If you are wondering what could possibly go wrong with getting Covid-19 while you are pregnant, take a look at a recent publication in Pediatrics. This publication detailed two separate cases of newborns ending up with quite severe brain damage after their mothers had had Covid-19 while pregnant. And one of those mothers didn’t even have symptoms while she was infected with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Add these two cases to the growing list of things that you should hate about Covid-19.

This is a reminder that while you are pregnant, it isn’t a good idea to say, “Hey, let’s figure out a way to catch the SARS-CoV-2.” Being pregnant can leave you at higher risk for more severe Covid-19. And getting Covid-19 would not be great for that little dude or dudette growing inside you either. As the Centers for Disease Control and Prevention (CDC) indicates, previous studies have already shown that mothers who have had Covid-19 during their pregnancies have been more likely to experience complications such as delivering preterm (earlier than 37 weeks) or stillborn infants.

How bad can these pregnancy complications be? In a word, very. The new publication in Pediatrics described what happened to two neonates who had the misfortune of being born in 2020 when our country’s leaders were caught with their collective pants down by the pandemic. If you recall, back in 2020, there were a number of politicians and personalities claiming that getting Covid-19 was no big deal and that a just-let-people-get-infected strategy—otherwise known as the do-nothing strategy—was actually a reasonable approach. This was all before Covid-19 vaccines were authorized and widely available.

In one case, the 21-year-old mother was healthy until 27 weeks into her pregnancy she landed in the intensive care unit (ICU) with pneumonia and multisystem disease having tested positive for SARS-CoV-2. Five weeks later, or 32 weeks into the pregnancy, after the mother was no longer SARS-CoV-2 positive, doctors performed a Cesarean section. The pre-term male infant was in bad, bad shape, suffering repeated seizures and requiring a ventilator to breathe due to significant lung disease. While testing didn’t find the virus in the infant, his blood did have antibodies against SARS-CoV-2 as well as elevated levels of serum inflammatory markers and cytokines. An MRI of his brain showed bleeding in his brain, which is never a good thing to see. Indeed, the infant’s brain development did not proceed normally so that when the infant was finally discharged after spending three months in the hospital, he had microcephaly, which is when the head is much smaller than expected. After discharge, the infant continued to have repeated respiratory infections and neurological issues until sadly passing away at just 13 months of age from a cardiac arrest.

In the second case, the 20-year-old mother had tested positive for SARS-CoV-2 late in her second trimester. She never experienced any Covid-19 symptoms then and when she tested positive again right around the time of her vaginal delivery. During her delivery at the 39-week mark, there were signs that the placenta and amniotic fluid were infected. The female infant required some oxygen after delivery and was placed on antibiotics. During her first day outside of her mother, the infant suffered seizures. While the infant didn’t have any detectable SARS-CoV-2, her blood did have antibodies against SARS-CoV-2 and markedly elevated inflammatory markers and cytokines. Although the infant left the hospital at five weeks of age, she had to return multiple times due to seizures and repeated respiratory infections. At one year of age, she had clear microcephaly and a variety of neurological issues, which landed her in hospice care.

Yeah, for those who have pushing the “Covid-19 is no big deal” line, try telling that to a mother who has had an infant pass away or end up in hospice. Both of these cases were tragic, featuring mothers who could have otherwise had uncomplicated pregnancies if it weren’t for that little, little, little virus.

So what specifically happened to these infants when they were still squatting in the wombs? Well, the researchers did look to see if a placenta cause existed. In both cases, the placentas had signs of inflammation such as elevated levels of cytokines. The placentas didn’t seem to be working properly too as levels of an important hormone, human chorionic gonadotropin (hCG), were markedly lower than normal. Examinations of the placenta also revealed that things were messed up with blood clots and loss of blood vessels. The placenta is pretty darn important to the fetus. After the fertilized egg attaches to the mother’s uterus lining, the placenta eventually grows and serves as a temporary organ that delivers oxygen and nutrients from the mother to the fetus through the umbilical cord. Thus, the placenta serves as the infant’s combination oxygen tank, mini-bar, refrigerator, and restaurant. If something goes uh-oh with the placenta, both the mother and the fetus can be at risk for lots of badness. Like lots.

Since neither infant tested positive for the actual virus, it’s not completely clear whether the SARS-CoV-2 ever crossed the placenta into the fetus. Thus, the damage to the infant’s brains could have been the result of inflammation disrupting the functioning of the uterus so that the fetus couldn’t get the full amount of nutrients and oxygen. It could also have been the result of the cascades of chemicals involved in the whole inflammation thing causing damage to the infants.

Then there’s the immune response to the virus that the fetuses may have had themselves. Back in 2020, when your body had never seen the SARS-CoV-2 before, your immune system could have behaved like a virgin on a first date, firing off in random directions just trying to see what may work. That could have ended up causing more damage to your body. A similar thing could have happened to these two infants, whose immune systems were essentially new to everything.

There is certainly the possibility that the SARS-CoV-2 did make its way across the placentas into both fetuses. SARS-CoV-2 testing can be like asking someone if they have read 50 Shades of Grey. You won’t always get an accurate answer. Just because some testing didn’t find the virus didn’t mean that it wasn’t present.

Of course, two cases in 2020 doesn’t necessarily mean that such situations are super common. It’s not totally clear how frequently such brain damage may occur in infants born to mothers who had Covid-19. Figuring this out would require more research, which, by the way, requires those little things that you call money and time. Covid-19 much we have to learn about, as Yoda would say.

In the meantime, these cases are a reminder that there are real risks to getting Covid-19 during pregnancy. This doesn’t mean that you should hole yourself up inside a castle of toilet paper and watch Love Is Blind on loop on Netflix. But there are precautions that you can take such as getting vaccinated against Covid-19, wearing a face mask while indoors in public areas, avoiding poor ventilated areas, and staying away from others who may be infected.

Of course, 2023 ain’t 2020 too or even 2022. Things have definitely progressively improved with the Covid-19 pandemic, regardless of how much various politicians have tried to mess things up. With many more people having been exposed to the spike protein through vaccination and natural exposure and everyone’s immune systems now more familiar with the virus, the virus doesn’t pose the same threat now as did in 2020. Nevertheless, getting Covid-19 is still not the same as getting a cold or the flu. People may claim that it is. But at this point, it just isn’t.

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