A black and white photo of a pregnant woman lying in shadow on a sofa in front of a window, hands wrapped around the lower part of her swollen belly as she looks down in contemplation.
Photo: Dexswaggerboy/Unsplash

As the country faces a sixth pandemic wave, a new study shows getting COVID-19 while pregnant “significantly” increases risks of hospitalization, ICU admission, and premature birth.

The Canadian surveillance study, Association of SARS-CoV-2 Infection During Pregnancy With Maternal and Perinatal Outcomes, was published online Monday by the Journal of the American Medical Association.

It included data analysis of 6,012 completed pregnancies between March 2020 and October 2021 across six provinces ⁠— Nova Scotia, Quebec, Ontario, Manitoba, Alberta, and British Columbia.

“We unfortunately confirmed our suspicions, which was that COVID for pregnant women resulted in more serious disease, higher rates of hospitalization, and higher rates of intensive care unit admission,” senior author Dr. Deborah Money said in an interview Monday.

“It was clearly impacting pregnant women more significantly than their age comparator non-pregnant women.”

A smiling women with blond short hair wearing a beige and brown patterned sweater under a dark brown jacket smiles at the camera and appears to be posing in an auditorium.
Dr. Deborah Money, professor of obstetrics and gynecology at the University of British Columbia, is the senior author of the new national study examining COVID-19 in pregnancy. Photo: Contributed

A researcher and professor in the department of obstetrics and gynecology at the University of British Columbia, Money said it was “painfully clear” at the beginning of the pandemic that there wasn’t much information on the impact of COVID-19 in pregnancy.

“This is often the case with new diseases, that pregnancy is not necessarily the first place where people start,” she said.

‘Not a trivial infection in pregnancy’

Money said that’s why in March of 2020 she launched the CANCOVID-Preg surveillance project with support from the Public Health Agency of Canada, the Canadian Institutes for Health Research, and researchers from across the country.

As of October 31, 2021, there were 8,786 recorded cases of COVID-19 pregnancies in Canada. The team analyzed maternal and pregnancy outcomes from 6,012 of these cases.

The data showed that being pregnant was associated with a significantly increased risk of COVID–19-related hospitalization compared with cases among all women between the ages of 20 to 49 in the general population of Canada (7.75% vs 2.93%).

Pregnant people also experienced an increased risk of intensive care/critical care unit admission when compared to the same non-pregnant population (2.01% vs 0.37%).

“It basically bumps pregnant women into a much older risk category, and mostly pregnant women look pretty darn healthy so we don’t necessarily associate that with risk for complications,” Money said.

Money said it’s critical that clinicians and public health planners be aware that pregnant people are at risk for more serious disease from COVID-19 infections and need to be closely monitored. Knowing the increased risks, she said they should also be considered a priority for preventative or therapeutic COVID-19 medications.

“This is not a trivial infection in pregnancy, and we need to be respectful of it and understanding of pregnant women as more vulnerable, both for them and their infants,” Money said. “And we really hope this might encourage more women to partake in vaccination.”

Urging vaccination in pregnancy

The study’s authors also found increasing age, pre-existing high blood pressure, and those diagnosed with COVID-19 later in their pregnancies were factors “significantly associated with worse maternal outcomes.”

They also noted that non-white people were disproportionately represented in the study.

“Our study is one of the few in Canada that really demonstrates that individuals that were non-white had both higher rates of infection and higher burden of complications,” Money said.

“Obviously, there’s some complex factors behind that, but even knowing that in terms of targeting vaccine messaging, targeting messaging about being aware of the seriousness of COVID in this population in a culturally appropriate way, is critically important.”

Money said it was important to stress it isn’t just the pregnant person who’s at risk. Infants were also found to be more vulnerable, as a COVID-19 infection in pregnancy is associated with a higher risk of preterm birth (before 37 weeks of pregnancy).

The study found that risk was “significantly elevated” in pregnancies where the patient contracted COVID-19. When compared to unaffected pregnancies during the same time period, the risk was 11.05% versus 6.76%, “even in cases of milder disease not requiring hospitalization.”

Money said research in Canada and globally continues to show that COVID-19 vaccines are safe in pregnancy, and that vaccination “absolutely” reduces the risk of complications and severity of disease and is the most effective way to protect the pregnant person and their infant.

That’s why she’s urging anyone who’s pregnant to be aware of the increased risk and to protect themselves and their infants by getting vaccinated, boosted, and avoiding exposure to COVID-19 whenever possible.

“We’re really, really urging pregnant women to ensure they’re maximally vaccinated as per where they’re at in this series of vaccines and to know it’s not just for them, it is actually for them and their baby,” Money said.

“Vaccines are safe in pregnancy and the disease is complicated in pregnancy, so we’re urging pregnant women to take the opportunity of being vaccinated.”

Seek help when feeling unwell

Money said their surveillance project is ongoing and they’ll soon be pulling data up to March, well into the Omicron phase and the higher rates of vaccinations across Canada.

They’ll also be looking more closely at pregnant patients who were hospitalized, at infant outcomes, and will continue with surveillance of COVID-19 vaccines in pregnancy “to validate the data so far that the vaccine is safe.”

Anyone who was/is pregnant or lactating during the pandemic is also encouraged to participate in the UBC-based national COVERED vaccine study (reported here last May). That survey and registry is intended to document the safety of vaccines for pregnant and lactating people, and you don’t need to be vaccinated to participate.

Money said she also urges anyone who’s pregnant to seek health care early when feeling unwell.

“Even in this phase where we’re going to more endemic COVID … get attended to for health care early on and make sure that you’re being picked up before there are any serious complications,” she said.

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Yvette d'Entremont

Yvette d’Entremont is a bilingual (English/French) journalist and editor, covering the COVID-19 pandemic and health issues. Twitter @ydentremont

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