COVID-19 in Pregnancy
On September 13th, 2021 the Ontario COVID-19 Science Advisory Table released a Science Brief about "The Incidence, Severity, and Management of COVID-19 in Critically Ill Pregnant Individuals."
The Key Message from the report was:
- The rate of SARS-CoV-2 infection in pregnancy does not appear to be higher than in the general population; however, compared to their non-pregnant counterparts, pregnant individuals have higher morbidity and mortality, with a higher risk of intensive care unit (ICU) admission, mechanical ventilation, and need for extracorporeal membrane oxygenation (ECMO). They also have a higher frequency of pre-eclampsia, Cesarean delivery, and a higher rate of preterm birth.
- Care of the critically ill pregnant patient with COVID-19 requires a multidisciplinary team that includes obstetrics, neonatology, anesthesia, infectious diseases, medicine, and critical care.
- Potentially life-saving evidence-based therapies such as corticosteroids and tocilizumab should not be withheld from pregnant individuals with severe COVID-19.
- Vaccines against SARS-CoV-2 are safe to use among pregnant individuals and vaccination is highly recommended in this population.
Munshi L, Wright JK, Zipursky J, et al. The incidence, severity, and management of COVID-19 across acutely ill
pregnant individuals. Science Briefs of the Ontario COVID-19 Science Advisory Table. 2021;2(43). https://doi.org/10.47326/ocsat.2021.02.43.1.0
The full brief may be found here: www.https://covid19-sciencetable.ca/sciencebrief/the-incidence-severity-and-management-of-covid-19-in-critically-ill-pregnant-individuals/
COVID-19 in pregnancy was also highlighted by CBC reporter Lauren Pelley on September 16th, 2021.
The report can be found here: https://www.cbc.ca/news/health/covid-pregnancy-risk-icu-hospitalization-1.6176742
The COVID-19 pandemic is continually evolving, as such, the SOGC is continually reviewing emerging evidence.
More information and statements may be accessed here: SOGC COVID-19 Resources
COVID-19 Vaccine in Pregnancy
Dr. Mark Walker, Maternal-Fetal Medicine Specialist, Professor + Former Head of Obstetrics and Gynaecology at the University of Ottawa and Interim Vice-Dean of Internationalization and Global Health at the uOttawa Faculty of Medicine, joins us for our thirteenth episode to discuss the Covid-19 vaccine in pregnancy and breastfeeding.
Download this infographic here: Why you should get the COVID-19 vaccine if you are pregnant
On April 20th, 2021 The Society of Obstetricians and Gynecologists of Canada (SOGC) released the following statement:
Many healthcare jurisdictions in Canada are facing a third wave of COVID-19 pandemic activity, with some centres rapidly exceeding peak daily case counts, hospital and ICU admissions compared to previous waves of the virus.1, 2 The current Canadian epidemiological trends are, at least in part, driven by low rates of vaccine coverage and circulation of new variants of concern (VOC) of COVID-19 that have been demonstrated to be more transmissible and severe compared to the wild-type virus which predominated previously.3, 4
Pregnancy is a known risk factor for COVID-associated morbidity with data clearly and consistently illustrating that pregnant individuals are at increased risk for hospitalization, ICU admission, mechanical ventilation and death compared to non-pregnant individuals. As a result of these factors, many Canadian centres are facing increased numbers of pregnant individuals infected with COVID-19 being admitted to the hospital and ICU.5 For many pregnant individuals in Canada, the risk of being unvaccinated and susceptible to COVID-19 is substantial.
The SOGC supports the use of all available COVID-19 vaccines approved in Canada in any trimester of pregnancy and during breastfeeding in accordance with regional eligibility.
