When COVID-19 Strikes in Pregnancy, C-Section Tied to Worse Outcomes
Pregnant women with COVID-19 who deliver by cesarean section may be at greater risk for complications that affect them and their babies, new research suggests.
The study focused on 82 women with COVID-19 -- four of them with severe symptoms -- who gave birth in hospitals in Spain. Thirty-seven women delivered by cesarean section (C-section), including eight as a direct result of COVID-19 issues.
Nearly 30% of babies delivered by C-section had to go to the neonatal intensive care unit, compared with fewer than 20% of babies delivered vaginally, the researchers found.
"Cesarean section should be done only when there is an indication for it outside COVID," said Dr. David Baud of the materno-fetal and obstetrics research unit at the Centre Hospitalier Universitaire in Lausanne, Switzerland.
Baud said a C-section should not be performed just because the mother has COVID-19 or to prevent transmission of the virus to the baby.
Risks associated with a C-section rise when the mother has COVID-19, he added. The study found that women who had a C-section were more likely to wind up in the intensive care unit themselves. They also were more likely to be obese, in need of oxygen when they entered the hospital and to have abnormal chest X-rays.
None of the mothers who delivered vaginally developed severe medical problems, while nearly 14% who had a C-section had to go to the ICU.
Five percent of women who delivered vaginally saw their COVID-19 worsen, compared with 22% who had a C-section, according to the report.
Whether COVID-19 can be passed to a baby in the womb isn't known, but this study may shed some light on the possibility.
Of 72 newborns tested for COVID-19 within six hours of birth, 4% were positive for the virus. Repeat testing after 48 hours found that all tested negative. None of these babies developed COVID-19 symptoms within 10 days, the study authors said.
However, two babies delivered by C-section did develop COVID-19 symptoms within 10 days. Both had contact with their parents immediately after birth, the researchers said. Their symptoms resolved within two days.
Dr. Adi Davidov, associate chairman of obstetrics and gynecology at Staten Island University Hospital in New York City, reviewed the study findings.
He said that "it is not surprising that women who required a cesarean section had worse outcomes."
Women who have COVID-19 and require a C-section are usually much sicker, Davidov said. It would make sense that their outcomes would be worse.
Although the authors tried to control for many factors, he said it is nearly impossible to control for every variable in this kind of observational study.
"Despite these confounding variables, it is safe to say that whenever possible, the best mode of delivery is vaginal. This is true for women who have COVID-19 or not," Davidov said.
The findings were published online June 8 as a research letter in the Journal of the American Medical Association.
For more about cesarean delivery, visit the American College of Obstetricians and Gynecologists.
SOURCES: David Baud, MD, PhD, materno-fetal and obstetrics research unit, Centre Hospitalier Universitaire, Lausanne, Switzerland; Adi Davidov, MD, associate chairman, obstetrics and gynecology, Staten Island University Hospital, New York City; Journal of the American Medical Association, June 8, 2020, online