covid-19, an important step to ensure that families understand the risks involved, mothers and babies receive the best possible care and health resources.

Pakistani mothers, newborns fared better than rest of the world

They found that expecting women with Covid-19 were at increased risk of pregnancy-related complications such as premature birth, pre-eclampsia, 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.

“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,” said Stephen Kennedy, professor of reproductive medicine at the University of Oxford, who co-led the study.

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.

Pakistani mothers fare better

Researchers stated 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 AKU faculty recruited over 300 pregnant women in Pakistan to the global study. They noted that women with Coivd-19 and babies in Pakistan had better outcomes than the rest of the world, with lower pre-term 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 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 pre-term and required admission to the neonatal intensive care unit for respiratory distress, they did not require invasive support such as ventilators.

Published in Dawn, April 23rd, 2021