Pregnant women who contract COVID-19 are at higher risk of having a severe case of it than women in the same age range who are not pregnant, prompting calls for prioritized access to vaccines for those who are expecting.
At Mount Sinai Hospital in Toronto, six of 20 intensive care beds are currently occupied by pregnant women who have COVID-19, said Wendy Whittle, medical director of labour and delivery and a team lead for the COVID-19 and pregnancy response at the hospital. A total of 11 pregnant women infected with the coronavirus required admission to the intensive care unit in the past two weeks, compared with five across the first and second waves of the pandemic.
Dr. Whittle said that physicians initially thought people who get critically ill with COVID-19 have pre-existing medical conditions such as diabetes, hypertension, asthma and obesity. “But we are seeing young, healthy women who have no other medical problems becoming critically ill. And that’s a little bit frightening,” she said.
As of mid-April, Canada had confirmed at least 4,631 cases of COVID-19 in pregnant women.
Emerging research on pregnant women infected by the coronavirus suggests an increased risk of hospitalization, admission to intensive care units and early labour compared with pregnant women who do not have COVID-19.
Dr. Whittle said data collected during the first wave of the pandemic showed a 12-per-cent rate of preterm birth for pregnant women with COVID-19, compared with 8 per cent for those who did not have the disease. The majority of preterm births for the women with COVID-19 happened toward the end of the third trimester, she noted – “mild prematurity that didn’t leave any long-term consequence for the baby.”
The data also showed a slight increase in the rates of low birth weight for babies born to mothers who had COVID-19, but without any additional risk of complications.
“That being said, this wave we’re seeing women who are sicker, and we know that any time a mom gets critically ill in pregnancy, there is an increased risk of complication for the pregnancy, including the risk of stillbirth, the risk of growth restriction, the risk of prematurity,” Dr. Whittle said.
“So perhaps with this more severe disease profile, we will see a greater impact on pregnancy outcomes. It’s too early to say, but it has us concerned.”
Deborah Money, a professor in the department of obstetrics and gynecology at the University of British Columbia, is leading a national surveillance project on COVID-19 in pregnancy.
“Consistent with international literature and evidence, we are seeing a three- to four-fold higher rate of hospitalization in pregnant women versus non-pregnant women who get COVID, and a five- to six-fold higher rate of admission to an ICU,” Dr. Money said.
“The absolute risks are still low. We’re looking at about a 2-per-cent ICU admission, but that compares to 0.3 per cent in non-pregnant.”
While pregnant women were largely excluded from early vaccine trials, many have received COVID-19 vaccinations around the world because women predominate in priority groups such as health care workers. In the United States alone, more than 90,000 pregnant women have been vaccinated without any safety issues arising, according to the Centers for Disease Control and Prevention.
“When we have data that suggests that pregnant women are actually going to be hit harder with COVID-19, we are very much in favour of pregnant women accessing the vaccine,” Dr. Money said.
The degree of access to vaccinations depends on location. Ontario, for example, last month added pregnant women to its list of at-risk populations, meaning they have priority over the general population.
Alberta, Saskatchewan and New Brunswick all prioritize pregnant women, while B.C. does so only if they also have a serious heart condition. Quebec’s guidelines state that “vaccination of children and pregnant women will be determined based on future studies on vaccine safety and efficacy in these people.”
The Society of Obstetricians and Gynaecologists of Canada (SOGC) described the situation as “alarming” and called for the immediate prioritization of COVID-19 vaccines for pregnant women.
“According to SOGC members, there is currently a daily wave of pregnant women coming into Ontario ICUs, many requiring ventilators,” the society said in an April 15 statement. “These women are getting extremely sick, very quickly.”
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