Infectious Disease

COVID-19 demise price amongst pregnant ladies elevated

February 05, 2021

2 min read

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Adams Waldorf does not report any relevant financial information. In the study you will find all relevant financial information from all other authors.

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Pregnant women with COVID-19 are more likely to die from the novel coronavirus than non-pregnant people of similar ages, according to a study published in the American Journal of Obstetrics and Gynecology.

“This study is another strong piece of evidence that pregnant women are more susceptible to SARS-CoV-2 infections, as well as other highly pathogenic respiratory infections.” Kristina M. Adams Waldorf, MD, FACOG, Professor of Obstetrics and Gynecology at the University of Washington, Healio Primary Care said, “With women making up a large portion of the essential workforce, we are still at great risk of more severe COVID-19 and death.”

Reference: Lokken EM et al. At J Obstet Gynecol. 2021; doi: 10.1016 / j.ajog.2020.12.1221.

Adams Waldorf and colleagues conducted a nationwide multicenter retrospective cohort study in Washington. They identified pregnant women with confirmed SARS-CoV-2 infection based on polymerase chain reaction tests from March 1, 2020 to June 30, 2020 in 35 cities across the state.

A total of 240 pregnant women were included in the study. Among these women, 10% were hospitalized for COVID-19 concerns and 3.3% were treated in the intensive care unit.

Photo by Kristina Adams Waldorf

Kristina M. Adams Waldorf

Of all pregnant women with COVID-19, 56.3% were diagnosed in the third trimester, 27.9% in the second trimester, and 15.8% in the first trimester. Most (77.1%) were symptomatic at the time of testing.

Adams Waldorf and colleagues found that 90.8% of women who tested positive had mild illness, 7.5% had severe illness, and 1.7% had critical illness.

The researchers found that the overall hospitalization rate for COVID-19 for pregnant women (10%) was 3.5 times higher than for non-pregnant adults aged 20 to 39 years (2.8%; RR = 3.5 ; 95% CI 2.3-5.3). in Washington.

Among hospital patients, 40.9% delivered during hospitalization for COVID-19 received 79.1% oxygen assistance, and 16.7% received mechanical ventilation.

Three pregnant women with COVID-19 died, resulting in a maternal mortality rate of 1,250 out of 100,000 pregnancies (95% CI, 258-3,653). The researchers found that this COVID-19 death rate was 13.6 times higher than the rate among non-pregnant adults of similar ages in the state, which was 91.7 per 100,000 pregnancies, with an absolute rate difference of 1.2% between the groups (95% CI; -0.26-2.57).

Pregnant female deaths accounted for 9.4% of COVID-19-related deaths in the Washington age group, according to the researchers.

Based on the results, Adams Waldorf said that pregnant women should be “absolutely” prioritized for COVID-19 vaccination.

“Pregnancy is a finite condition, and delaying the vaccine would withhold clear benefit from pregnant individuals, who are at risk as their gestational age increases,” she said.

She added that additional research is needed to further evaluate the effects of COVID-19 in pregnant women.

“The immune response during pregnancy is altered to protect the fetus from a ‘rejection reaction’ that resembles a transplanted organ with a different genetic makeup,” said Adams Waldorf. “Although this shift in immune profile benefits the fetus, it can come at the expense of the mother in fighting a severe respiratory infection such as SARS-CoV-2 or the influenza virus.”

She also said more information is needed to determine why pregnant women are more prone to respiratory infections and how they can be treated.

“These questions urgently need our attention,” she said.

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Neil S. Silverman, MD)

Neil S. Silverman, MD

This is an interesting study that unfortunately confirms the reports of increased severity of COVID-19 infection in pregnant women that have occurred since the pandemic started here in the US last March. A very worrying finding in this report is the higher death rate among pregnant women with COVID-19 infection in this study from Washington state. The researchers specifically compared a cohort of pregnant women with a non-pregnant woman of a similar age group and showed a significantly higher risk of mortality associated with COVID-19 infection during pregnancy. It is somewhat limited by the fact that although 240 patients were identified as infected with COVID-19, only 24 women were enrolled with concerns about a diagnosis of COVID-19. All others were essentially diagnosed with universal screening guideline incidentally, so that the actual comparison cohort is smaller than the entire group of women with COVID-19 infection. Still, there were significantly higher maternal mortality rates, and as other studies over the past 6 to 9 months have shown, pregnant women in this study with underlying conditions were at significantly higher risk of COVID-19-related complications.

These and other recent related studies underscore the fact that pregnancy appears to be an independent risk factor for more serious COVID-19-related illness, and that pregnant women with underlying conditions are even more at risk than pregnant women without pre-existing conditions. Last week was the annual scientific meeting of the Society of Maternal Fetal Medicine (SMFM) and results from mothers and newborns from larger cohorts were reported. The largest report comes from the network of the National Institute of Child Health and Human Maternal Fetal Medicine, a collaborative, multi-center network of high-risk OB units across the country. They retrospectively examined over 1,200 women who were diagnosed with COVID-19 infection during pregnancy in a similar period of time as in this study – from early March to late July last year. This group of researchers showed that there were higher rates of undesirable perinatal outcomes with increased severity of COVID-19 disease in mothers. They also showed a significantly higher rate of thromboembolic events in women with more severe disease, as well as more severe infection, which was associated with higher rates of preterm birth, cesarean section, and postpartum bleeding than pregnant women with less severe or asymptomatic diseases.

I firmly believe that this Washington State study, as well as the larger studies presented at the SMFM meeting last week but not yet published, clearly show the importance of protecting pregnant women against COVID -19 be vaccinated. This is despite the fact that conflicting patient-related information has recently been circulated between WHO and the organizations here in the US about the suitability of pregnant women for vaccination. ACOG, SMFM and CDC reiterate that pregnancy should not be an obstacle to vaccinating pregnant women. Those of us who work closely with these agencies in the US continue to express our frustration at the exclusion of pregnant women from trying vaccines such as the COVID-19 vaccine on the assumption that pregnant women are a fragile or at risk population and that adults are pregnant women are unable to give informed consent. The data showing that pregnant women are at higher risk of more severe diseases only confirms the fact that they are a population for which vaccination against SARS-CoV-2 is particularly important. This is especially true for pregnant health care workers – women make up a large percentage of health care workers – and hopefully the reality of this pandemic will help convince those deciding on these issues that pregnant women can make really informed decisions in future clinical research studies.

Neil S. Silverman, MD

Clinical Professor,

Department of Maternal Fetal Medicine,

Clinic for Obstetrics and Gynecology,

UCLA School of Medicine

Member,

ACOG Consensus Committee on Obstetrics

Disclosure: Silverman does not report any relevant financial information.

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