COVID Poses Severe Risks during Pregnancy, Especially in Unvaccinated People

Millions of people became pregnant and gave birth during the pandemic. When the virus that causes COVID, SARS-CoV-2, first emerged, it was not clear what additional risks it poses to pregnant women and their babies.

However, accumulating evidence now indicates that COVID infection during pregnancy not only increases the likelihood of severe outcomes and death for parents, but also increases the likelihood of fetal complications. .A large meta-analysis published in BMJMore In January, pregnant women infected with the virus were found to have a significantly higher risk of complications such as pneumonia, admission to intensive care units, ventilators and death compared to those who were not infected. . Babies born to infected women were also more likely to be admitted to the neonatal intensive care unit (NICU) and were more likely to be born prematurely or to be born with low birth weight.

Emily Smith, assistant professor of global health at the George Washington University Milken Institute’s School of Public Health and lead author of the meta-analysis, said that with COVID infection, “there are two reasons why you might really get sick during pregnancy.” “One [is] From COVID itself — pneumonia and others [could] I have it from COVID. And…it can cause or exacerbate existing maternal morbidity.

Fortunately, vaccination reduces many of these risks.Research published in the February 11 issue of lancet We found that vaccinated pregnant women were at lower risk of severe COVID, ICU admission, and death than unvaccinated pregnant women. And the risk was even lower if you received a booster shot.

“Pregnant women are generally young, fit and healthy, so they don’t consider themselves at risk,” he said. lancet Alice Papaorgiou, senior author of the study, professor of fetal medicine and director of research at the Oxford Institute for Maternal, Child and Perinatal Health, said: “But the truth of the matter is that there is a higher risk of COVID infection during pregnancy.”

It is well established that influenza and other infections are more dangerous during pregnancy. One hypothesis is that a pregnant person experiences immunological changes that prevent the body from rejecting the fetus, just as it rejects a transplanted organ. A growing uterus could put pressure on the lungs, making it difficult to breathe, he added. Additionally, some pregnant women may not be receiving treatment for infections because doctors are nervous about the effects of drugs on the fetus, Smith says.

Early in the pandemic, Smith and her colleagues sought to quantify the risk COVID poses to pregnant women and their babies. The researchers began collecting her data in April 2020, and the analysis was ultimately based on 12 studies involving more than 13,000 pregnant women. These surveys will be conducted between February 2020 and July 2021 and cover her 12 countries: Ghana, China, Italy, Kenya, Nigeria, South Africa, Spain, Sweden, Democratic Republic of the Congo, Turkey, Uganda and the United States. was carried out across , COVID was diagnosed with a PCR test. Importantly, most of the data were collected before the vaccine was widely available or in locations with low coverage, so it is likely that most of the women who participated in the study were not vaccinated, he said. Smith points out.

The results showed that pregnant women with COVID had, on average, more than seven times higher risk of death than those without COVID. However, only 3 of the 12 studies documented death. The study found that the absolute risk of pregnant women dying from COVID is relatively high, with 7 deaths per 100,000 pregnant women diagnosed with the disease, although some countries where the study was conducted It is important to note that maternal health care is much poorer in Higher than the United States (meaning this mortality rate is not representative of all women, especially in wealthy countries such as the United States). Nevertheless, it turns out that the risk is still significantly increased.

Pregnant women with COVID were also 23 times more likely to develop pneumonia, 15 times more likely to need to be on a ventilator, more than 5 times more likely to develop blood clots and be admitted to the ICU. is nearly four times higher. Pregnant.

Additionally, babies whose mothers had COVID were almost twice as likely to be admitted to the NICU, 1.7 times more likely to be born prematurely, and slightly more likely to be born with low birth weight. did not find an association between COVID infection and stillbirth.

“The important thing for me is that these are serious consequences and great risks for mother and baby,” says Smith. That is why we take some precautions for

The findings add to previous findings published in 2021. JAMA Pediatrics By Papageorghiou and his colleagues. It also found that a pregnant woman and her baby are at increased risk of severe complications and death from COVID.

But now there is growing evidence that vaccination protects pregnant women from the worst consequences of COVID.

their lancet In a study earlier this year, Papageorghiou and his team found that about 4,600 pregnant women died during the period when the first Omicron variant of SARS-CoV-2 was prevalent (late November 2021 to June 2022). Analyzed. Researchers found that COVID vaccination in the first series alone was 48% effective in protecting against severe disease in all pregnant women, while vaccination followed by at least one booster was 76% effective. I discovered that there is In fact, for pregnant women infected with COVID, the first series of vaccines made him 74% effective against severe disease, and boosters made him 91% effective.

“Almost all side effects were seen in unvaccinated women. “Women who had a booster were more protective than women who didn’t have a booster.” I was. [severe] symptoms. “

Asma Khalil, professor of obstetrics and maternal-fetal medicine at St George’s Hospital, University of London, and her colleagues also found that the vaccine is nearly 90% effective in preventing SARS-CoV-2 infection in pregnant people. bottom. He’s a week after the second dose, but over time the protection may decrease. The vaccinated man also had a 15% lower risk of stillbirth. (However, vaccination was not associated with a significantly lower risk of miscarriage or fetal abnormalities.) Mother and baby. “

Other studies have found that the antiviral drug paxlobid can be safely administered (for reasons unrelated to pregnancy) to pregnant women who are at high risk of developing severe COVID.

When the COVID vaccine first became available, clinical trials of the vaccine did not explicitly recruit pregnant women, so many who were pregnant were hesitant to get vaccinated. Some of the people who participated in the study became pregnant, but there was no evidence of adverse effects from the vaccination, says Papaorguiu. [data]there were no excess miscarriages and no difference in fertility,” he said, adding that the U.S. Vaccine Surveillance System, which tracks adverse events from vaccination, reports no congenital problems or problems with fetal growth. added.

Given the sizeable risks pregnant women face from COVID infection, and the safety and effectiveness of vaccination, a major challenge may be convincing more pregnant women to get vaccinated. Health care providers such as midwives and obstetricians and gynecologists have a role to play in educating patients. “All we can do is give women the best information,” says Papaorgiou. “Tell them the facts.”