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COVID-19 worsens maternal, fetal outcomes, studies find

COVID-19 worsens maternal, fetal outcomes, studies find

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 found yesterday in naturopathy. They were also more prone to poor birth outcomes, even if they weren’t critically ill, according to a US study in The Lancet Digital Health.

Vaccine uptake low in pregnant women

In the first studyResearchers from the University of Edinburgh and Public Health Scotland analyzed national population-level data on the intake of COVID-19 vaccines and SARS-CoV-2 infections in pregnant women.

From the launch of a COVID-19 vaccination program in Scotland on December 8, 2020 to October 31, 2021, 18,457 pregnant women received 25,917 doses. The uptake in this group was much lower than in non-pregnant women aged 18 to 44 years, with 32.3% receiving two doses of the Pfizer/BioNTech, Moderna or AstraZeneca/Oxford at delivery in October 2021. vaccine, compared with 77.4% of the other women .

There were 4,950 COVID-19 infections among pregnant women. The death rate among women who delivered a baby within 28 days of a COVID-19 diagnosis 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 1,000 births (95% CI, 5.1 to 6.2).

A total of 2,364 babies were born to COVID-infected women. Among them were 2,353 live births, of which 241 were premature, for a preterm birth rate of 10.2% (95% CI, 9.1% to 11.6%). The preterm birth rate in infants born within 28 days of maternal COVID-19 diagnosis was 16.6% (95% CI, 13.7% to 19.8%).

Of the 2,364 births, 11 were stillbirths and 8 live births died within 28 days of birth, for a perinatal death rate of 8.0 per 1,000 births after maternal infection at some point in 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 death rate was 5.6 per 1,000 births (95% CI, 5.1 to 6.2) .

A total of 77.4% (95% CI, 76.2% to 78.6%) of infections, 90.9% (95% CI, 88.7% to 92.7%) of COVID-related hospitalizations and 98% (95% CI, 92.5% to 99.7%) of women requiring critical care, as well as all neonate deaths, occurred in pregnant women who had not been vaccinated at 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 with 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.

“So, refusal of vaccines during pregnancy requires an approach, especially in light of new recommendations for booster vaccination 3 months after the initial vaccination course to help protect against new variants such as Omicron,” the study authors wrote. “Addressing low vaccination coverage in pregnant women is imperative to protect the health of women and babies during the ongoing pandemic.”

In expert commentary of the Science Media Centre, Allyah Abbas-Hanif, MBBS, of Imperial College London, said: “We have seen maternal deaths increase with each progressive wave of the pandemic, a trend that is being reversed in other at-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 during pregnancy than ever before, despite this, in four decades only one drug has been approved for use during pregnancy,” said Abbas-Hanif. “In the future, the Covid-19 pandemic should be a catalyst for improved research and health equity for pregnant women and their babies.”

Risk of preterm birth, low birth weight, stillbirth

A study led by researchers at the Institute for Systems Biology in Seattle showed that pregnant women infected with SARS-CoV-2 are more likely to have adverse birth outcomes, including preterm birth, small size for gestational age, low birth weight, and stillbirth.

The team used data from Providence St. Joseph Health’s electronic health records for pregnant women who gave birth at sites in Alaska, California, Montana, Oregon, or Washington from March 5, 2020 to July 4, 2021. None of the women had been 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 before February 14, 2021. Of the 73,666 women, 882 tested positive for COVID-19 during pregnancy, 85 in the first trimester, 226 in the second trimester and 571 in the third semester. In all, 19,769 women never tested positive for COVID-19 and received at least one negative test during pregnancy.

COVID-19 infection increased the risk of preterm birth and stillbirth, usually in the first and second trimester. Gestational age at diagnosis correlated with and had the most influence on predicting gestational age at delivery. The women all had mild or moderate disease and disease severity did not correlate with gestational age at delivery.

Infected women were more likely than their uninfected peers to be Hispanic or any race other than Asian or White and had Medicaid insurance, a lower age, a higher body mass index, and a lower educational level.

“Due to the increased maternal and fetal health risk of SARS-CoV-2 infection, we propose prioritizing vaccination of pregnant people in areas where vaccine distribution is scarce,” the authors wrote.

In a systems biology institute press release, corresponding author Jennifer Hadlock, MD, said pregnant women could benefit from increased monitoring after being diagnosed with COVID-19. “Both maternal and fetal health are at increased risk with COVID-19,” she said. “Therefore, this reinforces the importance of protecting pregnant women.”

In a commentary in 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, Maryland, said maternal health and COVID-19 differ in the United States require attention.

“[COVID-19] has dramatically alleviated both persistent health inequalities 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 an adverse pregnancy outcome,” the authors wrote. she.

Barr and colleagues called for a more inclusive body of research and dialogue about the importance of maternal health care and prevention of infectious diseases in women. “Recommendation from Piekos and colleagues to closely monitor pregnancy [sic] people who have had SARS-CoV-2 infection during the first or second trimester of pregnancy is an essential start,” they said.