Pregnant Women More Vulnerable to Long COVID

Victoria Coble, 39, of Greensboro, North Carolina, was 4 months pregnant when she started having symptoms of COVID-19. Things got much worse with the birth of her son, including intense anxiety, depression, and trouble concentrating, which expanded into nausea, chest pain, post-exertional malaise (PEM), and more. 

At first, she had trouble disentangling her pregnancy and postpartum symptoms with symptoms that are common with long COVID. “At the time, I confused all of it with postpartum depression,” Coble said. But 4 years later, the mother of two is still struggling just to get through the day.

Experts say pregnant women are diagnosed with long COVID in higher numbers than previously thought, although little historical data exist, and their symptoms are often misinterpreted for the normal signs of pregnancy. All of it makes motherhood and starting or expanding a family more difficult. 

While it’s hard to separate symptoms of pregnancy from long COVID, one of the key distinguishing factors is symptom persistence, said Ziyad Al-Aly, MD, a global expert of long COVID and chief of research and development at the Veterans Affairs St. Louis Health Care System, St. Louis, Missouri.

“Pregnancy symptoms eventually cycle out versus the fatigue with long COVID and post-exertional malaise, which often lingers,” said Al-Aly.

Pregnant women with long COVID are an understudied patient population. How often they get the disease and how it affects their pregnancy and their children were largely unknown until recently. But new research is beginning to unravel a mystery nearly 5 years in the making. Experts want to better understand how developing long COVID during pregnancy affects both mother and child and how new moms can care for their children while grappling with this debilitating disease.

In a study published this month in the journal Obstetrics & Gynecology, researchers found that nearly one in 10 pregnant women got long COVID after acute COVID-19 during pregnancy. Many went on to experience serious symptoms, including PEM — which occurs when symptoms worsen after even minor physical or mental exertion — gastrointestinal issues, and brain fog consistent with those experienced by the wider long COVID community. The numbers caught researchers by surprise.

“As an obstetrician, we typically take care of a younger, mostly healthy population in comparison to other specialties,” said study author Torri Metz, MD, vice chair of research for obstetrics and gynecology at University of Utah Health, Salt Lake City, Utah. “To see that over 9% of this population went on to have symptoms consistent with long COVID was a higher number than I would have expected.”

Additionally, said Al-Aly, during the height of the pandemic, COVID anti-vax rhetoric spread like wildfire, becoming a battle for the hearts and minds of a vulnerable patient population. A small study published in the November 2022 issue of the journal Midwifery found that even among those who later got the jab during pregnancy, anti-vaccine rhetoric fueled their hesitancy to do so. 

Lower vaccination rates, due to early misinformation about the safety of COVID shots in pregnancy, may have increased long COVID numbers in this patient population.

In pregnant women, the benefits of the COVID vaccine are far more than the small risks from vaccination, Al-Aly said. In a study Al-Aly and his colleagues released this month in The New England Journal of Medicine, researchers found that vaccinations resulted in a 70% reduction in the risk of developing long COVID. “This applies to everyone, including pregnant people who are also at risk of developing the condition,” said Al-Aly.

Medical Gaslighting, Complications Common

Coble first experienced symptoms of COVID-19 in January of 2020, before tests were available in her area. She said that without a positive COVID test and because of her pregnancy she’s experienced medical gaslighting from clinicians who doubted her condition. “Doctors never listen to me and it’s dehumanizing,” she said.

For pregnant women who do develop long COVID, it comes at a sensitive time and can put undue pressure on moms who are already experiencing an entirely new stage of life, said Obstetrics & Gynecology study author Vanessa Jacoby, MD, professor of obstetrics, gynecology, and reproductive sciences and associate vice chancellor for clinical research at the University of California San Francisco. 

In addition, experts say women with COVID-19 have an increased risk for pregnancy complications such as preterm birth and neurodevelopmental disorders compared with women who do not have COVID-19 during pregnancy. And a new study in Scientific Reports found that individuals who developed long COVID during their pregnancy had an increased risk for gestational hypertension, gestational diabetes, and fetal intrauterine growth restriction, a condition that results in the baby not gaining enough weight in utero.

On the whole, most of the treatments for long COVID are used to treat symptoms and it’s hard to make generalizations about their safety during pregnancy or breastfeeding. Women seeking treatment for long COVID should make sure that any medication taken for the treatment of symptoms is also safe for their child.

Impact of Long COVID on Children

Not only are new parents unduly affected by long COVID, researchers are also looking into what this might mean for their children. Acute COVID can cause preterm birth and long COVID can cause pregnancy complications that may have repercussions down the line. Still, there’s a lot that we don’t know about child outcomes, and considering how common the condition may be, it’s a hole in the research that needs to be filled, said Metz. 

Metz and Jacoby are working on a forthcoming study that gathers data on this important and understudied patient cohort. The study, funded by the National Institutes of Health’s long COVID RECOVER Initiative, will be enrolling children who were infected with COVID and also the children of women who were infected with COVID during pregnancy. According to the study’s preliminary preprint findings, children exposed and unexposed in utero to SARS-CoV-2 maternal infection undergo neurodevelopment screening tests at 12, 18, 24, 36, and 48 months of age.

Experts contend that the impact on offspring is an important piece of the puzzle. We know that you can get long COVID during pregnancy and that it can be devastating to new moms. Now we need to know what this means for their children.

Coble is increasingly concerned about her children and how they will fare down the line. She’s often immobile because of her extreme fatigue and can’t be with her children. She tears up talking about it.

“I just worry how having a mom who can’t play with them will impact them later on. It’s just so hard,” she said.