David McIntyre, MD, FRACP, outlines how metabolic factors could impact the severity of COVID-19 infections among pregnant people.
The rates of admission for intensive care and need for ventilatory support due to COVID-19 seem to be almost twice as common during pregnancy, said David McIntyre, MD, FRACP, a professor of medicine and an endocrinologist at the University of Queensland in Brisbane, Australia.
Can you discuss the intersection of metabolic and respiratory complications that could arise from a COVID-19 infection in a pregnant person with diabetes?
So this is something that's becoming clearer over time. In the beginning, it was thought that COVID-19 was no more severe at all in pregnancy than at other times. I guess with increasing case numbers, we know that the COVID-19 symptoms appear to be less prominent. So major fever and cough and shortness of breath are perhaps a bit less common, but nonetheless, the infection can quite rapidly become more severe. The rates of admission to intensive care and need for ventilatory support, etc, do seem to be at least one-and-a-half to twice more common during pregnancy in pregnant women who are affected. And we know that underlying comorbidities—and particularly the 2 big ones that are relevant here are preexisting obesity and type 2 diabetes—are major risk factors for severe COVID-19 infection of the sort that might end up requiring intensive care unit admission or even causing death. Tragically, that's been the case very much in the United States, I believe, where particularly certain ethnic groups who have high rates of diabetes and obesity have been very disproportionately affected.
In pregnancy, that has also been the case, and certainly elevated body mass index or obesity in the presence of nondiabetes are risk factors for severe COVID-19. GDM [gestational diabetes mellitus] itself at this point, slightly increased, but not significantly so. There are a number of people who are running what you would call a living review, where they're reviewing each piece of data as it comes in rather than just publishing a single paper. I guess we'll get better information about that in the longer term.
The other thing that's very relevant, which is only just starting to be realized, is the part of the so-called long COVID-19, or extended COVID-19, symptomatology. It does include metabolic dysfunction, in particular, hyperglycemia. So I think that will become clearer in the future about whether that long COVID-19 syndrome, which has a lot of other symptoms as well, to what extent that includes metabolic and gluco-metabolic dysfunction.