Pregnant patients should follow safety measures to stay healthy and protect themselves against COVID-19.

Based on current limited evidence, pregnant individuals may be at an increased risk of severe coronavirus disease 2019 (COVID-19) illness compared to non-pregnant patients.1 These risks may also include pregnancy-related complications such as preterm birth, although further evidence is needed.1

Pharmacists can play an important role in educating pregnant patients along with individuals planning to become pregnant about COVID-19 prevention strategies and tips to stay healthy during the pandemic.

CDC Study Findings and Implications
Data on COVID-19 positive cases from January 22-June 7, 2020 were electronically reported to the CDC through the National Notifiable Diseases Surveillance System for the study among women of reproductive age (15-44 years) from 50 states, the District of Columbia, and New York City.2  The data included demographic information, pregnancy status, underlying medical conditions, signs and symptoms, and clinical outcomes, including hospitalization, ICU admission, mechanical ventilation, and death. Among 1,573,211 laboratory-confirmed cases of COVID-19, 20.7% occurred in women aged 15-44 years. Pregnancy status was available for 28% of these women, and 9% were pregnant.2  

Data on underlying health conditions was available for 22.9% of pregnant women, and 35% of nonpregnant women. Chronic lung disease (21.8% pregnant; 10.3% nonpregnant); diabetes (15.3% pregnant; 6.4% nonpregnant); and cardiovascular disease (14% pregnant; 7.1% nonpregnant) were the most common underlying health conditions reported.2 However, data was not available to determine whether the chronic conditions were present before or were pregnancy-related health issues. Hospitalization was reported by more pregnant women (31.5%) than nonpregnant patients (5.8%). However, data was not available to determine hospitalization for COVID-19-related complications vs. hospital admission for pregnancy-related treatment procedures, such as delivery.

Pregnant women were admitted more frequently to the ICU (1.5%) than nonpregnant individuals (0.9%). Also, 0.5% of pregnant women needed mechanical ventilation vs. 0.3% of nonpregnant patients.
After adjusting for age, presence of underlying health conditions, and race/ethnicity, pregnant women were 5.4 times more likely to be hospitalized, 1.5 times more likely to be admitted to the ICU, and 1.7 times more likely to receive mechanical ventilation than nonpregnant women. There was no difference in the risk of death between pregnant and nonpregnant women in the study.2

This study provides important information that pregnant women may have an increased risk of COVID-19 related complications. However, outcomes with missing data were assumed not to have occurred which may have underestimated the results.2 Pregnancy status was missing for approximately 75% of women of reproductive age with COVID-19, which can have a large impact on the results.2 Further studies including more data are needed to understand how COVID-19 affects pregnancy. 

Safety Tips
Pharmacists should educate pregnant patients to keep up with their prenatal care appointments and ensure that they have at least a 30-day supply of their medications.1 Home delivery of medications and groceries can help to limit interactions with other individuals. It is important to wear a face covering in public places, and to wash hands frequently with soap and water for at least 20 seconds.1 If soap and water are not readily available, then use a hand sanitizer that contains at least 60% alcohol.1

Pharmacists can also counsel patients on the importance of keeping up with routine immunizations such as the influenza ,and tetanus, diphtheria, pertussis (Tdap) vaccines to protect them as well as their baby.1


REFERENCES
  1. Coronavirus disease 2019: If you are pregnant, breastfeeding, or caring for young children. CDC. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/pregnancy-breastfeeding.html. Last reviewed June 25, 2020. Accessed June 25, 2020.
  2. Ellington S, Strid P, Tong VT, et al. Characteristics of Women of Reproductive Age with Laboratory-Confirmed SARS-CoV-2 Infection by Pregnancy Status — United States, January 22–June 7, 2020. MMWR Morb Mortal Wkly Rep 2020;69:769–775. DOI: http://dx.doi.org/10.15585/mmwr.mm6925a1