During pregnancy, the placenta is the first organ to form. It connects the mother and developing fetus, providing nutrients to the fetus and removing its waste through the mother’s blood.
It’s very important developmentally, according to Dr. Jeffery Goldstein, the senior author of a recent study that found pregnant women who tested positive for COVID-19 had injuries to their placentas.
“This is a reason for concern, but not fear,” said Goldstein, an assistant professor of pathology at Northwestern University Feinberg School of Medicine.
The study analyzed the placentas of 16 women who were diagnosed with the coronavirus during pregnancy. Four patients had the virus weeks before delivery, two were diagnosed within a week of delivery and 10 were diagnosed when they came to the hospital to give birth. Northwestern has been testing all pregnant women for COVID-19 prior to delivery since early April, according to Goldstein, who said all of the women in the study have since recovered.
“This is a relatively heathy population,” he said. “A lot of these patients wouldn’t have been tested (for COVID-19) if they weren’t pregnant or coming in for labor and delivery.”
Researchers found blood clots in the placentas and abnormal blood flow between mothers and fetuses, called maternal vascular malperfusion, which is normally seen in women with hypertension or preeclampsia, a condition which only one woman in the study had.
“There’s an emerging consensus that problems with blood clotting and circulatory problems are a feature of the coronavirus,” said Goldstein. “And I think our work shows there might be something clot-forming about coronavirus, and it’s happening in the placenta.”
Despite the injuries researchers found, the majority of infants were healthy upon delivery, according to Goldstein. One infant was delivered prematurely at 34 weeks because the mother’s COVID-19 illness became worse; another woman had a miscarriage during the second trimester. Goldstein says that patient was asymptomatic and it’s not clear if the virus played a role in her miscarriage.
Previous research has found that children who were in utero during the 1918 flu pandemic, which is often compared to the current pandemic, have lower incomes throughout their lives and higher rates of cardiovascular disease, according to Goldstein.
That means infectious diseases can have long-term impacts, said Goldstein. With that in mind, researchers are working on ways to continue to examine the newborns in this latest study.
“We need to follow up on these kids. There’s a tendency in pregnancy research to sunset when everyone goes home from the hospital, and that’s not good enough,” he said.
Goldstein and his fellow researchers also say pregnant women with COVID-19 should be monitored more closely.
“The women who are pregnant now, the women who are delivering now didn’t know they’d be pregnant in the middle of a giant pandemic,” Goldstein said. “Pregnant women should avoid getting COVID-19 and should consider as the nation opens, as Chicago opens, whether to hang back a bit.”
Anyone considering becoming pregnant should consider the risks of COVID-19 as part of their planning, says Goldstein. “A lot of personal factors go into it, and I think this has to be one of them.”