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Recently, I met my first individual with something known as post-COVID-19 syndrome. The acquaintance, actually a relative of a friend, was sick for about a month with COVID-19 and was still not right about a month after that.
That got me thinking. We spend a lot of time in these pages with infections of all sorts and how their effects on pregnant women and their children-to-be. What do we know about post-COVID syndrome in a pregnant woman? Or even one that subsequently becomes pregnant?
Post-COVID-19 Syndrome Explained
Post-COVID-19 syndrome refers to the symptoms that a patient might suffer—sometimes for weeks to months—after an acute infection with COVID-19. One study, reported in the Journal of the American Medical Association, came from Italy, one of the countries that was most affected by the pandemic early on. The researchers looked at patients with COVID-19 who had been discharged from the hospital and had reverted to a negative test. Of those patients, almost 90% continued to have symptoms. The most common symptoms were fatigue, shortness of breath, joint pain and chest pain. About half the patients felt that their quality of life was less than before.
The question is: Why does this happen? Like so much with COVID-19, the disease is simply too new to furnish a definitive answer. We certainly do know that many infections are associated with a chronic form, though what is attributable to the germ and what is not is sometimes controversial. Epstein-Barr virus (which causes mononucleosis) and Lyme disease are two examples. Two more that are more closely related to what we’re dealing with here: SARS and MERS, both coronaviruses.
There’s still so much we don’t know about how post-COVID affects pregnant women and their babies. Although the risk of lasting symptoms is there, there does not seem to be reports of major effects on most pregnancies.
There are some clues that are beginning to emerge. Although COVID-19 is largely thought of as a respiratory illness, it has been found to affect many different organs in the body. In addition to the lungs, researchers have found effects of the illness on the kidneys, brain, senses—and heart.
The heart was the subject of one recently reported study from Ohio State University. The researchers screened athletes that previously had COVID-19 infections; in this study, the subjects had no symptoms or mild illness. About 1 in 7 of these subjects had evidence of myocarditis, an infection in the heart. Myocarditis, which is caused by a variety of germs, can be severe and even fatal; in this case, some subjects had no obvious symptoms. Remember, though, that these were elite athletes; if they were affected in this way by COVID-19, it’s not much of a stretch to imagine the problems that might be experienced by an older person or one with other health problems.
It doesn’t seem to be just the heart, by any means. Two studies out of Europe looked at formerly hospitalized COVID-19 patients and found ongoing lung damage. Although these individuals were sicker to begin with, (and in one of the studies, all needed help to breathe while hospitalized) what seems clear is there is probably more than one reason to have post-COVID symptoms.
So….What About Post-COVID-19 in Pregnancy?
In this blog, we’ve all talked a lot about COVID and pregnancy (and fertility, and infancy). However, we have yet to say too much about post-COVID syndrome. The reason for this may be easy to guess: there is simply a lot that we still don’t know.
Enter the National Institutes of Health, which is striving to close that knowledge gap by rolling out several studies. One study seeks to follow pregnant women in low- and middle-income countries by testing them for the COVID-19 antibody at delivery, then following their newborns for problems. Another study, this time in the U.S., will follow affected pregnant women through 6 weeks postpartum.
As far as giving recommendations based on what we do know, the American College of Obstetricians and Gynecologists has weighed in. Their recommendations, which were published in the spring, call for consideration of a mid-trimester ultrasound and no specific change to the timing of delivery.
To sum up, there’s still so much we don’t know about how post-COVID affects pregnant women and their babies. Although the risk of lasting symptoms is there, there does not seem to be reports of major effects on most pregnancies. If you’ve had COVID-19 at any level, the best advice is to let your obstetrician know of your history and of any symptoms you’re having. And like anything else with COVID-19, stay tuned for those continuously updated recommendations!