COVID-19 During Pregnancy May Increase Stillbirth Risk by a Staggering Amount
One of the major concerns of the pandemic has been how COVID-19 can affect pregnancy. Now, new data released on Friday by the Centers for Disease Control and Prevention underscore a significantly increased risk of stillbirth when pregnant people contract COVID-19.
Stillbirth describes losing a pregnancy at 20 weeks or later, including during delivery, according to the CDC. To analyze how COVID-19 and stillbirth may be related, the CDC evaluated 1.2 million births in 736 U.S. hospitals between March 2020 to September 2021. Stillbirths were rare overall, but there was a noticeable increase among pregnant people who contracted COVID-19. Among pregnant people who didn’t catch the virus, 1 in 155 experienced a stillbirth. Among pregnant people who did get infected, that number was 1 in 80.
The data reiterate what’s becoming increasingly clear as the pandemic continues: COVID-19 can be extremely dangerous for pregnant people. This is because a fetus represents foreign DNA in the body, so a pregnant person’s immune system adapts in order to not attack the pregnancy. But this change can leave pregnant people more vulnerable to infections, like COVID-19 and influenza.
“Compared with those who aren’t pregnant, current data shows that pregnant people infected by the COVID-19 virus are three times more likely to require ICU care; are two to three times more likely to require advanced life support and a breathing tube; face an increased risk of death; and face an increased risk of stillbirth and preterm birth,” Cynthia Gyamfi-Bannerman, M.D., a maternal-fetal medicine subspecialist in San Diego who serves on the Society for Maternal and Fetal Medicine (SMFM) COVID-19 Task Force, previously told SELF.
This is why major organizations like the American College of Obstetricians and Gynecologists, the SMFM, and the CDC have endorsed COVID-19 vaccines for pregnant and breastfeeding people, as SELF previously reported.
Among pregnant people with COVID-19, the CDC report suggest, stillbirths were more common when other factors were also present, including chronic high blood pressure, pregnancies with more than one fetus, and complications associated with COVID-19 such as acute respiratory distress syndrome, requiring a mechanical ventilator, and ICU admission. The report wasn’t able to assess how many of these people were vaccinated against COVID-19, though it notes that approximately 30% of pregnant people were vaccinated as of July 2021 (midway through the time period of the study), which means that most were likely unvaccinated.
There were other limitations to the analysis as well. Data was based on hospital discharge codes, so it’s possible that information such as underlying conditions, COVID-19 status, gestational age, and even stillbirth were miscategorized. The report wasn’t able to determine the gestational age of the fetus when COVID-19 infection occurred, which may be a factor experts ultimately realize affects the chances of worse pregnancy outcomes. Widespread testing of pregnant people for COVID-19 may have detected significant numbers of asymptomatic infections—and pregnant people with poor outcomes may have been more likely to be tested for COVID-19. The sample was also taken from the most convenient hospital reporting systems, which may not be representative of the U.S. as a whole. The report also wasn’t able to access data about COVID-19 infection that may have taken place before hospitalization for delivery or to assess which variants were at play for patients who tested positive. They do, however, note that the delta variant accounted for 90% of cases in the U.S. between July and September 2021.
While more research is needed to fully understand exactly how COVID-19 impacts pregnancy, including when it comes to stillbirth, the takeaway is clear, according to the CDC: “Implementing evidence-based COVID-19 prevention strategies, including vaccination before or during pregnancy, is critical to reduce the impact of COVID-19 on stillbirths.”
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