COVID-19 and Pregnant Women
COVID-19 has many hats of expression – asymptomatic carriage (60%-says the CDC) and florid symptoms. COVID-19 and pregnant women (particularly third trimester) represent a unique population of women, when hospitalized with the disease. Most of the women hospitalized and detected to have COVID-19 are in hospital for delivery of the baby. COVID-19 positivity is an incidental finding (a true screening test). A subset of these women presented for delivery and because of COVID-19 symptoms.
Their peri-delivery care became complicated, C-section rates spiked and outcomes worsened. Teasing out data from anecdote of trends noted is imperative. Women who contemplate pregnancy or who already are pregnant must consider whether they wish vaccination. Available data on trials of the two available vaccines (Pfizer and Moderna), excluded pregnant women in the initial trials. (Trials are ongoing).
Reproductive-age women tend to represent a healthier and younger cohort then the general population. Expecting to fair well through a COVID infection course, they are low risk – not a priority group for the vaccine. However, how does pregnancy affect risk calculation?
What We Know About COVID-19 and Pregnancy So Far
A recently published peer-reviewed paper published in JAMA Internal Medicine was able to data-mine a database of approximately 400,000 US delivered between April and November of 2020. Of these women, approximately 2% had a COVID positive test at the time of delivery.
Women who delivered a baby while infected with COVID tended to be younger than those without COVID (which may attest to different behavior bases in younger versus older Mothers-to-be). Because the incidence of bad factors is low, what needs to be compared is what is called “relative risk.”
For instance, the need for ICU admission and a ventilator was 25-fold higher in the COVID positive population than the COVID negative one. This number seems daunting. However, it represented on 1.3% of the population of COVID positive patients. The risk in COVID negative patients is 0.05%
Women with COVID had a relative increased risk in having a C-section, risk for preterm labor, and venous thromboembolism. Nine women died of COVID-related complications when compared to the COVID negative group. This adjusted relative risk to 26X. It is important to note that these numbers are small and represent relative risk and not absolute.
We are committed to continue care for our patients and remain focused, as always, on providing you with individual care that centers on you. The decision to vaccinate is a personal one and knowing the real facts is an important part of that decision. If you have more questions on COVID-19 and pregnant women or vaccines and fertility, please contact us for a free initial consultation. We are here to help.
*Your consultation is FREE if you don’t have infertility insurance coverage.
Jering, Clagget, Cunningham, et al. “Clinical Characteristics of Outcomes of Hospitalized Women Giving Birth with and without COVID” JAMA Intern Med. Jan 15, 2021.