Understanding the risk of severe COVID-19 in pregnancy
Pregnancy with COVID-19 is associated with 5 times greater risk of hospitalisation and also increased risk of admission to intensive care compared to women who are not pregnant (data from first wave in US and UK). The probability of death however, is similar for all women of reproductive age whether or not they are pregnant.
Severe COVID-19 has a clear association with comorbid conditions like chronic lung disease, diabetes, cardiovascular disease, genetics (Hispanics and Blacks) and obesity. This would fit perfectly with elevated serum ACE-2 being the most measurable risk factor differentiator. It is clear that measurement of serum ACE-2 would enhance the targeting of the most vulnerable population.
Why is hospitalisation 5 times higher in pregnancy, with similar risk of mortality? Most of the pregnancy admissions for COVID-19 were in the third trimester. This is a stage of pregnancy where shortness of breath may already be a factor because of pressure on the lungs from an enlarged (gravid) uterus. The reduced lung capacity is likely to exacerbate shortness of breath due to COVID-19.