Pregnant women with COVID-19 face an increased risk of complications from the illness, including preterm birth, delivery by cesarean section, and, compared with other women of the same age, higher likelihood of death or admission to an intensive care unit.
But nearly a year into the pandemic, it can still be difficult for some pregnant women to get COVID-19 testing on a regular basis. To understand more about the impact of the virus on pregnant women, researchers at Washington University School of Medicine in St. Louis have received a $791,317 grant from the National Institutes of Health (NIH) to study factors that keep pregnant women from getting tested for COVID-19, to evaluate whether it is important to test women regularly during their pregnancies, and to determine whether pregnant women with COVID-19 need more specialized prenatal care.
The study is part of the NIH’s national initiative, Rapid Accelerations of Diagnostics for Underserved Populations, or RADx-UP, with a goal of increasing access to COVID-19 testing in vulnerable populations. Funding for RADx-UP comes from the $1.1 billion CARES ACT, passed by Congress to accelerate the development of technologies for testing and education during the pandemic.
“Although pregnant women with COVID-19 are more likely to be asymptomatic initially, they are at risk for more severe disease,” said Megan Foeller, MD, co-principal investigator of the study and assistant professor of obstetrics and gynecology. “We think it is important to determine the impact of COVID-19 among this unique population, improve testing access and find ways to improve the prenatal care offered to these mothers, with the goal of reducing their risk of complications.”
In addition to Foeller, the Washington University study will be led by co-principal investigator Indira Mysorekar, PhD, the James P. Crane Professor of Obstetrics & Gynecology, and a professor of pathology and immunology. She is director of Washington University’s Center for Reproductive Health Sciences.
The researchers will enroll one group of 179 pregnant women who test positive for COVID-19 through standard and antibody testing, an indication they have been infected during the pandemic, and as a comparison, another group of 179 women who have not become infected with COVID-19. The study participants will be recruited from obstetrics and gynecologic clinics at the School of Medicine and at Mercy Hospital St. Louis.
“Pregnancy places women at increased risk for complications from COVID-19, but there is really very little research to guide care of pregnant women with COVID-19,” said Daniel Jackson, MD, principal investigator of the Mercy study site and a maternal-fetal medicine physician. “The information from this study will be very helpful to guide clinicians caring for pregnant women exposed to or infected with COVID-19.”
For the study, the researchers will use surveys and interviews to determine patients’ and providers’ perceptions of COVID-19 testing during pregnancy and how COVID-19 has affected access to prenatal care. The scientists also will evaluate the effect of COVID-19 infection during pregnancy on the risk of preterm birth and other adverse pregnancy outcomes, such as stillbirth and miscarriage, and fetal growth.
The impact of COVID-19 during gestation remains unclear. The researchers in this study will determine the risk of mother-to-fetus COVID-19 transmission and viral presence in umbilical cord blood, placenta, and amniotic fluid. Babies born to women with COVID-19 also will also be evaluated at six weeks.
This study is a collaboration among experts across departments at Washington University, including the Department of Medicine (Victor Davila-Roman, MD, professor of medicine, and Caline Mattar, MD, assistant professor of medicine); Department of Surgery (Aimee James, PhD, professor of surgery); Department of Obstetrics & Gynecology (Nandini Raghuraman, MD, and Ebony Carter, MD, both assistant professors of obstetrics and gynecology); and the Division of Biostatistics (Kenneth Schechtman, MD, professor of biostatistics and of medicine). The collaboration also includes the Brown School (Ana Baumann Walker, PhD, research assistant professor, and Darrell Hudson, PhD, associate professor).
“There still is a lot we don’t know about how COVID-19 affects women and their infants,” Mysorekar said. “We are excited about our collaboration with Mercy to answer some of these questions. Overall, we want to increase the numbers of pregnant women getting tested for this disease and improve how we counsel women who are pregnant or are considering becoming pregnant during this challenging time.”