Pandemic affects pregnancy health whether mums catch COVID-19 or not

New global research has found pressures from the COVID-19 pandemic can still take a physical toll on mums-to-be, even if they don’t catch the virus.

An international research collaboration, which included researchers from Saint Mary’s Hospital, pregnancy charity Tommy’s, The University of Manchester, involved 115 mums who gave birth during the pandemic. The study found far more physical abnormalities in the placenta – the baby’s support system while in the womb – than doctors expected to see in pre-2020 pregnancies.

Professor Alex Heazell, Consultant Obstetrician at Saint Mary’s Hospital, which is part of Manchester University NHS Foundation Trust (MFT), and Dr Kate Widdows, Research Fellow, are co-authors of the results papers, published in the journal, Placenta.

Professor Heazell and his team took samples from the placenta, umbilical cord and foetal membranes of mums who gave birth at Saint Mary’s Hospital from March to September 2020. When an expectant mother tested positive for COVID-19, researchers randomly selected someone without the virus who gave birth in Saint Mary’s Hospital at the same time, as well as comparing these groups with historic patient data.

Rates of placenta problems tripled among mothers with COVID-19 but doubled even among those who tested negative, suggesting that some changes in the placenta can be caused by the sheer stress of the pandemic as well as the virus itself.

Professor Heazell said: “The increase of placental problems we’ve seen during the pandemic is concerning, but we need more long-term research to understand the full effects of COVID-19 and related stresses on pregnancy. Both clearly affect the placenta, but we still can’t tell exactly what that means for the health of mothers and babies moving forward. In the meantime, there must be appropriate psychological care and support available throughout pregnancy, to help reduce the pandemic’s impact on maternal wellbeing.”

Stress in pregnancy can lead to inflammation and functional changes in the placenta, which can raise pregnancy risks and have long-term consequences for babies’ development. As COVID-19 triggers inflammation, the concern for expectant mothers who catch the virus is whether this can damage the placenta – but despite being classed as higher risk in the pandemic to protect their physical health, their mental wellbeing is more easily overlooked.

Although other studies are investigating how COVID-19 infection affects pregnancy, this was the first to look at pandemic-related stress more broadly in mums without the virus.

Research has shown that mums who gave birth during the pandemic are more likely to have clinical depression and anxiety, and a survey of 5,500 expectant and new parents across the UK found that nine in 10 felt more anxious because of COVID-19. While some were isolated in lockdown, others faced the stress of being unable to avoid unsafe environments – almost half of pregnant women didn’t feel safe going out to work, and one in ten were (or expected to be) made redundant.

More than three-quarters of mums with COVID-19 had abnormalities in their placentas (92.9 per cent in the UK / 80.6 per cent in Canada / 87.5 per cent in France) compared to half of those who gave birth during the pandemic without having the virus (45.5 per cent in the UK / 52.6 per cent in Canada) and a quarter of the pre-2020 group (25 per cent in Canada, consistent with other large studies).

Trends varied across countries, but common issues found in the UK were; excess of a blood-clotting protein called fibrin (which can restrict babies’ growth) and calcification (calcium in the placenta builds up in late pregnancy to prepare for birth, but too much too soon can cause dangerous deterioration). Some abnormalities were only found in mums who had COVID-19, suggesting they are caused by infection – but others happened across 2020 pregnancies and not in the control group, implying links to the stress of the pandemic rather than the virus itself.

Researchers concluded that both COVID-19 and pandemic-related stress can affect the placenta, but more long-term studies are needed to properly assess the pandemic’s impact on the health of mothers and babies.

Tommy’s CEO Jane Brewin said: “Good research evidence takes time, and the pandemic is still unfolding – so while our scientists keep working to understand how this affects pregnancy health, it’s vital that mums-to-be are supported mentally as well as physically.

“We’ve seen a huge rise in calls to the midwives on our helpline throughout the last 18 months, as the pandemic has created extra confusion and anxiety for many families along the pregnancy journey. Services are adapting but they’re still running, so mums shouldn’t hesitate to raise any concerns with their care team and seek help when needed.”