The following article is a part of conference coverage from the American Academy of PAs 2021 Conference (AAPA 2021), held virtually from May 23 to May 26, 2021. The team at the Clinical Advisor will be reporting on the latest news and research conducted by leading PAs. Check back for more from AAPA 2021.

 

Pregnant non-Hispanic Black persons are at heightened risk for morbidity and mortality during pregnancy. In 2020, the COVID-19 pandemic added a sudden and unexpected layer of vulnerability to this risk beyond what is common in this group, specifically hypertension, diabetes, obesity, and anemia, as discussed by researchers in a poster at the American Academy of PAs 2021 Conference (AAPA 2021).1  

“The impetus of our systematic review was to measure the impact of [SARS-CoV-2] on non-Hispanic Black pregnant women and perinatal outcomes,” said Yanique S. Campbell, PA-S, a physician assistant student at Charles R. Drew University in Los Angeles, California.


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Case Management Recommendations Lacking

“We searched Google Scholar and PubMed databases for all case reports from February to November 2020. Our eligibility criteria included peer-reviewed articles published in English that included non-Hispanic Black patients with confirmed diagnosis of COVID-19 infection,” Campbell said. “In terms of admission rates, rates of infection, maternal death, necessity for emergency cesarean delivery, we examined maternal outcomes. For neonatal outcomes, we looked at infant infection, and more specifically, infants who tested positive for COVID-19 following birth, including pregnancies at increased risk for fetal loss, preterm birth, and stillbirth.”

Reports of non-Hispanic Black patients infected with SARS-CoV-2 are limited, the study authors found. Racial bias, low socioeconomic status, and comorbidities increase the risk for adverse outcomes associated with COVID-19 in these patients, the researchers noted.

Table 1 provides a summary of data on comorbidities, COVID-19 symptoms, hospital admissions, and deaths among Black and White pregnant and postpartum patients in Brazil.2 “The comorbidities coupled with COVID-19 demonstrates the vulnerability of this [Black] population,” Campbell said.

Table 1. Comorbidities and COVID-19 Symptoms Among Pregnant and Postpartum Patients in Brazil (n=669)2

 Black (n=134)White (n=535) 
 Number (%)NumberP valuea
Comorbidity/Risk Factor   
Cardiovascular diseaseb22/134 (16.4%)67/535 (12.5%)>.05
Diabetesc19/134 (14.2%)57/535 (10.6%)>.05
Obesity12/134 (8.9%)37/535 (6.9%)>.05
Any comorbidity45/134 (33.6%)160/535 (29.9%)>.05
Symptoms at admission   
Dyspnea85/124 (68.5%)260/474 (54.8%)<.001
Respiratory distress69/120 (57.5%)238/463 (51.4%)>.05
SpO2 <95%56/118 (47.5%)137/446 (30.7%)<.001
ICU admission37/134 (27.6%)104/535 (19.4%)<.001
Mechanical ventilation20/134 (14.9%)39/535 (7.3%)<.001
Deathd17/100 (17.0%)38/423 (8.9%)<.001
aChi-square test; bIncludes both heart diseases and hypertension, whether chronic or gestational; cIncludes both gestational and pregestational diabetes; dAmong women with a recorded outcome in the database.
Table adapted from de Souza Santos et al.2

Key Takeaways

  • Pregnant non-Hispanic Black patients with COVID-19 may have higher seropositive rates and present with symptoms (eg, increased dyspnea, decrease oxygen saturation) that required ICU admission and mechanical ventilation.
  • Prenatal and antenatal counseling can help prevent SARS-CoV-2 infection and decrease complications related to COVID-19 in non-Hispanic Black patients.
  • Pregnant non-Hispanic Black patients with comorbidities (eg, hypertension, diabetes, obesity) are likely to experience negative birth outcomes (eg, preterm labor, fetal distress).
  • Pregnancy loss was common in non-Hispanic Black patients who were symptomatic or asymptomatic.

“We found few recommendations for managing this vulnerable group during the ever-evolving pandemic and want to prompt providers to look for key red flags within this population to improve case management and increase positive outcomes,” said Campbell.

“Physician assistants are a tightly knit community of qualified and highly skilled practitioners ready to go out and serve. If we recognize racial disparity and inequity, we can provide meaningful care for everyone who is marginalized,” Campbell concluded.

Visit Clinical Advisor’s meetings section for complete coverage of AAPA 2021.

References

  1. Campbell YS, Kibe LW, Bazargan M. Clinical manifestations and perinatal outcomes in non-Hispanic Blacks who are pregnant and infected with SARS-CoV-2: A systematic review. Poster presented at: American Academy of Physician Assistants Conference; May 22-26, 2021. Poster 51.
  2. de Souza Santos DS, Oliveira Menezes M, Betina Andreucci C, et al. Disproportionate impact of COVID-19 among pregnant and postpartum Black women in Brazil through structural racism lens. Clin Infect DiscI. Published online July 28, 2020. doi: 10.1093/cid/ciaa. Accessed May 23, 2021. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7454418/pdf/ciaa1066.pdf