Understanding how Covid-19 affects pregnancy
While the pandemic is still unfolding, the long-term effects of catching the virus during pregnancy are not yet clear, but our scientists across the UK are working hard - and collaborating with experts worldwide - to learn as much as possible about the impact of Covid-19 on mothers and babies. For example, our team at Kings College London has reviewed the research evidence on a steroid which can treat the virus but can also cross the placenta, and their advice on treating expectant mothers while keeping their babies’ safe was recently published in the American journal Obstetrics & Gynecology.
Our Stillbirth Research Centre is using electron microscopy to closely inspect cells from the placenta and see if the virus is present; these will also be stored in our National Reproductive Health Biobank to be used in other studies. Dr Carolyn Jones, who retired some years ago, has come back to work on this as she’s a leading expert in this technique. Others in the Manchester team recently published a review in Science Direct summarising all the current evidence (around 50 studies) on how Covid-19 can affect the placenta. There are strict review processes before research can be published so the information is limited, but we’ll continue to share important developments when we can.
Up in Edinburgh, our researchers are working with Public Health Scotland to link up all the national data and look for changes in the health of mothers and babies during the pandemic – as well as any differences in how pregnant women use healthcare services, such as whether they’re less likely to attend antenatal appointments, which are still running in lockdown and shouldn’t be missed. This project is a unique opportunity for us to study pregnancies across a whole country in real time and will provide incredible insight to help us make pregnancy safer for all.
We’re also continuing our work with the Stillbirth Centre of Research Excellence on a global research study to understand the experiences of parents who have lost their baby through miscarriage, stillbirth or neonatal death during the pandemic.
Protecting mothers from blood pressure problems in pregnancy
Another consequence of Covid-19 is that healthcare services have been forced to rethink and adapt, so they can give people the care they need while still following social distancing guidelines to keep them safe from the virus. There’s been a big shift towards ‘telemedicine’ with appointments being held over the phone or even on video call where possible – and this is an area researchers at our hypertension clinic are interested in, as it could make the regular check-ups that some mothers with high-risk pregnancies need much easier to keep on top of. Prof Lucy Chappell and her team recently published their recommendations for using telemedicine to support pregnant women with high blood pressure in the journal Hypertension.
The journal also published exciting new findings from our MAViS (Manchester Antenatal Vascular Service) team, showing that a drug called enalapril can improve the heart health of mums-to-be with serious blood pressure problems. High blood pressure during pregnancy leaves mothers vulnerable to cardiovascular diseases later in life, and those who develop pre-term (before 37 weeks) pre-eclampsia have an 8x higher risk of dying from these diseases, so this research could be lifesaving. 60 women having specialist care for preterm pre-eclampsia at our Manchester clinic joined the 6-month trial to see if they could benefit from targeted early stage treatment, and those who took enalapril had better heart function than those given a placebo. The next step is a clinical trial with hospitals across the UK to see if these promising results are found in the wider population.
Myth-busting on miscarriage and chlamydia
While it’s not always possible to know the cause of a miscarriage, there is evidence that 5% of losses in early pregnancy and two-thirds in the second trimester are linked to reproductive tract infections. Some reports have suggested an association with chlamydia, but the evidence is very mixed – probably because tests can generally only tell if someone currently has the infection and not whether they’ve been exposed to it in the past but recovered with treatment. Our researchers at the University of Edinburgh have used a new antibody test, which is more sensitive and specific than other tests, to clear up the confusion around this.
Scientists performed a case-control study, comparing 251 women diagnosed with a miscarriage and 118 women from the same population whose pregnancies had progressed into the third trimester. They expected to find antibodies suggesting exposure to the infection in 15% of women who had experienced loss and 7% of those who hadn’t, based on the previous evidence, but actually found the rates were similar for both groups. Their findings were recently published in the Journal of the American Medical Association, where they will be reassuring news for anyone worried about the potential impact of chlamydia infection on future fertility.