by Emily Stembridge
Physicians at Vanderbilt University Medical Center (VUMC) have recently noticed an increase in pregnant patients ill with COVID-19. These cases are especially concerning due an increased risk of hospitalization, ICU admission, need for mechanical ventilation and ventilatory support, and increased risk of death in pregnant patients with COVID-19 compared to non-pregnant patients.
“Pregnant patients are at a high risk for severe disease compared to individuals who are not pregnant,” said Jennifer Thompson, MD, associate professor of Obstetrics and Gynecology. “Studies have also found increased risk of pre-term birth, cesarean delivery and pre-eclampsia in pregnant patients with COVID-19 infections.”
As cases of COVID-19 continue to increase in the general population, they will also continue to increase for pregnant patients. In contrast to past COVID-19 increases, the most recent increase has been affecting young, healthy patients, said Warren Sandberg, MD, PhD, professor and chair of Anesthesiology and Chief of Staff for Vanderbilt University Adult Hospital.
“We are receiving frequent requests for extracorporeal membrane oxygenation (ECMO) support in young, previously well patients who hadn’t gotten vaccinated and now have COVID-19,” Sandberg said. “ECMO, mechanical ventilation and ICU care are not sure cures — in fact, if you get to the point of needing those, there’s a real chance you may die, even as a young patient.”
The risks of ECMO, mechanical ventilation and ICU stays are harmful for all people, but for pregnant patients, those risks can also affect the patient’s baby.
Sara Brown, a Union City, Tennessee, native, is a 36-year-old expectant mother who was diagnosed with COVID-19 at 33 weeks pregnant. After her diagnosis, her oxygen levels quickly dropped below 90% — a level that did not ensure appropriate oxygenation for Brown’s baby. Brown was admitted to Vanderbilt Wilson County Hospital for access to an oxygen machine, breathing treatments and constant monitoring.
When her oxygen levels did not improve, Brown was transferred to the ICU at VUMC. Physicians wanted her in proximity to a NICU in case she had to undergo an emergency C-section to ensure her baby remained oxygenated and healthy. “When they started talking about the NICU, I realized there was a chance I was sick enough that they would have to take my baby,” Brown said.
Fortunately, Brown’s oxygen levels stabilized after 12 days in the hospital, and she was able to return home. She will deliver a healthy baby girl on Aug. 2.
Brown shared that she was not vaccinated prior to getting COVID-19. “When the vaccine became available, I was hearing mixed things about if it was safe and whether it could cause miscarriages. I thought I would just wait nine months and get vaccinated after my baby was born. I believed if I got COVID-19, I wouldn’t get that sick because I’m young, healthy and have no underlying conditions. That changed very quickly after I tested positive,” Brown said.
Thompson says fears surrounding the vaccine are common for pregnant patients, partly due to the spread of misinformation on social media. “Recent data regarding the COVID-19 vaccine in pregnancy has found no safety concerns related to the vaccine. Among 827 completed pregnancies there was no difference in outcomes compared to background rates for miscarriage, stillbirth, preterm delivery or birth defects,” Thompson said.
Sandberg urges pregnant patients to heavily weigh the advice they receive from their health care providers. “Doctors and healthcare workers have been educated to analyze evidence and apply scientific rigor to claims in ways that social media influencers have not,” he said. “The evidence is clear: vaccines are safe and vaccinated patients are well protected from COVID-19.”
“Knowing what I know now, I wish I would have gotten the vaccine,” Brown said. “I would much rather have some side effects from a vaccine than have to lay in a bed and struggle for my breath and scream out for air, knowing I could have done something to prevent that from happening.”
The American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM), the two leading organizations representing specialists in obstetric care, now recommend that all pregnant individuals be vaccinated against COVID-19. To schedule your vaccine, visit: www.vumc.org/coronavirus/GetVaccines.
