番茄社区

Physicians from the division of maternal-fetal medicine at the University of Alabama at Birmingham (UAB) that 39 pregnant women with COVID-19 had been admitted to their hospital over the month of August. Of this group, 10 were admitted to the ICU and seven are currently on ventilators.

In an average year -- not during a pandemic -- it's not uncommon for UAB's ICU to see one or two pregnant patients a month, said Akila Subramaniam, MD, in a . But, on top of these more routine cases, the ICU has seen "almost a five-fold increase" in the number of pregnant patients needing intensive care.

The majority of UAB's pregnant patients were in their second or third trimester when they were hospitalized. Most were not vaccinated or not fully vaccinated; some had received their first dose within the last couple of weeks before hospitalization.

Earlier this month, the CDC strongly recommended that pregnant women get vaccinated against COVID-19 in the wake of new safety data. However, statistics show that, as of August 14, only of the pregnant population overall have received at least one dose of the vaccine.

At a White House COVID-19 Response Team briefing on Tuesday, Surgeon General Vivek Murthy, MD, underlined the seriousness of getting COVID while pregnant.

"There's a significant increased risk of hospitalization, of ICU stay, of preterm labor and preterm birth. These are not insignificant risks," he said. "And the best way to reduce your risk, to take care of yourself during pregnancy, is to get vaccinated. That's why we're working hard to get that message out."

According to , vaccine hesitancy is high among pregnant women, with many citing safety concerns. However, have shown no increased risk of spontaneous abortion or miscarriage among vaccinated women. Additionally, as reported in a published in JAMA Network Open, it was found that pregnant women who contracted severe COVID-19 were 10 times more likely to die while hospitalized, and six times more likely to deliver preterm.

In Alabama, the rate of severe COVID among pregnant patients is higher now than it was during both last summer's peak and during the following spike in the winter, Subramaniam noted.

The COVID positivity rate among pregnant patients that have come through UAB's hospital has increased significantly since June of this year, she added.

Nearly all of the pregnant women hospitalized due to COVID in the last few months have delivered preterm, Subramaniam said. "And not because they are laboring preterm, but because we are affecting a preterm birth."

Some of these patients may need to be intubated, she noted. Oftentimes, this leads to higher rates of intubation failure and "worsening of maternal status," which means delivery is affected whenever it needs to happen -- which is likely before term, or 37 weeks.

"We're seeing deliveries at 30 weeks, 32 weeks, 34 weeks, even as early as 28 and 26 weeks," she added. "Delivery preterm ... from a resource standpoint is consuming, but delivery less than 28 weeks still has a high rate of neonatal morbidity and risks for prematurity." Still, the long-term downstream effects of having severe COVID during pregnancy remain unclear at this time, she concluded.

To date, UAB has reported that two pregnant COVID-positive patients died at the hospital; six have lost their babies during their second trimester, and three have lost their babies during their third trimester.

Ashley Roman, MD, a maternal-fetal medicine doctor at NYU Langone Health in New York City, told 番茄社区 that almost all of the COVID-positive pregnant patients admitted to her hospital are unvaccinated.

When she treats patients who resist the vaccine, she said she tries to keep the conversation data-focused.

"What's a little bit ironic to me is that these are the women who decline vaccination during pregnancy, but when they get severe COVID, they're willing to accept other medications that we don't have robust data on -- medications like remdesivir or monoclonal antibodies," Roman said.

She added that she often encounters major misconceptions about the COVID-19 vaccine among pregnant patients, such as the vaccine causing miscarriage, infertility, and other pregnancy complications. Still, during conversations with patients, she relies on the currently available data.

What does she tell her vaccine-hesitant patients? "The vaccine stays in the arm, the vaccine itself does not cross the placenta," Roman said. "But what it does is it builds a very robust immune response, and those antibodies that the mother builds to COVID -- that's what does cross the placenta. And so the vaccine not only protects the mother from getting severe illness in pregnancy, it has the potential to protect the baby as well."

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