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This transcript has been edited for clarity.
Welcome Impact factor, Your weekly commentary on new medical research. Dr. F. Perry Wilson, Yale University School of Medicine.
In the era of coronavirus, pregnant women represent a unique cohort in hospitals. They may exhibit glorious COVID-19 symptoms and deaths have been reported. Of course, they are in the hospital just for childbirth and may accidentally detect COVID.
Early in the pandemic, a friend of mine, an anesthesiologist in New York City, told me how overwhelmed he was with the COVID case. Not in ICU. He worked in the obstetrics ward. Normal pregnancies have become complicated, caesarean sections have surged, and outcomes have worsened.But until I see this paper Appeared in JAMA Internal Medicine, His experience was just another anecdote at the sea of the COVID war story.
Finally, there are some solid data on the risk of COVID-19 during pregnancy. And women who are pregnant or are thinking of becoming pregnant are more needed than ever because they need to make decisions about vaccination evaluated in studies that specifically exclude pregnant women.
Pregnant women tend to be younger and healthier than the average US adult. Therefore, in the absence of pregnancy, it is often considered low risk rather than the vaccine priority group. However, this treatise shows that COVID-19 has a fairly significant effect on pregnancy, and these risks should be considered when considering whether to recommend vaccination.
The study leveraged a very large database of records from multiple payers to capture 20% of all deliveries in the United States from April 1st to November 23rd, 2020. .. Of the total of 406,446 women, 6380 (1.6%) had a COVID at the time of delivery. .. The authors compared baseline characteristics and results between these two groups.
Women who gave birth while infected with COVID tended to be younger than women without COVID. Reflecting the national prevalence, they are more likely to be black or Hispanic, more likely to suffer from diabetes, obesity..
The authors adjusted these and other factors to determine how the independent effects of COVID-19 affected pregnancy outcomes.Well, bad things rarely happen during pregnancy in this country, so I would like to clarify what I am presenting. Relative Increased risk, not absolute risk.For example, COVID was associated with a 25-fold increase in risk Mechanical ventilation — However, only 1.3% of women with COVID were intubated overall.
Women with COVID had a relatively 7% increased risk. Caesarean delivery, Risk increased by 19% Early labor pain, The risk of stillbirth increased by 23%. They had a 6-fold increased risk of going to the intensive care unit and a 3.5-fold increased risk of veins. Thromboembolism.. Nine women died in the COVID group, and only 20 died in the COVID-negative group, which is 60 times larger.
Again, most women didn’t have these things, but the presence of COVID clearly The risk increases.
Against this background, what do we know about the risks and benefits of vaccination for pregnant women? not much. They have been excluded from the major clinical trials that led to the current vaccine approval in the United States.Some women became pregnant During ~ Their participation in the Pfizer and Moderna trials — I analyze their results here — but most of the results are unknown, probably because these women are still pregnant. There is no danger signal, but obviously there is not much data.
Biologically, there is little reason to think that mRNA vaccines have a negative effect on pregnancy, but that may not be reassuring for many women. For many women, vaccines are a great way to balance risk and benefit assessments. For others, increased alertness to hand hygiene, wearing masks, and avoiding crowds may be the best choices to mitigate risk.
There is one thing that is clear. If you can avoid getting COVID during pregnancy, you probably should.
F. Perry Wilson, MD, MSCE, is an Associate Professor of Medicine and Director of Clinical and Translational Research Accelerators at Yale University. His science communication work can be found at the Huffington Post, NPR, and here in Medscape.He tweets @fperrywilson Host a repository of his communication work at www.methodsman.com..
