Women who gave birth within 28 days of a positive COVID-19 test died at a significantly higher rate than their healthy counterparts, a Scottish study finds yesterday in natural medicine. According to an American study in Digital Health The Lancet.
Low vaccination rate among pregnant women
In the first study, researchers from the University of Edinburgh and Public Health Scotland analyzed national population-level data on COVID-19 vaccine uptake and SARS-CoV-2 infections among pregnant women.
Since the launch of a COVID-19 vaccination program in Scotland on December 8, 2020 until October 31, 2021, 18,457 pregnant women have received 25,917 doses. Uptake was much lower in this group than in non-pregnant women aged 18-44, with 32.3% who gave birth in October 2021 having received two doses of the Pfizer/BioNTech, Moderna or AstraZeneca/Oxford vaccine, compared to 77 .4% of other women .
There have been 4,950 COVID-19 infections among pregnant women. The mortality rate among women who gave birth within 28 days of being diagnosed with COVID-19 was 22.6 per 1,000 births (95% confidence interval [CI], 12.9 to 38.5), compared to the pandemic background rate of 5.6 per 1000 births (95% CI, 5.1 to 6.2).
A total of 2,364 babies were born to women infected with COVID. Of these, 2353 were live births, including 241 premature, for a prematurity rate of 10.2% (95% CI, 9.1% to 11.6%). The preterm birth rate among babies born within 28 days of maternal diagnosis of COVID-19 was 16.6% (95% CI, 13.7% to 19.8%).
Of the 2,364 births, 11 were stillborn and 8 liveborn babies died within 28 days of birth, for a perinatal mortality rate of 8.0 per 1,000 births after maternal infection at any time. pregnancy (95% CI, 5.0 to 12.8). Ten stillbirths and four neonatal deaths occurred in babies born within 28 days of maternal infection.
During the study period, the background preterm birth rate was 8.0% (95% CI, 7.8% to 8.1%) and the prolonged perinatal mortality rate was 5.6 per 1000 births (95% CI, 5.1 to 6.2).
Overall, 77.4% (95% CI, 76.2% to 78.6%) of infections, 90.9% (95% CI, 88.7% to 92.7%) of hospitalizations and 98% (95% CI, 92.5% to 99.7%) of women requiring intensive care, as well as all newborn deaths, occurred in unvaccinated pregnant women at the time of the diagnosis.
Of all first trimester COVID-19 infections, 6.7% (95% CI, 5.5% to 8.1%) resulted in hospitalization, compared to 10.7% (95% CI, 9. 3% to 12.2%) of those in the second trimester and 33.5%% (95% CI, 31.2% to 35.9%) of those in the third trimester. No infections in the first trimester led to the need for intensive care, compared to 2.0% (95% CI, 1.4% to 2.8%) of those in the second trimester and 4.3% (95% CI, 3.4% to 5.5%) in the third trimester.
“Vaccination hesitancy during pregnancy should therefore be addressed, particularly in light of new recommendations for the administration of booster vaccination 3 months after the initial vaccination course to help protect against new variants such than Omicron,” the study authors wrote. “Addressing low vaccination rates among pregnant women is imperative to protect the health of women and babies in the ongoing pandemic.”
In expert comments from the Science Media Centre, Allyah Abbas-Hanif, MBBS, of Imperial College London, said: “We have seen maternal deaths increase with each gradual wave of the pandemic, a trend reversed in d other high-risk groups by the protection afforded by vaccines.
She called for a review of the long-term practice of excluding pregnant and breastfeeding women from clinical trials and drug development. “There is now more drug use and disease use in pregnancy than ever before, despite this, only one drug designed for use in pregnancy has been licensed in four decades,” Abbas-Hanif said. “Moving forward, the COVID-19 pandemic must catalyze improved research and health equity for pregnant women and their babies.”
Risk of premature birth, low birth weight, stillbirth
A study by researchers at the Institute for Systems Biology in Seattle showed that pregnant women infected with SARS-CoV-2 have a higher risk of adverse birth outcomes, including premature birth, short stature for gestational age, low birth weight and stillbirth.
The team used electronic medical record data from Providence St. Joseph Health for pregnant women who gave birth at sites in Alaska, California, Montana, Oregon or Washington from March 5, 2020 through July 4, 2021. None of the women were vaccinated against COVID-19.
A total of 73,666 pregnant women gave birth, of whom 18,335 had at least one COVID-19 test during pregnancy by February 14, 2021. Of the 73,666 women, 882 tested positive for COVID-19 during pregnancy, 85 in the first quarter, 226 in the second quarter and 571 in the third half. Overall, 19,769 women never tested positive for COVID-19 and received at least one negative test during pregnancy.
COVID-19 infection has conferred an increased risk of preterm delivery and stillbirth, most often in the first and second trimester. Gestational age at diagnosis correlated with and had the most impact on the prediction of gestational age at delivery. The women all had mild or moderate disease, and disease severity was not correlated with gestational age at delivery.
Infected women were more likely than their uninfected peers to be Hispanic or of another race other than Asian or Caucasian and to have Medicaid insurance, younger age, higher body mass index and higher health status. lower education.
“Due to the increased maternal-fetal health risk of SARS-CoV-2 infection, we propose to prioritize vaccination of pregnant women in areas where vaccine distribution is scarce,” the authors wrote. .
In a press release from the Institutes for Systems Biology, corresponding author Jennifer Hadlock, MD, said pregnant women may benefit from increased monitoring following a diagnosis of COVID-19. “Maternal and fetal health is at increased risk with COVID-19,” she said. “Therefore, it reinforces the importance of protecting pregnant women.”
In a comment from the same journal, Elizabeth Barr, PhD, and Damiya Whitaker, PsyD, both of the National Institutes of Health, and Pamela Stratton, MD, of the Scientific Consulting Group in Gaithersburg, Md., said maternal health and COVID-19 disparities in the United States demand our attention.
“[COVID-19] dramatically shed light on both the persistent inequalities in health and the failure of research, clinical care and medical education to address the social and structural factors that generate and perpetuate these inequalities among those most at risk of adverse pregnancy outcomes,” they wrote.
Barr and her colleagues called for a more inclusive body of research and dialogue on the importance of maternal health care and infectious disease prevention in women. “The recommendation of Piekos and her colleagues to closely monitor the pregnancy [sic] people who had SARS-CoV-2 infection during the first or second trimester of pregnancy is an essential start,” they said.