By Lesego ‘Sophie’ Moya and Kathy Fray
New research is concluding women who are pregnant, or who take oestrogen either through birth control or HRT hormone replacement therapy (ie, for menopause and male-to-female transgender) appear to have a higher risk of developing blood-clots if they contract COVID-19. One of the many complications of COVID-19 is the formation of blood-clots in previously healthy people – and medicine knows higher levels of Oestrogen additionally increase chances of blood-clots.
Dr Daniel Spratt from the Division of Reproductive Endocrinology at the Maine Medical Center in Portland, has co-authored with haematologist Dr Rachel Buchsbaum of Tufts University School of Biomedical Sciences in Boston, a paper titled “COVID-19 and Hypercoagulability: Potential Impact on Management with Oral Contraceptives, Estrogen Therapy and Pregnancy”. [This is a collaboration between the Department of Obstetrics & Gynecology and the Division of Reproductive Endocrinology & Infertility at the Maine Medical Center, with the Division of Hematology/Oncology at the Tufts’ School of Medicine.]
“During this pandemic, we need additional research to determine if women who become infected during pregnancy should receive anti-coagulation therapy – or if women taking birth control pills or hormone replacement therapy should discontinue them” study co-author Dr Daniel Spratt said. “In pregnancy the risk of blood clots increases four to five-fold” Spratt explains.
According to Spratt & Buchsbaum’s review:
- The novel coronavirus is proving unusual with the spectrum of its pathological effects, including macro and micro-vascular thrombosis causing troubling amounts of VTEs (venous thromboembolic events), eg strokes from blood-clots.
- All of the underlying mechanisms of COVID-associated hypercoagulability are still unclear, because laboratory blood screens are identifying a plethora of abnormal manifestations related to the Coagulation Cascade.
- One preliminary report also indicates abnormalities in pregnancy Placental vasculature can accompany Covid-19 – thus the question: How does that affect the unborn Fetus?
Founding Director of IIMHCO (Intl Integrative Maternity HealthCare Org) and senior midwife Kathy Fray comments “Strong questions are being asked as to whether Covid-19 infection exacerbates the usual pregnancy-associated risks of blood-clots”. Fray continues “In fact for women generally who are Plus on oestrogen medication it is very normal to recommend they discontinue the drug two weeks before routine activities such as long-haul flights – but a pregnant woman can’t temporarily stop being pregnant. Her risk continues, and in fact compounds”.
Fray concludes “I fervently agree with Drs Spratt and Buchsbaum, that globally we need a Covid-19 Registry of Pregnant Women to facilitate understanding what measures can and should be taken to reduce risks of hypercoagulability in these patient populations. Partnerships between clinicians internationally is crucial.”