by Sally James

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Pregnant women in Washington state who contracted COVID-19 were 13 times more likely to die from the virus than their peers who were not pregnant, according to a study published last week in the American Journal of Obstetrics and Gynecology. One study author called the mortality rate “shockingly high.” The study was led by University of Washington researchers.

The study of 240 pregnant women around the state who contracted COVID-19 between March and June 2020 showed that the majority had mild or asymptomatic cases and healthy pregnancies. However, in addition to higher mortality rates, the pregnant women were 3.5 times more likely to be hospitalized than non-pregnant women of similar ages who contracted the virus. 

The higher risk of mortality and hospitalization for pregnant women adds more complexity to the question of whether pregnant women, who have not been part of any vaccine clinical trials, should be prioritized to receive the vaccine.

For one local pregnant woman, the news of increased risk did not incite immediate panic. The Beacon Hill resident, who asked not to be identified by name for this story, is three months pregnant. She works from home helping nonprofits with grant applications. She has a 2-year-old and says most of her COVID-19 worry centers around her older child and decisions about going to playgrounds or not and which friends might be safe to visit outdoors.

“When I saw my doctor about a month ago, she said that she recommended that I get the vaccine if I could. But I haven’t really thought about it, because I’m not high in the line,” the woman said. If the vaccine were available to her now, she says she would lean toward getting it but would need to read more about it.

While pregnant women were not included in any of the clinical trials for the Pfizer BioNTech or Moderna COVID-19 vaccines, the U.S. Centers for Disease Control and Prevention (CDC) advises that pregnant patients should have the choice to receive the vaccine if they are otherwise eligible. Last week, the World Health Organization (WHO) also changed the wording in its COVID-19 vaccine guidance for pregnant people. Initially, the WHO issued a statement against offering the vaccines to pregnant women, citing the lack of research, but has since removed the explicit opposition to immunization following an outcry from the American College of Obstetrics and Gynecology and other women’s health advocates.

Dr. Kristina Adams Waldorf, an obstetrician-gynecologist at the University of Washington School of Medicine and the lead author on the recent study, says the increased risk of death and hospitalization would certainly impact her decision to get the vaccine if she were pregnant. “If it were me and I’m balancing grave risks with disease versus theoretical risks of vaccination, I would take the vaccination in a heartbeat,” she said. “Thankfully we live in the United States where the major clinical and scientific organizations have left women with the right to choose.”

Adams Waldorf was glad that the WHO changed its recommendation. She says the new statement is “much improved, because it respects a woman’s autonomy in making this decision, reflects our understanding that a COVID-19 mRNA vaccine biology is extremely unlikely to pose risks to the pregnancy, and finally that the risks of acquiring COVID-19 in pregnancy are significant and can be fatal.”

But having the right to choose a vaccine is not the same as having it available. Currently, pregnant women in Washington are not at the head of the line. People over 65, over 50 and living in a multigenerational home, health care workers, and first responders make up the groups eligible for  vaccines now, according to the Washington State Department of Health. Pregnant people are not currently noted in any of the Phase 1 vaccine availability groups specifically.

Adams Waldorf says she cannot offer her patients the vaccine at this point unless they fall into the categories that are currently eligible for the vaccine for other reasons. She recommends that pregnant women follow CDC guidelines on wearing masks and staying socially distant at work. 

In light of the results of her study, Adams Waldorf says she wishes she could move pregnant women up to be eligible to receive the COVID-19 vaccine sooner.

The Beacon Hill woman who spoke to the Emerald says she felt lucky that both she and her husband can work from home, which greatly reduces their family’s risk of contracting the virus. She knows many others do not have that choice.

Thirty-five different hospitals and clinics across Washington collaborated to provide data for the study. Of the 240 pregnant women included in the research study, 1 out of 10 was hospitalized and 1 out of 80 died. The three women who died were all racial minorities and had public insurance coverage as well as significant underlying health conditions, such as obesity, hypertension, and autoimmune disease. All of the women in the study were diagnosed with COVID-19 before delivery, but of the three who died, two died postpartum.

Dr. Regan Theiler, the chair of obstetrics at the Mayo Clinic in Rochester, Minnesota, told the Emerald the results of the Washington study are shocking. Theiler, who did not have any role in the study, said this new data raises questions about changing the priority for pregnant women to receive the vaccines faster. Theiler hopes there will be safety data coming soon regarding any adverse events from COVID-19  vaccines in pregnancy. 

Adams Waldorf, who is also a specialist in reproductive immunology, says doctors still don’t know exactly why COVID-19 is deadlier in some pregnant women. 

As doctors have learned more about effectively treating patients with COVID-19, they have found some methods have helped patients recover, such as steroids or plasma from patients who have recovered from the virus. Adams Waldorf says it’s unclear whether any of those newer treatments would have saved any of the pregnant women who died last year or shortened the hospitalizations of those who had to be admitted.

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Featured image belongs to the Public Domain.

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