“The potential benefits of a universal testing approach include the ability to use Covid-19 status to determine hospital isolation practices and bed assignments, inform neonatal care, and guide the use of personal protective equipment,” write the authors in a letter published in The New England Journal of Medicine. “Access to such clinical data provides an important opportunity to protect mothers, babies, and health care teams during these challenging times."
Nearly 14 percent of pregnant patients admitted to two hospitals in New York were later found to be asymptomatic carriers of SARS-CoV-2, the virus responsible for the respiratory disease Covid-19.
New York is one of the hardest hit cities in the world, currently seeing nearly one-quarter of total US death rates. The first case of a pregnant patient with Covid-19 was reported in the state nearly a month ago and in the time since, researchers have reported two other women who were initially asymptomatic but developed symptoms and tested positive for SARS-CoV-2 after delivery, prompting doctors to implement universal testing measures on pregnant patients admitted to the hospital.
Between March 22 and April 4, 215 pregnant women delivered infants at the New York-Presbyterian Allen Hospital and Columbia University Irving Medical Center, most of whom were admitted during delivery. Upon entrance, each patient was screened for Covid-19 symptoms and just four (less than 2 percent) presented with fever or other symptoms related to Covid-19. All four subsequently tested positive for the virus. The other 211 patients did not have fevers and were otherwise asymptomatic. Researchers tested 210 of them and found that 29 (nearly 14 percent) tested positive for the virus.
In short, 29 of the 33 women who tested positive for the virus – or about 88 percent – were asymptomatic. Of those asymptomatic women, three developed a fever before delivering and two received antibiotics for endomyometritis, a complication of pregnancy where the uterus is perforated. Another patient developed a fever due to Covid-19 infection, while a third, who initially tested negative for the virus, developed symptoms and tested positive three days later.
The Centers for Disease Control and Prevention (CDC) reports that it is unknown whether pregnant people have a greater chance of getting sick or developing a serious illness, though it appears they have the same risks as those who are not. Changes in the body could increase their risk of some infections and there is a higher risk of severe illness for other viruses related to Covid-19. Pregnant patients could be at a higher risk of infection given the number of medical visits required during pregnancy, such as ultrasounds and checkups. A small subset of studies from China has found conflicting evidence about whether or not pregnant people can transmit the virus to their infants.
New York overwhelmingly has the highest number of reported Covid-19 cases in the US, making it difficult to generalize the findings to other communities with lower infection risks. The authors note the findings underscore the importance of tracking viral infection rates in pregnant women. The prevalence of the infection may be underreported and this could be exacerbated by the false-negative results of detection tests.