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Kaiser Permanente researchers study pandemic pregnancies

Survey finds low prevalence of COVID-19 overall but higher risk among some groups


Soon after the COVID-19 pandemic began, investigators who study women’s and children’s health at the Kaiser Permanente Division of Research realized they had a unique, one-time opportunity to learn about the experience of having COVID-19 and living through a pandemic while pregnant. They would survey pregnant members of Kaiser Permanente Northern California, but they had to be quick about it.

A dozen members of the women’s and children’s research section created a wide-ranging survey headed by co-principal investigators Lisa Croen, PhD, and Assiamira Ferrara, MD, PhD, with questions about the patients’ health, experience with COVID-19 testing and infection, symptoms, lifestyle, and economics during pregnancy. The 20-minute online survey, which is administered twice over the course of the pregnancy, has been completed by more than 25,000 patients and researchers are already working with the resulting data.

Jennifer Ames, PhD, staff scientist, Division of Research.

The first findings from the survey were published Sept. 3 in the journal PLOS One and focus on COVID-19 infections among pregnant women through April 2021. It found a low percentage of COVID-19 infections, with higher prevalence among younger women, Hispanic women, and those living in neighborhoods with greater economic deprivation.

This  first study’s lead authors —Division of Research Staff Scientist Jennifer Ames, PhD, and Croen — explain their results and expand on the potential for this survey to provide important insights on a wide variety of women’s health topics.

What did you want to find out about pregnancy and COVID-19?

Croen: We had an opportunity to gather information in real time that we couldn’t get from medical records. Compared with other research on COVID-19 during pregnancy, our sample is larger, more diverse, and is being followed over time. It’s possible pregnant people may be more susceptible to severe COVID-19 disease because of reduced immunity and increased stress during pregnancy, and there is little information on how the pandemic is impacting maternal and neonatal health outcomes.

What did this newly published study find?

Ames: Of the 19,458 respondents in our study, 2.5%, or 494, said they had been told by a medical professional they had COVID-19.

What’s unique about our sample is that we have a comparison group of women who didn’t have a COVID-19 diagnosis. That means we’re able to distinguish the symptoms that appear to be associated with COVID-19 from those that are probably related to the pregnancy. For example, 20% of our sample without COVID-19 experienced headaches during pregnancy, but slightly over 50% of those with COVID-19 had headaches. This gives us insight into symptoms that may be specific to COVID-19 in pregnancy.

Our study also found half the women with COVID-19 reported loss of taste or smell. In fact, it was one of the most common symptoms in COVID-19 but was reported by less than 2% of women without COVID-19.

Lisa Croen, PhD, research scientist, Division of Research.

Croen: We also found disparities in risk of getting COVID-19. In particular, young women, women of color, and women living in high-deprivation neighborhoods had the highest rates of infection. It could be beneficial to enhance outreach and monitoring efforts for these patients to promote preventive health, access to vaccination, and follow-up for their own health and their child’s health.

Ames: We also found that around two thirds of women with COVID-19 had interacted with someone who had or likely had COVID-19 in the two weeks before their symptoms. In the majority of these cases, this was someone living in their household. However, a third of women with COVID-19 did not recall interacting with someone who had COVID-19, suggesting that a sizable number of people may not have known where they got their infection from.

What other topics are likely to come out of this survey?

Croen: We have collected a wealth of information about the pandemic’s impact on a variety of issues, from general health care, employment, stress, and childcare, to food insecurity, exercise, and changes in use of health care services. Other papers currently in progress by our colleagues at the Division of Research are addressing pandemic-related factors associated with prenatal depression and anxiety, including changes in health, health care, economics, and coping strategies related to stress.

What is next for the survey?

Croen: We are continuing to recruit people to take the survey, which is offered shortly after 12 weeks of pregnancy and then again towards the end of pregnancy. We recently added questions about the COVID-19 vaccination and experiences of discrimination, and we’ll likely continue to adapt the survey with shifts in the course of the pandemic. The information gathered from the survey will also be used to enhance other ongoing and future studies of COVID-19.

Do you expect to continue the survey indefinitely?

Croen: We’ll just keep going, as long as the pandemic continues. There’ll be some very important and interesting information that comes out of it; there already is. The pandemic, unfortunately, keeps going on.


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