The four COVID-19 vaccines approved for use in Canada have been demonstrated to be safe and highly effective for preventing serious disease from COVID-19.6, 7 Passive surveillance has been ongoing on a global scale and has not detected adverse pregnancy outcomes related to any COVID-19 vaccinations and emerging evidence shows passive antibody transfer to infants. Given that pregnancy is a demonstrable risk factor for severe COVID-19 disease, and that emerging reports from major Canadian centres have identified an increased burden of disease affecting pregnant individuals, the SOGC recommends that all pregnant people should be eligible to receive a COVID-19 vaccine.
While international reports have emerged documenting extremely rare events of arterial and venous thrombosis associated with low platelets following the adenovirus vector COVID-19 vaccines (AstraZeneca, COVISHIELD, Janssen COVID-19 vaccines), these events occur in as few as 1 in every 125,000 to 1 in 1 million people.8, 9, 10, 11 Most cases have occurred in women <55 years of age, however, this may reflect a workforce gender bias due to the decision to prioritize front-line health care workers, most of whom identify as female. There is no known association between this syndrome and pregnancy and no physiologic basis to increase this risk in pregnancy.
Rare adverse outcomes observed following vaccination with viral vector COVID-19 vaccines should be discussed in context of the disease they are designed to prevent. Specifically, approximately 1 in 10 pregnant individuals will require hospital admission and 1 in 100 pregnant individuals will require intensive care following infection with COVID-19. For some individuals with additional risk factors such as advanced maternal age, obesity and pre-existing medical conditions, the risk of morbidity will be substantially higher. Preventing COVID-19 disease among pregnant individuals must be considered a priority and vaccination is a central tool to protect individuals from severe COVID-19 infection.
You may access the statement here: SOGC Vaccination Statement
More information and full statement may be accessed here: SOGC COVID-19 Resources
On the same day, Dr. Graeme Smith, founder of The MotHERS Program, High-Risk Obstetrician, and Medical Director of Obstetrics and Gynecology at Kingston Health Sciences Centre (KHSC) offered the following advice.
“I would advise any of my healthy patients to get the vaccine as soon as it is offered to them,” says Dr. Smith. “The risk of serious infection, hospitalization, or premature birth associated with contracting COVID-19 far outweighs any of the potential risk associated with the vaccine.”
The full story & interview may be viewed on the KHSC website here: KHSCconnect
Canadian Surveillance of COVID-19 in Pregnancy: Epidemiology, Maternal and Infant Outcomes
Globally, there are limited data on COVID-19 in pregnancy to inform recommendations for pregnant women and their care providers. This national surveillance project serves to better our understanding of the epidemiology and outcomes associated with COVID-19 in pregnancy and to thereby provide critical data to inform recommendations for pregnant women and their infants.
https://ridprogram.med.ubc.ca/cancovid-preg/
Are you pregnant, breastfeeding or planning to get pregnant within the next year? The OMNI Research Group wants to hear from you!
We are currently inviting pregnant, breastfeeding and individuals planning to get pregnant within the next year to participate in a 5-minute survey on knowledge, beliefs and attitude about the COVID-19 vaccine.
The survey is available here: https://omni.ohri.ca/plan-v-study/
Questions? Email our team: copenetwork@ohri.ca
Research Survey about COVID-19, Mental Health and Physical Activity
Researchers at the University of Alberta are looking for women who are currently pregnant or postpartum (up to 1 year post-birth) to participate in a research survey about COVID-19, mental health and physical activity!
This project involves completing a 20-minute online questionnaire about the impact of Covid-19 on your mental health and physical activity. The questionnaire is available here: https://redcap.link/covid19andpregnancy
This survey is open to women anywhere in the world. Please share!
University of Alberta Pro00099671 Covid-19 and Physical Activity During Pregnancy/Postpartum.
For more information on COVID-19 and pregnancy please refer to the following resources:
For updates on Coronavirus (COVID-19) in Canada visit the following Public Health Agency of Canada website:
https://www.canada.ca/en/public-health/services/diseases/coronavirus-disease-covid-19.html
For local updates and information in KFL&A visit:
https://www.kflaph.ca/en/healthy-living/novel-coronavirus.aspx