Apr 21, 2020

image of dr. dena goffman with nyp/cuimc background
New York

About 15% of pregnant women admitted to two maternity wards in northern Manhattan in late March and early April were already infected with the new coronavirus, though most had no symptoms, according to a new study by physicians at Columbia University Irving Medical Center and NewYork-Presbyterian. In the study, the researchers tested all 215 women who were admitted to the two labor and delivery units as soon as the women arrived at the hospital.

The data were reported April 13 in a letter to the New England Journal of Medicine.

“It is important to recognize that there are a significant number of women (and likely others) who are in the community and asymptomatic,” says Dena Goffman, MD, associate professor of obstetrics & gynecology at Columbia University Vagelos College of Physicians and Surgeons and chief of obstetrics at NewYork-Presbyterian/Columbia University Irving Medical Center.

“Obstetric services and other teams that will have patients coming in for necessary health care need to recognize this potential risk,” Goffman says. “We need to take precautions to keep our moms, babies, families, and teams safe.”

A solution, continues Goffman, may involve broader testing of patients admitted to non-COVID-19 wards and more universal protection across hospital departments with PPE to prevent ongoing spread.

New York City is currently the epicenter of COVID-19 with nearly 140,000 cases as of April 20, nearly 20% of confirmed cases in the United States.

Universal coronavirus screening for maternity admissions

Obstetricians at NewYork-Presbyterian/Columbia University Irving Medical Center first reported a case of COVID-19 in an obstetrical patient on March 13, 2020. Just over a week later, all women admitted to the labor and delivery unit were tested for SARS-CoV-2 infection.

The new letter in NEJM reports the results of universal screening of expectant mothers admitted to maternity wards at NewYork-Presbyterian/Columbia University Irving Medical Center and NewYork-Presbyterian Allen Hospital between March 22 and April 4.

Of the 215 women admitted during those two weeks, 33 tested positive for the virus. Only four women displayed symptoms of COVID-19 at the time of admission.

For now, COVID-19 in pregnant women resembles general trends

During other pandemics, pregnant women have experienced more severe disease than other groups. Pregnant women may be more susceptible to respiratory pathogens and pneumonia due to the physiological adaptations of pregnancy as well as pregnancy-related immunological changes.

Preliminary findings reported recently by Columbia and NewYork-Presbyterian obstetricians suggest pregnant women may fare no worse than others with COVID-19. Among 43 confirmed COVID-19 obstetrical patients, the physicians reported that most women (86%) experienced mild disease, four (9.3%) exhibited severe disease, and two (4.7%) developed critical disease. These figures are similar to those described for non-pregnant adults with COVID-19 (about 80% mild, 15% severe, and 5% critical disease).

But Goffman cautions that there is reason to remain concerned about COVID-19 in pregnant women, despite these encouraging early reports.

“Because testing has largely been reserved for the sickest patients, our study can’t compare pregnant women with the wider population where milder disease is more prevalent,” Goffman says. “Our findings must be interpreted with caution until more data become available.”

Courtesy Columbia University Irving Medical Center newsroom

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