Utah researchers work to understand how COVID-19 affects premature births, stillbirth rates

(Trent Nelson | The Salt Lake Tribune) Megan Briley at her home in Kamas on Saturday, Dec. 5, 2020.

Megan Briley was about six months pregnant when the fever, aches and cough set in days before Thanksgiving as COVID-19 cases were surging in Utah.

Briley said she doesn’t know how it happened; she works alone at her Park City home and always wears a mask when she shops. But her coronavirus test was positive.

”To be honest, I’m worried about the long-term effects and any effects to the baby,” Briley said. “But I decided not to research too much and make myself scared.”

Instead, Briley is now part of research into a question that is worrying many expecting parents in Utah: How does COVID-19 affect pregnancy outcomes, both for the mother and for the baby?

Briley is participating in a study at the University of Utah, helping doctors learn “the rate of infection of COVID in pregnant women, duration of symptoms and if there are any associated complications,” she said.

Doctors aren’t exactly sure how COVID-19 may be connected to premature births and stillbirth rates, but multiple studies are underway in Utah to help figure that out.

There have been some studies done abroad and in the U.S., with mixed results, but until more data is collected and analyzed, “we just don’t know yet,” said Dr. Torri D. Metz, an associate professor of obstetrics and gynecology at the University of Utah.

At Intermountain Healthcare, doctors are tracking patients based on a variety of criteria, said Dr. Helen Feltovich, a specialist in maternal fetal medicine in obstetrics and gynecology and an associate professor. They’re looking at what trimester mothers get COVID-19 during pregnancy, she said, and if anyone contracted the virus twice.

They’re also looking at mothers’ ancestries, and whether it was a spontaneous preterm birth, or if it was medically necessary due to a pregnancy complication, according to Feltovich.

Meanwhile, Metz is leading a national study, supported by the National Institutes of Health, that will explore how COVID-19 and the societal reactions to the pandemic have affected pregnant women and their babies. Researchers plan to analyze medical records of up to 21,000 pregnant women, and track the health of more than 1,500 expecting mothers with confirmed cases of COVID-19 for six weeks after they give birth.

Metz’s study is expected to run through year’s end, and, as of mid-November, researchers were continuing to recruit patients. Metz said she hopes to start analyzing their data in early 2021.

Feltovich estimated that Intermountain had collected data from roughly 700 patients and said their plan is to publish a report in coming months.

“Our hope is to figure out what’s going on right here, right now in Utah,” she said, “so that we can figure out the best thing to do for our patients.”

Preterm birth is already a “complex” issue, without a global pandemic factoring into it, said Feltovich, who researches the topic as an associate scientist in the medical physics department at the University of Wisconsin in Madison. The preterm birth rate has risen in the U.S. since 2014, she said, and researchers aren’t sure why.

With attention on premature births and stillbirths with COVID-19, Feltovich and Metz said there’s an opportunity to better understand these issues.

“We are basically having a large natural experience now of changes in the health care system, changes in society,” Metz said.

(Photo courtesy of University of Utah Health) Dr. Torri D. Metz is an associate professor of obstetrics and gynecology at the University of Utah. She is leading a national study exploring how COVID-19 and the societal reactions to the pandemic have affected pregnant women and their babies.

Early studies in Denmark and Ireland suggested a decrease in preterm births in the spring during pandemic lockdowns, Feltovich said, which made doctors curious about what was happening.

That prompted researchers in the Netherlands to conduct a larger study, she said, looking at 1.5 million deliveries from 2010 to 2020. Their findings, published this fall, state that initial COVID-19 mitigation measures were “associated with a substantial reduction in the incidence of preterm births in the following months.”

Researchers added, though, that there needs to be more data collected around the world “to further substantiate these findings” and understand the underlying factors.

What Feltovich said stood out to her in the Netherlands study was that, while not “statistically significant,” the decrease in preterm births “predominantly occurred in populations living in high-socioeconomic-status neighborhoods.”

“What that addresses” Feltovich said, “is what we’ve always known about preterm birth, which is that there are health inequities ... that really drive rates of preterm birth.”

In early November, the Centers for Disease Control and Prevention released a study in its Morbidity and Mortality Weekly Report looking at pregnancy outcomes of more than 4,000 women with COVID-19. They found that preterm births had increased to 12.9% during the pandemic from 10.2% of the general population in 2019.

In the study, though, Black and Hispanic women “were disproportionately represented.” This complicates the findings, Feltovich said, because “women of color have a higher risk of preterm birth ... for a whole bunch of reasons; some we know, some we don’t know.”

“It’s not clear,” she said, “how that impacts the data, as opposed to the pandemic itself.”

Feltovich said she couldn’t provide specifics about what Intermountain has seen until its data is published, but she noted, “The data that we’ve been seeing does not agree with the study in the Netherlands. Let’s just say that.”

(Photo courtesy of Intermountain Healthcare) Dr. Helen Feltovich is a specialist in maternal fetal medicine in obstetrics and gynecology and associate professor at Intermountain Healthcare. She is also associate scientist in the department of medical physics at the University of Wisconsin - Madison.

There was also a study in the United Kingdom, Metz said, which found “an increase in the stillbirth rate during the pandemic.”

“But when they looked at those stillbirths,” Metz added, “they weren’t in women who had COVID-19.”

The study suggests the increase could have resulted from other factors, such as patients’ “reluctance to go to the hospital when needed” and a “fear of contracting infection.”

There is a lot of speculation in these early studies, Metz said, and one key factor will be determining whether there’s a difference in women spontaneously having premature births, or if the change is because doctors are delivering mothers early for medical reasons. More data and analysis are required to figure that out, she said.

Until that happens, the pandemic will continue to cause stress for a lot of new and expecting parents.

Briley said she is still recovering from her COVID-19 infection, with congestion and shortness of breath lingering at least 17 days after she first got sick. But with so little data available, she’s trying to suppress any anxiety about the baby.

“I figure as long as I get myself healthy again and the baby seems to be doing great, very active,” she said, “then I’m going to try not to worry too much.

From her bed at Utah Valley Hospital in Provo, Katie Branham said she was both excited and nervous to return home with her daughter, Ezri, who was born last week in an emergency cesarean section.

Branham’s placenta separated from her uterus a few days before a scheduled C-section, and because Branham’s own doctor was in quarantine for possible coronavirus exposure, a new doctor had to sub in for the early delivery. Ezri spent her first hour in the neonatal intensive care unit.

Ezri is doing well now, Branham said, but COVID-19 affected the whole pregnancy — from her husband not being allowed at prenatal appointments to her doctor having to miss the delivery and her other children being forbidden from meeting their sister until they return home this weekend.

Not knowing how the virus might affect the pregnancy made the family nervous about being infected. And soon she’ll return to her home in Sanpete County, which has had some of the Utah’s highest rates of new cases in the past two weeks.

“We’ve had to be really careful to avoid catching it. You hear so many things ... about COVID that it’s really hard not to have worried during the pregnancy about possible complications,” Branham said. “That fear actually doesn’t go away when the pregnancy ends either, as now we have a newborn to worry about.”

Becky Jacobs is a Report for America corps member and writes about the status of women in Utah for The Salt Lake Tribune. Your donation to match our RFA grant helps keep her writing stories like this one; please consider making a tax-deductible gift of any amount today by clicking here.