Little was known about COVID-19 when it first appeared in 2020, including its effect on different groups of people.

During the first wave of infections, some pregnant women become seriously ill with the virus and needed intensive care. However, it wasn’t clear if an early caesarean or induced birth would help women recover more quickly, and if an earlier birth was best for their babies.

Professor Marian Knight, Professor of Maternal and Child Population Health at the University of Oxford, has been comparing different birth journeys and the treatment women received to find out the care that resulted in the best outcomes.

Funded by Wellbeing of Women, Prof Knight has used this insight to understand how care can be optimised for pregnant women hospitalised with COVID-19 in the future.

Optimising care for pregnant women with severe COVID-19

Prof Knight and her team examined data from the UK Obstetric Surveillance System (UKOSS) of 4,436 pregnant women who were admitted to hospital with confirmed COVID-19 between 1 March 2020 and 31 October 2021.

Almost two in three were diagnosed with a mild infection. One fifth had a moderate infection. One in seven were severely affected and needed respiratory support and intensive care.

From their analysis, Prof Knight and her team found that nearly one in five women with a severe infection did not have an early caesarean or induced birth. Instead, they were sent home once they had recovered from the virus. Most of their babies were born healthy at full term (considered to be at around 39 weeks), although some babies were sadly stillborn.

Of the women who did have an early caesarean or induced birth, their babies appeared to have better outcomes if they were born within two days of their mother becoming ill compared with those who were born between three and 10 days later. However, only a small number of pregnant women had an early birth.

Prof Knight says, “COVID-19 raised a lot of questions for pregnant women – how dangerous the virus was for mother-to-be, the safety of existing and emerging treatments and the potential impact on their unborn baby.

“Our data provides reassurance that pregnant women with severe COVID-19 infection who were discharged from hospital before giving birth mostly had good outcomes. However, a small number of babies were stillborn, indicating a need for careful monitoring after discharge until their baby is born.

“As we continue to learn about the virus, its composition and its behaviour, we will be able to ensure pregnant women receive the right care for them at the right stage to ensure they and their babies are happy, healthy and safe.”

Next steps

To minimise the risk of stillbirth in pregnant women with severe COVID-19, Prof Knight highlights a need for studies to examine how well the placenta continues to work and the impact of ongoing fetal monitoring.

The link between timing of birth and neonatal outcomes for women with a severe infection also needs further investigation with larger datasets.

Our research on pregnancy and birth

Wellbeing of Women is funding several research projects to help improve treatment and care during pregnancy and birth, including:

• Dr Jane Cleal’s study into why some women struggle to become pregnant or experience miscarriage
• Dr John Allotey’s work to reduce the rate of stillbirth by understanding early pregnancy risk factors
• An investigation by Dr Matina Iliodromiti into how we can identify health risks in babies too small or too large during pregnancy
• Midwife Joanne Cull investigating how maternity services can empower pregnant women affected by trauma