PregnancyExamOhio State participates in NIH study to focus on long-term outcomes

The Division of Maternal Fetal Medicine in the Department of Obstetrics and Gynecology at The Ohio State University Wexner Medical Center is participating in National Institutes of Health (NIH)-sponsored research studies to better understand the post-acute sequelae of SARS-CoV-2 infection (PASC). The work is part of the NIH’s Researching COVID to Enhance Recovery (RECOVER) Initiative, which is devoting more than $1 billion to fund research that seeks to understand, prevent and treat “long COVID” symptoms.

The Ohio State Wexner Medical Center is participating in the research as a site of the Maternal Fetal Medicine Units (MFMU) Network, a national consortium established in 1986 to improve maternal and fetal outcomes. The network’s first COVID-19 study was published in April 2021 in Obstetrics & Gynecology.

In that study of about 1,200 pregnant participants, researchers learned that those who had more severe COVID-19 during pregnancy were at increased risk of perinatal complications, including cesarean birth, hypertensive disorders of pregnancy and preterm birth. In addition, severe or critical maternal illness was associated with higher risk of neonates being admitted to the neonatal intensive care unit and having lower birth weight compared with neonates of asymptomatic patients.

Following the original study, the MFMU Network sites are now part of the RECOVER Initiative Consortium and will be completing a four-year follow-up study to understand the long-term outcomes of people who tested positive for SARS-CoV-2 and developed COVID-19 while pregnant. The study will also follow their offspring to understand the impact of that COVID-19 infection on the long-term health of the child — a concept called fetal programming.

Among MFMU Network sites, participants will include approximately 1,500 patients with asymptomatic or symptomatic COVID-19 during pregnancy who gave birth at MFMU Network hospitals, as well as a control group of pregnant participants from the same window of time who did not test positive for the SARS-CoV-2.

People who participate in the four-year follow-up study will undergo extensive medical evaluations, particularly if they experienced severe COVID-19 symptoms during pregnancy. Evaluations include assessment of cardiopulmonary function, cognitive status, mental health, eyesight, hearing, sense of smell and many other aspects of their health. Their offspring will also be evaluated using neurodevelopmental assessments and minimally invasive cardiovascular and metabolic evaluations.

Researchers will seek to understand:

  • What proportion of patients with COVID-19 in pregnancy are at risk for long COVID
  • Whether the severity of COVID-19 in pregnancy influences the likelihood of developing long COVID
  • How the proportion of patients who develop long COVID after COVID-19 in pregnancy compares to that of non-pregnant people who develop long COVID
  • Whether being exposed to COVID-19 infection in pregnancy, and the severity and timing of that infection, worsen the neurodevelopmental and cardiometabolic health of offspring

“There is a lot we don’t know about the long-term implications of having COVID-19 during pregnancy,” says Ohio State site principal investigator Maged Costantine, MD, director of the Division of Maternal Fetal Medicine at the Ohio State Wexner Medical Center. “We hope the study findings will inform efforts to reduce the risk of long COVID after pregnancy and treat its symptoms.”

Lingering COVID-19 symptoms among patients with severe cases are common. In one study of 270,000 people, more than a third of participants had at least one symptom three to six months following their initial illness. Long COVID effects include fatigue, shortness of breath, difficulty concentrating, sleep disorders, fevers, anxiety and depression.

Ohio State hopes to recruit about 300 people and the children they delivered to participate in the follow-up study. “We know from other research that patients from minority ethnicities and races have worse outcomes in the setting of COVID-19 infection, and we hope to enroll a demographically diverse group,” Costantine says. “This will help us identify high-risk populations and target interventions accordingly.”

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