COVID PREGNANCY UPDATE
COVID19 PREGNANCY UPDATE
Hey guys! I know this is weighing on your mind. Many of you have already reached out to me at appointments, via texts or phone calls to our office. Right now no one knows who or what source to trust with regards to COVID19 and the vaccine. I understand it is scary and we are here for you. Thought I would just give you my thoughts and recommendations to help with your decisions. Ultimately the choice is yours and it is one that you have to be comfortable with in your heart and soul and I will support your decision either way! Please let me know if you have questions. This is a long post as there is a lot to cover so bare with me… :)
What has changed with regards to COVID in pregnancy? I know what I see on the news but what are you seeing Dr Watkins and what are you hearing?
Things have changed a bit in the past month. Despite hopes and prayers that we were “done” with COVID it appears it has definitely resurfaced and things are a bit different regarding recs and COVID’s impact on pregnancy and pregnant women. The new surge also appears to be impacting healthier and younger patients. There are growing concerns that the delta variant may be somehow more dangerous in expectant mothers than earlier strains of the coronavirus. The previous surge of COVID in my practice did not appear to impact my patient population. Many, >100 , had COVID, but most were either asymptomatic or had mild disease. We admitted NO patients with COVID disease. This does not hold true for this round of COVID. I have had to admit patients, my friends who are OBGYNs in other states and in local hospitals are admitting patients as well to critical care floors and to ICUs. Here are some quotes from my colleagues and friends at other hospitals and across the country that I have on my phone in text messages:
“ I have had to do 3 bedside ICU csections in the past 2 weeks.”
“ We have had 2 maternal deaths from COVID in last 6 weeks. We have previously only had 1 maternal death every 2 years at my hospital.”
“For the first time in my career I have had to do a bedside csection.”
“We have 6 admitted to ICU just in last 5 days. Two are intubated and one on ECMO.”
“I am worried for my patients. I did not have to worry a year ago. They are getting sick. I just admitted 2 yesterday.”
These quotes are not meant to scare you..promise. I too at times don’t know who to trust. I spend much time scouring through research, data and guidelines. I research local hospital posts about their ICU numbers. But...I also reach out to the people I trust. My friends and colleagues that I went to medical school with, residency with and other fellow doctor moms too to get a feel as to what really is going on..and we are seeing an increased impact and risk of COVID morbidity and mortality to pregnant women for this new variant.
What are the risks of getting COVID in pregnancy?
The reassuring fact is that it does not appear that pregnant women are at a greater risk of GETTING COVID but it does appear that IF you get COVID in pregnancy you are more likely to suffer from complications then pregnant women without COVID and nonpregnant individuals. We now are seeing that pregnant women WITH COVID are more likely to have pregnancy complications such as miscarriage, preterm birth and preeclampsia. Pregnant women WITH COVID are also at a greater risk of being admitted to the ICU, being intubated (ie require a ventilator) and die. This likely comes from the fact that both pregnancy and COVID increase the hypercoagulable state of the blood and thus can increase risk of blood clots, stroke and heart attack as well as it is more difficult to ventilate (ie bring oxygen to) a pregnant woman then those who are not pregnant due to the gravid uterus and the inability of the diaphragm to fully distend.
The GOOD news is this percentage is still low and >90% of pregnant women will recover without undergoing hospitalizations.
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2782978
Per the CDC 109,773 cases of Covid-19 have been reported among pregnant women throughout the pandemic.
More than 18,000 had to be hospitalized, with 490 sick enough to be admitted to the intensive care unit.
This is ~6% risk of admission to hospital and 0.45% risk of admission to ICU
If the risk is low then why should I worry?
So risk is low but still to an OB any risk of our patients being admitted is terrifying. It is UNCOMMON for our patients to be admitted to hospitals in pregnancy other than for pregnancy related reasons..ie labor, preeclampsia, preterm labor etc. It is even more uncommon for our patients to be admitted to ICU. I have a busy practice and we deliver 250-300 babies a year. It is rare that I ever admit a patient to the ICU. In the last 3 years I have admitted none. I have delivered over 2,000 babies in the last 12 years and in those 12 years I have only admitted 3 patients to the ICU. Per the 0.45% risk above for ICU admission risk..for my practice currently of roughly 300 babies due for the year would mean I would admit 1.35 this year...1 momma in the ICU is one momma too many!!!
What about the babies? How are the babies of these mommas doing?
Ultimately it is not COVID19 specifically that is impacting babies. Over 95% of newborns of COVID positive moms have been healthy at birth. Babies of moms who have or had COVID19 are not suffering from complications due to COVID disease but rather they are put at risk due to preterm delivery that is necessitated because of their moms being sick with COVID. In Obstetrics if mom is getting sick and not getting better this puts baby in jeopardy and also makes it harder to treat mom while she is still pregnant. So early delivery may be indicated. This holds true with COVID. So the main risk to babies is prematurity if mom’s state indicates early delivery.
