Public health “detectives” will track potential links between COVID-19 and poor pregnancy outcomes

Did COVID-19 worsen pregnancy outcomes in South Carolina? Did it affect the health of mothers and infants? Two Medical University of South Carolina researchers in the Department of Public Health Sciences will try to answer those questions with more than $1.5 million in grant funding from the National Heart, Lung, and Blood Institute.

Angela Malek, Ph.D., and Kelly Hunt, Ph.D., are epidemiologists – public health “detectives” who look for patterns in disease data and statistics to improve our understanding of threats to human health and how to mitigate them. A unique South Carolina resource of statewide medical claims data will aid them in their investigation into potential links between COVID-19 and pregnancy.

“South Carolina is really unique in that it is able to interlink all of the hospital data on births and discharge diagnosis codes, all of the COVID diagnostic information and even Medicaid data,” said Hunt. “That made it feasible for us to actually look at the state level at what the impact of COVID was on pregnancy.”

“South Carolina is really unique in that it is able to interlink all of the hospital data on births and discharge diagnosis codes, all of the COVID diagnostic information and even Medicaid data. That made it feasible for us to actually look at the state level at what the impact of COVID was on pregnancy.” — Kelly Hunt, Ph.D.

“Even before the pandemic, South Carolina had a poor track record on pregnancy and maternal and infant mortality,” said Hunt. Between 2015 and 2019, for every 100,000 live births, South Carolina saw 26.2 mothers die – versus 20.1 nationally in 2019 – and that number jumped to 42.3 for Black women and women of other racial groups. In 2019, for every 1,000 live births in South Carolina, 6.9 infants died – versus 5.6 nationally – with that number climbing to 11.8 for Black women and women of other racial groups.

Poor outcomes were due in part to a high rate of preeclampsia and other cardiovascular complications of pregnancy. Preeclampsia is a complication sometimes occurring in the second half of pregnancy. It can lead to severe high blood pressure and can increase the risk of stroke, seizure and heart or kidney injury in mothers during or immediately after pregnancy. It can also lead to increased cardiovascular risk for mothers for years after pregnancy. Black women are three times more likely than White women to die from preeclampsia and its effects.

The newly funded study will determine whether pandemic-caused disruptions made an already bad situation worse. Malek and Hunt also want to see whether pregnant women of racial and ethnic minority communities were disproportionately affected.

Dr. Angela Malek and Dr. Kelly Hunt standing in a garden
Angela Malek, Ph.D., left, and Kelly Hunt, Ph.D., right

“Early on, the pandemic caused economic volatility, with massive job losses; cancellation and/or suspension of health care and social services; and widespread isolation due to social distancing,” said Hunt. “To date, few studies have examined the relation between the pandemic and adverse maternal or infant outcomes. Not all have been able to compare potential differences by race and ethnicity. That is one of the things that we hope to be able to look at in this study.”

Malek and Hunt also want to study whether infection with the virus causing COVID-19 worsens pregnancy outcomes and maternal health. Early evidence suggests that this could be the case. In a study of Hispanic women with COVID-19, those who were pregnant had a risk of death that was 2.4 times higher than those who were not pregnant. Another study of more than 400,000 women of diverse races found links between COVID-19 infection and poor maternal health during and after pregnancy, including severe illness and poor cardiovascular outcomes. However, more studies are needed to clarify the interplay of race, health care disparities, COVID and pregnancy outcomes.

“If the data show a link between COVID-19 and worse pregnancy outcomes, then that would suggest that a woman who is pregnant and develops COVID-19 should be followed up more closely to help prevent these cardiovascular complications from occurring.” — Dr. Angela Malek

Likewise, they hope that their study of the South Carolina statewide data will begin to answer some of the pressing questions about COVID-19 and pregnancy. Did pregnant women in racial and ethnic minority communities fare worse than their White counterparts? Does COVID-19 infection make women more likely to develop cardiovascular complications during pregnancy? Will those complications increase the mother’s risk of stroke, diabetes or heart attack in later life? How does exposure to the virus as a fetus affect the development and health of the child, and does it increase his or her risk of developing cardiovascular disease?

Malek and Hunt are passionate about their work because they know answers to such questions are the first step toward improving the lives of pregnant women and their children in South Carolina. Their findings could help to target public health initiatives and funding to improve pregnancy and maternal and infant outcomes.

What do they hope will ultimately come from this research? “If the data show a link between COVID-19 and worse pregnancy outcomes, then that would suggest that a woman who is pregnant and develops COVID-19 should be followed up more closely to help prevent these cardiovascular complications from occurring,” said Malek.

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