For the first several months of the pandemic, the U.S. Centers for Disease Control and Prevention assured pregnant patients they were in no greater danger from the novel coronavirus than anyone else.
It wasn't until the agency analyzed national data last summer that they discovered pregnant people with COVID-19 appeared to be at higher risk for serious illness and hospitalization.
Now, a new study from Washington state confirms those results and also finds a much higher risk of death than previously reported, suggesting the peril to pregnant patients continues to be underestimated across the country.
The analysis found the COVID-19 mortality rate among them was more than 13 times higher than among those of similar ages who were not pregnant. Those pregnant women with COVID-19 were also 3.5 times more likely to be hospitalized due to the disease and had higher rates of preterm birth.
"The idea that pregnant patients were protected from COVID-19 is a myth," said lead author Dr. Kristina Adams Waldorf, an obstetrician at the University of Washington School of Medicine.
The findings underscore how important it is for pregnant patients to take precautions against getting infected, said Dr. Emily Adhikari, an obstetrician at University of Texas Southwestern who was not involved in the project but has also examined COVID-19's impacts on pregnant women. Her studies found 95% have no adverse outcomes — but it's hard to predict the 5% who will.
"Prevention is key," Adhikari said.
Adams Waldorf and her colleagues, who represent a collaboration among the 35 largest medical centers across the state, followed 240 pregnant women who tested positive for the novel coronavirus last year between March 1 and June 30.
Most of the women had mild illness and no problems with their pregnancies.
But 10% were hospitalized due to COVID-19, compared to 2.8% among the comparison group, according to the study published Wednesday in the American Journal of Obstetrics and Gynecology.
Three women died from the virus — representing 1.3% of the expectant patients. That's a "shockingly high rate," Adams Waldorf said, and far more than the 0.1% mortality among similarly aged people in Washington who were not pregnant.
"It's really, really rare for pregnant women to die and we work really hard to keep them alive," Adams Waldorf said. "To fail in these three instances says a lot about the disease and how it impacts pregnant patients."
The women in the study who died were from ethnic minority groups and had other health conditions, including obesity and high blood pressure.
Washington's COVID-19 death rate for pregnant people was much higher than a recent estimate by the CDC. But Adams Waldorf said it's more likely that the national estimates are low, than that Washington's high rate is exceptionally high.
Dr. Denise Jamieson, chief of gynecology and obstetrics at Emory University School of Medicine, said she wouldn't put too much emphasis on the exact death rate calculated by the Washington group, because the sample size was small.
"But the fact that it's similar to what was found (by the CDC) tells a consistent and compelling story that there seems to be an increased risk of death," said Jamieson, who was not involved in the Washington study.
She agrees that the CDC is probably underestimating deaths of expectant people, because much of the federal data on COVID-19 patients fails to note whether they were pregnant or not.
The Washington study also found 45% of patients who suffered severe infections late in their pregnancies gave birth early.
"Many people don't realize that getting COVID-19 in pregnancy can put you at risk for a preterm birth and an infant that might have to spend months in a neonatal ICU," Adams Waldorf said.
She urges pregnant patients who work in high-risk jobs to consider vaccination when they qualify.
Pregnant people were not included in clinical trials on the two COVID-19 vaccines approved in the U.S., but both the CDC and the American College of Obstetricians and Gynecologists recommend they be offered the shots.
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