COVID-Related Perinatal and Maternal Outcomes Worse in Unvaccinated Women

Pavankumar Kamat

January 18, 2022

According to a new Scottish study, pregnant women who have SARS-CoV-2 infection within 28 days of their delivery date have an increased risk of perinatal and maternal complications. Furthermore, the majority of the complications, including COVID-19-related critical care admissions, are likely to occur in pregnant women who are not vaccinated against COVID-19.

The findings published in  Nature Medicine  come from the COVID-19 in Pregnancy in Scotland (COPS) study, a sub-study of the larger EAVE II project. Researchers at the Universities of Edinburgh, Glasgow, Aberdeen, Strathclyde, and St Andrew’s; Public Health Scotland; and Victoria University of Wellington assessed the COVID-19 vaccine uptake and outcomes of SARS-CoV-2 infection in pregnant women using data from the national, prospective cohort.

Vaccination Uptake

A total of 25,917 COVID-19 vaccine doses were administered to 18,457 pregnant women between December 8, 2020 and October 31, 2021 in Scotland. Pregnant women aged 18-44 years had lower vaccination uptake rates than women in the general population (32.3% vs 77.4%, fully vaccinated). Uptake was lowest among younger women and those residing in the most deprived areas.

Among the 4950 COVID-19 cases reported during pregnancy since the start of the vaccination program, unvaccinated women accounted for 77.4% (95% CI 76.2 to 78.6) of the cases.

Perinatal and Maternal Outcomes

The extended perinatal mortality rate for women delivering within 28 days of a COVID-19 diagnosis was 22.6 (95% CI 12.9 to 38.5) per 1000 births compared with a background rate of 5.6 (95% CI 5.1 to 6.2) per 1000 births during the pandemic. All perinatal deaths during the study period were reported in unvaccinated women.

The preterm birth rate for women delivering within 28 days of a COVID-19 diagnosis was 16.6% (95% CI 13.7 to 19.8) compared with a background preterm birth rate of  8.0% (95% CI 7.8 to 8.1) during the pandemic.

Unvaccinated women accounted for 90.9% (95% CI 88.7 to 92.7) of COVID-19-related hospitalisations and 98.1% (95% CI 92.5 to 99.7) of COVID-19-related critical care admissions during pregnancy.

Importance of Vaccination

Commenting of the findings, the study's corresponding author, Dr Sarah Stock from the University of Edinburgh, said: "Our data add to the evidence that vaccination in pregnancy does not increase the risk of complications in pregnancy, but COVID-19 does. COVID-19 vaccination in pregnancy is crucial to protect women and babies from preventable, life-threatening complications of COVID-19."

Echoing Dr Stock's comments, Prof Nicola Steedman, deputy chief medical officer for Scotland, said: "These findings are of concern and reinforce the importance for pregnant women or those thinking of getting pregnant of getting vaccinated as soon as possible."

EAVE II, the parent study of COPS is funded by the Medical Research Council with the support of BREATHE, the Health Data Research Hub for Respiratory Health. Aziz Sheikh and Chris Robertson are members of advisory groups, including those of the Government and Pharma. Rachael Wood  and Chris Robertson are employed by Public Health Scotland. Sarah Stock has received research grants paid to the institution. The remaining authors report no competing interests.

Stock SJ, Carruthers J, Calvert C, Denny C, Donaghy J, Goulding A, Hopcroft LEM, Hopkins L, McLaughlin T, Pan J, Shi T, Taylor B, Agrawal U, Auyeung B, Katikireddi SV, McCowan C, Murray J, Simpson CR, Robertson C, Vasileiou E, Sheikh A, Wood R. SARS-CoV-2 infection and COVID-19 vaccination rates in pregnant women in Scotland. Nat Med. 2022 Jan 13 [Epub ahead of print]. doi: 10.1038/s41591-021-01666-2. PMID: 35027756. Full text

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