Back to school in a pandemic can be 'perfect storm of infection' for pregnant women
Kids will bring home more than homework when school starts again. They'll also bring home germs — and this year that could mean COVID-19 and its deadly Delta variant. And if Mom is pregnant and tests positive for the virus, she's at significantly higher risk for serious complications and death.
"We think of pregnancy as a happy time, but it's not happy if you get COVID-19," said Berga, who is president of UBMD Obstetrics and Gynecology, chair of the University at Buffalo's OB/GYN Department and medical director of OB/GYN and Women’s Health Program Development at Kaleida Health.
Berga spoke during two physician panels this week discussing what has been learned over the last 18 months about the virus and pregnancy.
She said the pandemic can be scary for pregnant women, who are already at higher risk for complicating illnesses because their immune systems are compromised from the pregnancy. It can also be scary to those wanting to conceive, because COVID can impair fertility in women and men.
Last month, the Delta variant pushed up the number of COVID-19 cases to where the Centers for Disease Control and Prevention now categorizes all of Western New York as high transmission risk. This month, children who have been home with pregnant Moms are going back to school, where bacteria spread faster than rumors.
Add it all together and it creates what Berga called a "perfect storm for infection." She said we're learning "terrifying" risks to pregnant women who get COVID:
- ICU admission is 5 times higher
- Respiratory failure is 44 times higher
- Death is 15 times higher
- Risk of preterm birth is 22 times higher
- 2% of pregnancies have been lost because of COVID
That was the picture before the Delta variant, which has led to more hospitalizations and is more than twice as contagious than the original virus.
"Objective data on how the Delta variant affects pregnant women is not currently available. However, anecdotally, we can see that this variant is tearing through the age group that we serve," according to Dr. Heather Link, a maternal-fetal medicine specialist at Oishei Children's Hospital and OB/GYN assistant professor at UB.
Link said the University at Arkansas in July reported 20% of their COVID patients were pregnant, while the University of Alabama announced 38 pregnant women admitted to its hospital with COVID. And like other illnesses, COVID has been transferred from mother to newborn.
"So we're seeing media reports of significant disease burden, especially in the South where vaccination rates are lower," Link said. "To prevent these tragedies, we need our pregnant individuals to be vaccinated."
Erie County Health Commissioner Dr. Gale Burstein, who's also a pediatrician, said New York on Aug. 23 issued guidance to OB/GYN physicians to actively promote COVID vaccinations among their pregnant patients.
"This is the best way not only to protect pregnant women, but it's also the best way to protect our newborns, right? Because then they get passive transfer of antibodies and then they're born with some level of protection instead of nothing," Burstein said.
The CDC, American College of Obstetricians and Gynecologists and Society for Maternal-Fetal Medicine all recommend pregnant women get vaccinated against COVID, but only about 11% are nationwide, according to the CDC.
Berga said among the barriers is the notion that the vaccine is unsafe, for the woman or her baby. It's true that no vaccine has been explicitly tested in pregnant or lactating women, but Berga said much has been learned.
"They thought, 'Oh, this could get across the placenta and hurt the baby. And if it's in my body before I get pregnant, it might actually cause my eggs to have the COVID-19 vaccine in it' and that does not happen," Berga said. "And then people felt, 'If I get vaccinated in early pregnancy, I might have a miscarriage.' And there's a lot of, what I would say, chat groups that have promoted this idea and now we know that it's not true."
What about Moms who have already had COVID? Burstein said the CDC still recommends getting vaccinated.
"For several reasons," she said. "One, we don't know the durability of the natural immunity. So we believe that it's much shorter than the durability of immunity provided by completion of the vaccine series. And then also, your natural immunity is maybe very specific to the strain that you were infected with. And so if you were infected a few months ago, it probably won't impart good protection against the Delta variant."
Burstein said there's also no optimal time to get vaccinated while pregnant.
"The best time to get a COVID-19 vaccine for anybody is, as soon as you can get it, and the best vaccine to get is the one that you are offered," she said. "Although we know with a Delta variant, the Moderna and the Pfizer look like they have better coverage than the Johnson & Johnson. Also, there's not a good supply of Johnson & Johnson right now in the community, so it's unlikely that women will get access to that."
Link suggested OB/GYNs share this message with their patients and families:
"Dr. Akila Subrmaniam from UAB. Here is her pitch that she gives her patients: 'So the good news is we have a vaccine that has been tested on more humans than any other vaccine in history. The vaccine is safe for pregnant women, regardless of the trimester we're in and it's safe for breastfeeding moms. The data is convincing.'"