Five things to know about COVID-19 and risks to pregnant women – MLive.com

September 29, 2021

Pregnancy can be a difficult, anxiety-riddled adventure even outside a pandemic.

Women, once peppering doctors with questions about allowed or prohibited foods, exercise duration or hair dye, are now faced with the reality of beginning or growing a family during a long-lasting pandemic.

Cases are rising in Michigan and across the nation. The population is divided on the necessity of masks. Efforts to vaccinate the residents against COVID-19 are continuing, with less success.

Though the Centers for Disease Control and Prevention and the American College of Obstetricians and Gynecologists recommend immunization against COVID-19, some patients remain leery of the vaccines.

RELATED: Vaccinating pregnant women more urgent than ever, CDC says in recommending shots

Doctors and studies here address the risks to pregnant women.

Pregnant women already are vulnerable.

Generally, women of child-bearing age are young and healthy. However, pregnant women are undergoing physiologic adaptations.

Pregnancy is considered an immunocompromised state, said Dr. Alissa OHagan, an obstetrician and gynecologist at the Grand Traverse Womens Clinic and Munson Medical Center in Traverse City.

Younger pregnant patients with COVID will likely do better than, say, a 70-year-old with the coronavirus. But theres so much individual variation that thats not an observation thats worth carrying too far, said Dr. Gregory Goyert, division head of maternal, fetal medicine at Henry Ford Health System in Detroit.

You give them COVID and make them critically ill with multi-organ failure. Well, all competitive advantage has now been lost, Goyert said.

Though it is rare, pregnant women sick with COVID-19 are more likely to die than those who are not infected.

A study, published in August by the peer reviewed medical journal JAMA Network, looked at about 870,000 pregnant women at 499 U.S. medical centers from March 2020 to February 2021. It found 24 of 18,715, or 0.1%, infected with the coronavirus died. In comparison, 71 of 850,364 or less than 0.001% of women without COVID-19 died.

Of 1,378 people identified in 2020 as pregnant with COVID-19 in Michigan, two died. Their babies survived, according to the Michigan Department of Health and Human Services. (Not all of the women had yet given birth.)

An earlier study, also published by JAMA, found pregnant women infected with COVID-19 were 22 times more likely to die than women who had not contracted the illness. Eleven of 706 women with a COVID-19 diagnosis died. Four had severe preeclampsia. Five experienced respiratory failure and two developed fever, cough and breathlessness within seven days of an uneventful delivery. Of 1,424 women without COVID-19, one died because of a preexisting liver concern.

RELATED: Pregnant during a pandemic: Babies in Michigan fare better than in other states

Patients with COVID are at significantly increased risk for adverse pregnancy outcomes compared to those who are not infected.

There is an increased rate of preterm delivery, either spontaneous or induced by medication or cesarean section due to severe maternal disease. There are greater chances of hypertensive complications, such as preeclampsia, a potentially fatal blood pressure condition if untreated, and risk of a caesarean section, doctors said.

If you are entering into a cesarean section with severe consequences from COVID pneumonia and other organ systems, thats a significantly greater risk for mom than the patient without COVID, Goyert said.

Underlying medical conditions, such as diabetes, obesity or cardiovascular disease, can increase those risks among people who get COVID and get sick, as can being part of racial or ethnic minority groups because of health inequities.

You kind of put all those numbers and start multiplying, Goyert said.

Chance of going to ICU or requiring mechanical ventilation increase.

Most pregnant patients will not get COVID, but if they do, their chances of having to go to the ICU or requiring mechanical ventilation increase.

In the study published in August 2021, 5.2% of COVID-positive pregnant women versus 0.9% of women who did not have the virus were admitted to ICUs. About 1.5% of the coronavirus group and 0.1% of the larger group required respiratory intubation and mechanical ventilation.

Usually, babies survive when mothers contract COVID-19.

The U.S. Centers for Disease Control and Prevention reports of 27,268 women with confirmed cases of COVID-19 in 2020, there were 27,449 live born infants and 266 pregnancy losses, according to most recent data, updated monthly.

This means for every 1,000 live birth plus fetal deaths, there were about 9.6 deaths, according to information collected through 26 state and local health departments across the country, including Michigan.

In Michigan, of pregnant women who tested positive in 2020, there were 2.4 deaths per 1,000 live births plus fetal deaths.

The state, as of Sept. 1, recorded three deaths and 1,273 live births attributed 1,247 pregnant women identified as infected by the coronavirus in 2020, according to a spokeswoman for the Michigan Department of Health and Human Services.

The closer a baby is carried to term, 40 weeks, the greater its chance of success, doctors said.

About 12% of babies born to women who contracted the coronavirus in 2020 were born before 37 weeks, according to data from the U.S. Centers for Disease Control and Prevention.

In the study published in August, about 16% of women with COVID had a preterm birth vs about 12% in the larger group.

According to the national CDC data, about 3,600 babies have been tested at birth and about 6% were positive for SARS-CoV-2.

What to do to minimize the risks?

Vaccination is probably the biggest tool presently available, said OHagan, who encourages her patients to get immunized.

As far as other precautions, OHagan points to what has been recommended to all throughout the pandemic: Frequently wash hands, maintain distance from others and wear masks in certain situations, particularly while indoors and in public.

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