COVID-19 Infection in Late Pregnancy Tied to Birth-Related Complications in Unvaccinated Women

NEW YORK (Reuters Health) – Women infected with SARS-Co-V-2 late in their pregnancy are at increased for birth-related complications, a study from Scotland shows.

Preterm births, stillbirths and neonatal deaths were significantly more common among women who had the virus 28 or fewer days before their delivery date, with nearly all COVID-related critical-care admissions and all baby deaths occurring in unvaccinated women, researchers report in Nature Medicine.

“The low vaccine uptake in pregnant women, compared to its uptake in the general female population of similar age, was striking,” lead author Dr. Sarah J. Stock of the University of Edinburgh told Reuters Health.

“This is especially concerning given all the evidence that suggests that the COVID-19 vaccine is safe and effective in pregnancy and that the vaccine prevents serious COVID-19 complications in pregnancy,” she added by email.

Dr. Stock and her colleagues analyzed data from a national prospective cohort of all women in Scotland who were pregnant on or after March 1, 2020. Those data were linked with SARS-CoV-2 infection data and COVID-19-vaccination data.

Between December 8, 2020, and October 31, 2021, 18,457 pregnant women received 25,917 COVID-19 vaccinations. Compared with the general population of women between 18 and 44 years of age, pregnant women had lower vaccine uptake: By October 31, 2021, 77% of all women had received two vaccine doses vs. only 32% of women who gave birth in October 2021.

The extended perinatal mortality rate for women who gave birth within 28 days of being diagnosed with COVID-19 was 22.6 per 1,000 births, compared with 5.6 per 1,000 births for all babies born between March 1 and October 31, 2020, a highly significant difference.

Overall, 77% of SARS-CoV-2 infections, 91% of SARS-CoV-2 infections involving hospital admission and 98% of SARS-CoV-2 associated with critical-care admission – as well as all baby deaths – occurred in pregnant women who were unvaccinated when they were diagnosed with COVID-19.

Dr. Jeanne S. Sheffield, a professor of gynecology and obstetrics and the director of the Division of Maternal-Fetal Medicine at Johns Hopkins Medicine in Baltimore, Maryland, said the “results strengthen earlier data reported from several countries.”

“Vaccination of pregnant women significantly decreases hospital admissions and critical-care admissions, and vaccination decreases preterm birth and perinatal mortality. Unfortunately, a significant amount of vaccine hesitancy among pregnant women still remains,” Dr. Sheffield, who was not involved in the study, told Reuters Health by email. “We need to continue to educate patients and providers regarding the importance of COVID-19 vaccination in reproductive-age women.”

For Dr. Katherine E. Bunge, an assistant professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences at the University of Pittsburgh Medical Center (UPMC) in Pennsylvania, “The major strength of this very valuable study is the sheer number of women included.”

“Drawing from population-level data, over 130 thousand pregnant women were included in the analysis, representing over 99% of women in Scotland who were pregnant during the study period,” Dr. Bunge, who also was not involved in the study, told Reuters Health by email.

Dr. Stock noted that “whole-population data allow the most accurate estimates of the effect of COVID-19 on complications such as baby deaths.”

She and her team are continuing their research, investigating COVID-19’s impacts on miscarriage and other early-pregnancy outcomes, and quantifying Omicron’s effects in pregnant women.

“Omicron levels are very high, unvaccinated people are particularly vulnerable, and severe complications can happen with Omicron. Vaccination at any stage of pregnancy is the safest and most effective way for pregnant women to protect themselves and their babies from COVID-19,” Dr. Stock advised.

The study did not receive commercial funding. The authors and independent experts declare no commercial competing interests.

SOURCE: Nature Medicine, online January 13, 2022.

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