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AHA News: What Pregnant Women With High Blood Pressure Need to Know About COVID-19

Pregnant women and coronavirus
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TUESDAY, April 7, 2020 (American Heart Association News) -- High blood pressure during pregnancy can put mother and baby at risk during normal circumstances. But with the novel coronavirus spreading rapidly, many are wondering how this highly contagious threat may affect them.

The good news is, thus far, nothing researchers have learned about COVID-19 raises additional concerns for pregnant women – even if their blood pressure runs high, or if they have been diagnosed with problems such as gestational diabetes. The bad news is, because the virus is new and relatively unstudied, there's still a great deal researchers don't know.

"Researchers are still learning how COVID-19 affects pregnant women," said Dr. Lisa Hollier, chief medical officer for Texas Children's Health Plan and a past president of the American College of Obstetricians and Gynecologists, known as ACOG. "It's important for women who have medical complications to stay in very close touch with their OB-GYN and other health care professionals who are taking care of them during their pregnancy."

ACOG guidelines for pregnant women are no different than for anyone else trying to avoid infection from the coronavirus that causes COVID-19, a respiratory illness with symptoms that can include cough, fever and, in more severe cases, difficulty breathing. However, because respiratory infections can be harmful to pregnant women and their unborn children, ACOG does consider pregnant women an at-risk population.

"They need to be doing all of the things that all other women are doing to be sure that they reduce their risk of getting COVID-19 – washing their hands often, using hand sanitizer, not touching their faces," Hollier said. "For all pregnant women, we are recommending you stay in touch with your health care professional about the best ways to continue prenatal care. Some visits can be done online with video."

The Centers for Disease Control and Prevention cautions that people who have underlying conditions such as heart disease, severe obesity or diabetes are at greater risk for severe illness from COVID-19. And researchers know that high blood pressure disorders during pregnancy are one of the leading causes of maternal death worldwide – suggesting further investigation is warranted. The University of California in San Francisco is currently registering pregnant and postpartum women diagnosed with or being evaluated for COVID-19 to study how the virus affects them. The study will include women with hypertension and pre-eclampsia, a dangerous condition characterized by high blood pressure and protein in the urine.

Thus far, neither the CDC nor ACOG has separate COVID-19 guidelines for pregnant women with conditions such as gestational hypertension, gestational diabetes, chronic hypertension or pre-eclampsia.

"What little we do know comes from a small number of reports that have come out of China," said Dr. Elizabeth Langen, clinical associate professor in the University of Michigan's department of obstetrics and gynecology.

"They were the first who had to take care of women who had coronavirus during pregnancy. Unlike the flu, which is really dangerous to pregnant women, this virus does not appear to be any more dangerous to pregnant women with similar risk factors. Most people will have more mild symptoms and recover."

But with so little data, it's hard to say anything definitive, warns Hollier. "It's certainly possible that it affects them worse. We just don't have all of the data we need to give anyone firm answers."

What should a pregnant woman with hypertension, pre-eclampsia or other complications do if she thinks she has COVID-19?

"If you have both pregnancy and something that affects how your heart is functioning," Langen said, "if you are symptomatic, we are going to want you to go in and be seen."

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