However, we are seeing a potential increased rate of still birth in COVID moms...3% versus 0.3% COVID negative moms. Our practice as well as many others and early data also report a likely increased risk of miscarriage.
Sooooo….what do you think about this vaccine? Do you recommend it?
YES. It is because of these stories I hear from my friends that are fellow OBGYNs and moms….because of hearing them explain first hand accounts of bedside csections done in ICUs for deteriorating mommas and because of the growing data that is emerging regarding this new Delta variant impacting pregnant women more than the previous variant that I have to recommend that my pregnant patients and those considering pregnancy strongly consider the vaccine. Especially those that have risk factors such as obesity, diabetes or hypertension as these patients are at an even greater risk.
I also recommend the vaccine because now The American College of Obstetrics and Gynecology (ACOG) and The Society for Maternal Fetal Medicine (SMFM) also fully recommend the vaccine. These are two societies that I trust wholeheartedly. They did not initially jump on the band wagon but also sat back and waited and watched the data. My belief is that their decisions are not political and they too are concerned for our patients and now feel that enough data is present to recommend the vaccine. See the below two links:
So what safety data is available?
Per SMFM….”To date, more than 139,000 pregnant people have self-reported within the CDC v-safe program, and the types and frequency of self-reported acute side effects do not appear to differ from those in the general population.”
Over 3,900 pregnant moms have been followed in the Vaccine Pregnancy Registry and of these 827 of them have delivered. Again per the SMFM: “adverse pregnancy outcomes of completed pregnancies (including spontaneous abortion, stillbirth, preterm birth, small size for gestational age, congenital anomalies, and neonatal death) all fell within the normative ranges expected based on the medical literature and background rates.”
Anecdotally..in my practice...I have seen over 50 patients receive the vaccine during pregnancy and so far so good..no adverse outcomes to date.
Another good point to remember...we do have data that babies born to moms who had the vaccine in pregnancy have antibodies as well! This is also backed up by the science that supports why we give the pertussis vaccine (TDAP) and Flu vaccine in pregnancy. These vaccines protect pregnant moms but also we have years of data to show that antibodies also present in these babies when born and protect them too!
What if I am trying to conceive..should I get the vaccine?
Again due to the increased risk of COVID19 in pregnancy the recommendation would be yes. Some recent data was also published on this as well.
Per the SMFM: “ A recent study of 2,456 pregnant people enrolled in the CDC v-safe pregnancy registry who were vaccinated preconception or before 20 weeks of gestation shows that miscarriage rates following vaccination were similar to the background incidence of miscarriage.”
Also please see below. I did my residency with Dr Kenan Omurtag who is now a Reproductive Infertility Specialist in Missouri. He is an all around amazing doc, father of 4 and friend. I trust him completely and this is what he says below:
QUOTED FROM DR KENAN OMURTAG
My partners and I help 3000 people a year pursue their family building goals. Many of those patients are from Southwest #Missouri and points in between on I-44.
I want to again attempt to dispel #covidvaccine myths for those #ttc and #stopmisinformation:
#COVID #Vaccination does not cause female infertility or sterility. Nor. Will. It. The threat of #infertility is a common trope used by opponents of vaccination. The vaccine will NOT cause #infertility. Period.
COVID Vaccination in the first trimester does not increase risk of #miscarriage. Data summarized above demonstrated that the miscarriage rate among those vaccinated in the first trimester is ~13%. The baseline miscarriage rate among any pregnant person is 15-20%.
(A reminder that #miscarriage is not uncommon with 1:4 women of reproductive age experiencing a miscarriage in their lifetime)
Getting vaccinated does NOT increase the risk of miscarriage.
Patients should be encouraged to vaccinate prior to #ttc. If you are in the middle of #ttc, there is no medical contraindication to the vaccine. You can get it. There are no signs that vaccination at any time during attempts at pregnancy and or fertility treatment are harmful to the pregnancy.
COVID Vaccination does not cause problems with #sperm or #maleinfertility.
Some still harbor concerns about unknown long term risk and unknown adverse outcomes to their child but recall
the mRNA vaccine platform supplies instructions to build a protein. It does not integrate into the cell nucleus and is gone within 5 hours.
the reassuring animal data AND ongoing surveillance lead me to conclude that any theoretical risks to the child are greatly outnumbered by the KNOWN benefits that vaccination provides to the individuals: (lower risk of ICU admission, ventilator need and death), resulting child (immunity) and society at large (return to life without restrictions).
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