Dr Laura Moro-Martin, freelance medical writer at Kolabtree, the freelance platform for scientists, explores the effects of COVID-19 on maternal health.

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), continues to escalate worldwide, with Europe and the USA now the epicentres of the pandemic. As of May 1, there are over three million declared cases and almost 240,000 deaths globally, with many countries undergoing community transmission. Although a majority of infections with SARS-CoV-2 are mild, the elderly and people with comorbidities — including cardiovascular and respiratory diseases, hypertension, diabetes, and cancer — are at increased risk of severe disease and death.

Pregnant women are particularly vulnerable to several infectious diseases that can cause both maternal and fetal adverse outcomes. Immunological and physiological adaptations occurring during gestation are behind this increased risk. During previous outbreaks caused by SARS-CoV and Middle East Respiratory Syndrome CoV (MERS-CoV), several pregnant women acquired the infection. SARS-CoV −a 'cousin' of SARS-CoV-2− was associated with severe maternal illness, maternal death, spontaneous abortion, severe intrauterine growth restriction, preterm delivery, and life-threatening gastrointestinal complications in the newborn. Among the few known cases of MERS-CoV-infected pregnant women, several maternal and neonatal deaths and stillbirths were reported.

The scientific and medical communities are putting an immense effort into sharing information about COVID-19. There are currently a growing number of published case reports and case series presenting pregnant women infected with SARS-CoV-2 and a few case-control studies. Pregnant women appear to show a similar disease presentation than their non-pregnant counterparts, being fever and coughing the most frequent symptoms. There is no evidence for vertical transmission of the virus from infected mothers to the fetus, although a few neonates tested positive a few hours after birth.

Several maternal and fetal adverse outcomes have been reported, including preterm delivery, fetal distress, low birth weight, and respiratory symptoms in the newborn, among others. Preterm delivery, the leading cause of death in children under five, appears as the most common adverse pregnancy outcome caused by coronaviruses. Thus, future mothers should be considered in prevention and treatment strategies against COVID-19, ensuring the safety of drugs and vaccines during pregnancy.

Pregnant women and neonates in low-resource settings, as well as refugees and those in conflict zones, constitute one of the most vulnerable populations, and concerted efforts are urgently needed to ensure their health and wellbeing. Health service delivery ? including, for example, malaria chemoprevention for pregnant women− should be guaranteed during the pandemic, avoiding the disruptive effect of previous disease outbreaks.

The World Health Organisations (WHO), as well as other international organisations and national health authorities, issued interim recommendations for the care and management of SARS-CoV-2-infected pregnant women. These recommendations advised against unnecessary caesarean deliveries and encourage breastfeeding if possible. Although we still have little data on the impact of COVID-19 on pregnant women and neonates, systematic screening and careful follow-up of any suspected SARS-CoV-2 infection during pregnancy is crucial to ensure maternal health.

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