Pregnant women still at risk from COVID-19

Pregnant women still at risk from COVID-19

On Sunday the Chief Health Officer of Queensland reported that two pregnant women were in ICU with COVID-19– almost half of the total five people who were in ICU due to COVID at the time. This once again highlights that this is not a pandemic that affects all equally. But for those who are pregnant and may have been exposed or are infected please know that mild disease is still the most common outcome.

There are some small increases in risk for pregnant women but Omicron, the dominant strain currently circulating, remains less severe than its predecessors. And for those who are pregnant or thinking of becoming pregnant there are things you can do to decrease the risk of infection to you and your unborn baby.

What are the risks of COVID for pregnant women?

Unfortunately, there is a continually growing body of research which shows that pregnant women are at increased risk of severe disease if they become infected with COVID.  Whilst they are not at higher risk of initially becoming infected, they are more likely to be hospitalised. A large study in Norway of over 1 million people found pregnant women were approximately 5 times more likely to be hospitalised. A large-scale review combining the available global evidence has also identified that pregnant women are at increased risk of admission to an ICU and requiring ventilation if infected.

There are also COVID associated risks for the unborn baby. Global evidence shows that COVID infection can increase the risk of premature birth and stillbirth. It is important to note that the risk of premature birth is only a slightly elevated at 1.5 times higher than those without COVID infection, and overall numbers of stillbirths in studies to date remain low. However, infection can also increase other less severe complications such as babies showing stress in delivery and requiring admission to a newborn care unit, which is why doing everything you can to protect yourself is important.

What can you do to protect yourself?

Pregnancy can be an anxiety filled time in any woman’s life, even before you throw in a global pandemic. But there are a number of things pregnant women can do to protect themselves and their unborn baby. Importantly, vaccination has been shown to be both safe and effective for pregnant women in large scale studies as well as population level data from other countries.

Other less invasive protections can also help. Things we all now know well after the last two years, maintain social distancing and wear a face mask when in public, try to avoid contact with those who are symptomatic, and practice good hand hygiene. Whilst no single measure is 100% effective, each will significantly lower your overall risk of infection and are most effective when used in combination.

COVID vaccine in pregnancy: the benefits versus the risks

Accepting a vaccine for not only yourself, but that of your unborn child, can understandably cause concern. However, when we think about the risks of vaccines, we can at times forget to weigh this up with the risks of disease. In this case, that risk is severe disease and pregnancy complication caused by COVID. And whilst the majority of Australia has experienced low case numbers during the initial phases of the pandemic, rising numbers of infections across the country show this is no longer the case. 

Under the national COVID vaccine strategy, pregnant women are now a priority group for vaccination. Specifically, the Comirnaty (Pfizer) COVID-19 vaccine is now recommended for pregnant women at any stage of pregnancy. There is now sufficient global data to show that this specific vaccine is safe and effective in this group.

Studies and vaccine roll outs in other countries have not identified any significant safety concerns with this vaccine when given to pregnant women. Whilst studies have not identified any side effects specific to pregnancy, there are general side effects which anyone can experience which have been identified. These are generally mild such as tiredness and headache and usually resolve within a few days. More serious adverse events are extremely rare. In short, the benefits far outweigh the risks.

If it’s safe, why were pregnant women not included in the initial vaccine rollout?

The recommendations to routinely offer COVID vaccine to pregnant women was first announced by ATAGI in June 2021. This particular group were not included initially due to lack of safety information available at the time. Lack of evidence does not mean that the vaccine was unsafe, it simply means that with vulnerable groups such as pregnant women, research evidence is harder to generate. Hence, with any new vaccine whilst evidence is still being collected, the best way to move forward is with caution. There is now sufficient data to show the safety of this vaccine in pregnant women, which is why the recommendations have changed.

So whilst this is a time of increased risk and associated anxiety, there are a number of strategies that can be employed to decrease the risks for both women and their unborn babies. And if you have any concerns, please do speak with your doctor who can provide advice about your specific situation and hopefully help to ease any anxiety.

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