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As the delta variant leads to an increase in hospitalizations in the South, doctors say they are seeing an unprecedented number of seriously ill pregnant women with Covid-19.
“None of us have ever seen this scale of really, really sick women at some point,” said Dr. Akila Subramaniam, associate professor in the Birmingham division of maternal and fetal medicine at the University of Alabama. Subramaniam and his colleagues estimate a tripling – if not quadrupling – of pregnant patients hospitalized for Covid.
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In North Carolina, Dr Brenna Hughes, chief of the maternal and fetal medicine division at Duke University Medical Center in Durham, said her team was also treating more pregnant patients than at any time during the pandemic. At Vanderbilt University Medical Center in Nashville, Tennessee, the ICU has treated more than a dozen pregnant women with Covid in recent weeks, when it typically sees only one or two pregnant women per month.
“Their deterioration is faster,” said Dr. Todd Rice, director of Vanderbilt’s medical intensive care unit. “They go faster from needing a little oxygen to fucking shit, they need a lot of support.”
Some need to be placed on fans. Others are placed on machines called ECMOs to support their severely damaged hearts and lungs. So far, a total of 131 pregnant women in the United States have died, according to the Centers for Disease Control and Prevention. More than 200 have lost their pregnancies.
Only 23% of pregnant women are fully vaccinated against Covid-19, according to the CDC. Among women hospitalized, experts say, virtually all are not vaccinated.
A total of 109,773 cases of Covid-19 have been reported in pregnant women throughout the pandemic, according to the CDC. More than 18,000 had to be hospitalized, including 490 sick enough to be admitted to an intensive care unit.
The CDC does not have a current tally of the number of pregnant women hospitalized with Covid-19, and data to date is too early to show whether the rate of pregnant women hospitalized with Covid has increased significantly in recent weeks.
But doctors treating the sickest Covid-19 patients tell NBC News they are seeing a significant increase in the number of pregnant women with coronavirus.
“A lot of people don’t realize how easy it is to catch this virus, how transmissible it is and how, if you are pregnant, how seriously ill you can get,” Hughes said. “Most people who are otherwise young and healthy think they might not be so seriously ill. But we clearly saw that was not the case.
Pregnant women who are HIV positive tend to walk into emergency departments breathlessly, Subramiam said. They are stable when they arrive, but often deteriorate quickly.
“Many pregnant women are young and healthy,” Subramiam said, “until they are not”.
These patients often need to be put on oxygen earlier than other patients. Lower oxygen levels can be very dangerous for a growing fetus. “You don’t have the same ability to enlarge your lungs when you’re pregnant,” Hughes noted.
A recent study from the University of California at Irvine Health found that pregnant women diagnosed with Covid-19 were 40% more likely to give birth prematurely. “To have a healthy baby, you need to have a healthy mother,” said Dr. Joseph Khabbaza, pulmonary and critical care specialist at the Cleveland Clinic.
This study also found that pregnant women had higher rates of intensive care admissions, intubation, and mortality.
There is growing concern that the delta variant may be somehow more dangerous in pregnant women than earlier strains of the coronavirus.
“Obviously this is anecdotal, and we don’t have all the answers yet, but some of the emerging data suggests that the delta variant may have a bigger impact on pregnant women now,” Subramaniam said. “We had more patients in August than we had in the previous two outbreaks, and they are just positive women. The worrying factor is that we are seeing so many more who are seriously ill.”
Rice of Vanderbilt University Medical Center recently noted the same trend. “Pregnant women who have Covid tend to be sicker” now than at the start of the pandemic.
Has advice on vaccines come too late?
Pregnant women have been eligible to receive the Covid-19 vaccine since injections were first authorized last December, but it is only in recent weeks that major medical organizations and federal agencies have thoroughly approved the vaccinations.
The American College of Obstetricians and Gynecologists and the Society for Maternal Fetal Medicine have issued a statement recommending vaccines for pregnant women. The CDC updated its guidelines on August 11.
The delay is due to a lack of solid data to ensure the safety and effectiveness of the vaccine in pregnant women. The three major vaccine clinical trials in the United States, from Pfizer-BioNTech, Moderna and Johnson & Johnson, did not aim to recruit pregnant women, although some did become pregnant during the trials.
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This led the American College of Obstetricians and Gynecologists and the CDC to encourage pregnant women to consider vaccination, but both stopped before a full recommendation.
Hughes, who is a member of the college’s Covid-19 OB expert working group, upheld the decision to wait to issue the recommendation. “I think it would have been irresponsible to say we knew it was safe until we actually had the data to back it up,” she said.
Sascha Ellington, epidemiologist and team leader for the Emergency Preparedness and Response Team in the Reproductive Health Division at CDC, agreed. Although there has never been any indication that vaccines would cause harm to pregnant women, “we did not have as much data as we would have liked,” she said.
Ultimately, the vaccines were found to be safe: Reports from more than 35,000 pregnant women found that vaccination was not linked to an increased risk of miscarriage or other complications.
Still, some patients told intensive care doctors that one of the reasons they didn’t get the injections was because their providers – obstetricians or midwives – advised against them.
The advice against vaccination is anathema to the doctors now responsible for treating this upsurge of sick women.
“We feel like we are fighting on our own,” Rice said.
“We told people, go talk to your doctor or a trusted health care professional, and have them answer your questions” about the vaccine, he said. “We all went to medical school together. We’re all in there to try to help people and do what we think is best for people’s health.”
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