Hidden victims of the Covid pandemic: Pregnant women
Of all the groups still at risk from Covid-19 – including the elderly and the immunocompromised – pregnant women seem to be the ones most unaware of the risks.
Covid can kill pregnant women and it can result in spontaneous abortion, premature birth and stillbirth, even when the woman has an asymptomatic or mild disease. The infection can also affect the baby brain development.
However, only 70 percent of women do completed the primary series of vaccinations for Covid before or during pregnancy, meaning that approximately 30 percent of pregnant women did not have this basic protection. Since the beginning of September, only 15 percent decided to get vaccinated.
Even the flu vaccine did not prove popular with pregnant women this year: only 37 percent of pregnant women were vaccinated vaccinated against influenza at the end of October, compared to almost 60 percent at the end of September 2020.
The United States is now battling a mix of respiratory syncytial virus, influenza and coronavirus, all of which can cause serious illness in pregnant women. Winter looks dark.
“I’m concerned about that, especially given the low vaccination rates,” said Dr. Denise Jamieson, an obstetrician at Emory University in Atlanta and a member of the American College of Obstetricians and Gynecologists’ Covid Expert Group.
Even early in the pandemicit was obvious that Covid was dangerous in pregnancy. Data from a study in June 2020 showed that among pregnant women infected with Covid, about one in three ended up in hospital, compared to about 6 percent of women who were not pregnant.
Infected pregnant women were 50 percent more likely to be admitted to intensive care units and 70 percent more likely to need a ventilator.
“It’s now very clear that if you’re pregnant, planning to become pregnant, or breastfeeding, it’s very important for you and your baby to get vaccinated,” said Dr. Neel Shah, an assistant professor at Harvard and chief medical officer of Maven Clinic, a digital healthcare provider. for women and families.
Pregnant women, their families and even their doctors may not understand the importance of immunization because of “sluggish and confused” communication by public health agencies, Dr. Shah said.
The Centers for Disease Control and Prevention is not wholeheartedly support vaccination for pregnant women until September 2021, about three months before the Omicron variant swept the nation and months after Society for Maternal-Fetal Medicine of the American College of Obstetricians and Gynecologists highly recommended injections for pregnant women.
At that time, mistrust and misinformation were already sown, and only about a third of pregnant women were vaccinated. “Honestly, that was a big part of the failure,” Dr. Shah said.
Scientists previously believed that pregnant women were essentially immunocompromised – that the body tolerated the fetus by reacting to it as a foreign invader and suppressing its own immune responses. “We now know that’s not true, it’s an oversimplification,” Dr Jamieson said.
Pregnancy is accompanied by some immune changes, she said, but they do not compromise the ability to defend against infections, as might occur with organ transplants or certain medical conditions.
However, pregnant women are vulnerable for other reasons. The growing uterus compresses the lungs, hindering, for example, the ability to take in air. Pregnancy can also cause conditions such as diabetes and high blood pressure, which themselves put a person at risk of severe Covid.
Studies have shown that the placenta of pregnant women infected with the coronavirus resembles the placenta of women with preeclampsia, a form of dangerously high blood pressure in pregnancy.
The placenta is a sponge of blood vessels that enables the exchange of oxygen and nutrients between mother and fetus. It takes over the role of lungs, liver and kidneys for the fetus, but Covid can to ravage that, said Dr. Anne V. Herdman Royal, a pathologist at the Tulsa Medical Laboratory who studies placental tissue.
“The placenta is essentially the lungs for the fetus and it’s damaged in the same way that the lungs are damaged by Covid,” she said. Most babies are fine as long as they complete at least 30 weeks of pregnancy, she added.
Why then did so many pregnant women avoid vaccination? Many have focused on risk claims for which there is little or no evidence, ignoring the very real dangers of Covid, Dr Royal said.
This is true not only for pregnant women, but also for friends, family, even their health care providers.
In October 2021. Maven Clinic 500 women were surveyed In the United States of America. Nearly 70 percent said at least one person suggested they avoid the vaccine during pregnancy. In about one-third of these cases, the source was a health care provider.
Doctors were already wary of taking even the smallest of risks with pregnant women, and any uncertainty in the evidence surrounding the Covid vaccine may have heightened their fears, said Dr. Anne Lyerly, a bioethicist at the University of North Carolina at Chapel Hill.
dr. Lyerly pointed to one scientific work in the journal JAMA under the title “Association of vaccination against Covid-19 in pregnancy with adverse peripartum outcomes”.
The researchers concluded that there was no significant association. But leaving that information out of the headline certainly didn’t reassure doctors, she said.
“Neutral messaging, like those in the JAMA article, is not neutral against the backdrop of fear,” Dr. Lyerly said.
“The prevention-than-cure attitude that so many people in the public, so many doctors — even so many public health officials — tend to take with regard to pregnancy is ultimately not safer,” she added. “In fact, it puts pregnant women at risk.”
She also said that public health messages did not sufficiently emphasize the risks of Covid for pregnant women and the benefits of vaccination for the fetus, she said.
Many women are happy to receive the Tdap vaccine — which protects against diphtheria, tetanus and pertussis — in the third trimester because they understand that it is necessary to protect the baby.
But the message hasn’t gotten across that flu and Covid vaccines are also necessary in pregnancy, Dr Jamieson said. In the Maven survey, for example, one in three women said they planned to get vaccinated against Covid only after giving birth.
dr. Jamieson said she was able to convince some women to get vaccinated by first asking them what they thought about the vaccine, then returning to the topic at a later meeting.
The key is “not to push too hard on the first visit,” she said, “and sometimes they’ll change their minds.”