Non-Communicable Diseases and COVID-19 – March 2020 guidance
It is important to consider the potential impact of pre-existing hyperglycemia and hypertension on the outcome of COVID-19 in pregnant women. Currently, there are higher risks of infection and poorer outcomes, including very high mortality, among the elderly population and those with co-morbidities such as hypertension and diabetes in this global pandemic.
There are at present no studies to guide us on the clinical concerns of comorbidities in pregnancy but based on evidence from nonpregnant cases it is logical to assume that there is a potential risk for exhibiting more severe clinical manifestations in pregnant women with hypertension or hyperglycemia. Because patients with hyperglycemia and hypertension require closer monitoring and more frequent visits in the health care system, they are potentially at increased risk for acquiring COVID-19.
To date, with limited clinical results, there is no information on comorbidities and COVID-19, and no suggestion from SARS that patients with comorbidities have higher incidence of acquiring such infections.
The stress of infection, accompanied by severe anxiety and use of high doses of corticosteroids, has the potential to worsen glycemic control and could enhance the risk of secondary infections. Likewise, there is currently no evidence to guide regarding the development of pregnancy complications such as preeclampsia.
It is important to highlight that one in seven pregnancies is impacted by hyperglycemia and one in ten is impacted by hypertension. These considerations must be kept in mind in clinical evaluation and management. Data collection, observations and shared results during this time of rapidly evolving practices are critical in making informed decisions.
At this point, the clinical management of these conditions must follow established protocols including screening for pre-eclampsia and initiation of aspirin prophylaxis. Women with hyperglycemia should preferably receive insulin in case medical therapy is required. FIGO can serve as a clinical repository of information as clinicians in each of our countries share observations on a real-time basis.