What Is Known About Long COVID and Pregnancy

We don’t know enough about long COVID and its impact on pregnancy, unfortunately. While over the past two and a half years, scientists and physicians have learned a great deal about SARS-CoV2 (the virus that causes COVID-19), they are still collecting, analyzing, and trying to understand how pregnancy impacts long COVID and vice versa. Keep reading to learn more about long COVID, how to avoid getting it during your pregnancy, and ongoing research into the relationship between long COVID and pregnancy.

While there are many names for it (long COVID, long-haul COVID, post-acute COVID-19, or post-acute sequelae of SARS-CoV-2 infection [PASC]), doctors and scientists generally agree that long COVID is the persistence of symptoms four weeks or longer after the diagnosis of COVID-19. Global reports show that one out of every three people who have COVID-19 experience lingering symptoms or new chronic health problems—some as long as a year after their initial COVID-19 infection.

Doctors and patients alike are frustrated and puzzled by long COVID. Some people may experience only some symptoms, while others may have two or more. Symptoms can also vary significantly from one person to the next. Long COVID does not prefer older or younger people – long COVID affects all ages. The most commonly reported long-term side effects include fatigue, shortness of breath, difficulty concentrating, sleep disorders, anxiety, and depression. But the list of other symptoms reported by long-haulers (nickname for those with long COVID) shows that nearly every body system can be impacted by this syndrome. Symptoms experienced include:

  • Headache
  • Chest pain or discomfort
  • Cough
  • Persistent loss of smell or taste
  • Joint pain
  • Muscle aches and pain/weakness
  • Memory loss
  • Brain fog (sense of confusion or disorientation)
  • Dizziness
  • Low-grade, intermittent fever
  • Rapid or irregular heartbeat (palpitations)
  • Post-traumatic stress disorder (PTSD)
  • Earache, hearing loss, and ringing in ears (tinnitus)
  • Rashes
  • Bowel and digestive changes such as diarrhea, nausea, and/or abdominal pain, diminished appetite
  • Hair loss
  • Loss of libido.

Long COVID symptoms are hard to explain and manage. Clinical evaluations and results of routine blood tests, chest x-rays, and electrocardiograms may be normal. The symptoms are similar to those reported by people with ME/CFS (myalgic encephalomyelitis/chronic fatigue syndrome) and other poorly understood chronic illnesses that may occur after other infections. Many long-haulers report frustration, anger, exhaustion, and desperation in trying to find providers that acknowledge the severity of their symptoms and who will work to try to find effective treatments.

Identifying COVID-19 symptoms in pregnant or postpartum people is complicated because many are also normal discomforts during pregnancy or postpartum. Beyond having a positive COVID-19 test, and reporting symptoms, doctors do not have much else to go on when trying to determine whether or not someone has long COVID. There is not yet a single test to diagnose long COVID, which makes treating and studying long COVID very difficult.

We don’t yet know whether pregnant people at increased risk for long COVID.

Researchers report that long COVID is more common among women and people with six or more symptoms during the first week of COVID-19. We also know that people who are hospitalized with COVID-19 are more likely to experience long COVID. The past two and a half years has shown us that unvaccinated pregnant women who get COVID-19 are more likely to get sicker and need to be hospitalized. So, by virtue of being female and pregnant, pregnant people may be more likely to develop long COVID, especially if they are unvaccinated or not up to date on boosters.

Pregnancy itself causes major changes in nearly every body systems. Some of those changes could make it more likely that people who get COVID-19 in pregnancy become long-haulers. COVID-19 causes inflammation in various organ systems and because the immune system is depressed naturally by pregnancy, COVID-19 related inflammation could be more widespread or severe in pregnant people. This inflammatory response could then show up in other organ systems as symptoms, not recognized until later.

Researchers reported in October of 2020 that one out of every four pregnant people they studied had lingering COVID-19 symptoms lasting longer than two months Incidentally, the majority of the pregnant people in this study had mild COVID-19 cases and were not hospitalized.

There remain so many unanswered questions about the relationship between long COVID and pregnancy. For example, what proportion of patients with COVID-19 in pregnancy are at risk for long COVID? How does the number people who become long-haulers after COVID-19 in pregnancy compare to that of non-pregnant women who develop long COVID. What we need to know is, if a person contracts COVID-19 in pregnancy, are there treatments or behaviors to reduce the risk of developing long COVID? Are there parts of the long-COVID inflammatory response that makes their pregnancy a higher risk? And what many expecting parents want to know: how are the offspring of mothers with long COVID during pregnancy or postpartum impacted? Drawing from research on postpartum depression, we know that children of mothers with postpartum depression can have delayed growth, language development and behavioral problems. If a postpartum mom is struggling with long COVID brain fog, chronic joint pain, and depression for example, it seems reasonable to hypothesize that her long COVID will impact her child’s growth and development, as well.

Fortunately, there are several large-scale studies underway to try to answer some of these questions. The PRIORITY study (Pregnancy Coronavirus Outcomes Registry) is an ongoing study in the United States launched on March 22, 2022. Researchers will be following women who are pregnant or up to six weeks after pregnancy and have a confirmed or suspected case of COVID-19. They will be collecting data on how many people go on to develop long COVID, either during pregnancy, or during their postpartum period.

The National Institutes of Health is one year into a four-year follow-up study on the potential long-term effects of COVID-19 on women infected with SARS-CoV-2 during pregnancy. The RECOVER study (Researching COVID-19 to Enhance Recovery Initiative)  will also follow their offspring for any potential long-term effects.

While we all wait for the results of those studies to learn more about long COVID and pregnancy, the fact remains that getting vaccinated and boosted is the best way for anyone to avoid getting long COVID. People who are not vaccinated against COVID-19 and become infected may also be at higher risk of developing post-COVID-19 conditions compared to people who were vaccinated and had breakthrough infections. If you are pregnant and received any brand of a COVID-19 vaccine during pregnancy, join the COVID-19 Vaccines International Pregnancy Exposure Registry (C-VIPER). This study is sponsored by Pregistry and is the world’s largest one on COVID-19 vaccines and pregnancy. You can help contribute to what we know about COVID-19, pregnancy, vaccination, and long COVID. In the meantime, remember that the best way to prevent getting long COVID during your pregnancy or postpartum is to avoid getting COVID-19 in the first place, which can be done by wearing masks and getting your recommended vaccine shots and boosters.

Abby Olena
Dr. Abby Olena has a PhD in Biological Sciences from Vanderbilt University. She lives with her husband and children in North Carolina, where she writes about science and parenting, produces a conversational podcast, and teaches prenatal yoga.

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