New meta-analysis reaffirms ‘serious health risks’ of COVID-19 infection during pregnancy

New meta-analysis reaffirms ‘serious health risks’ of COVID-19 infection during pregnancy
New meta-analysis reaffirms ‘serious health risks’ of COVID-19 infection during pregnancy

In a context of high neonatal and maternal relative risk, investigators of a new meta-analysis advocate COVID vaccination for all women of childbearing age; “substantial and convincing” evidence

A new meta-analysis of more than 13,000 pregnant women found “serious health risks” in those infected with the COVID-19 virus.(1) They were at a seven times greater risk of dying and at a significantly higher risk of admission to intensive care or pneumonia than those who are not infected. Additionally, the study also suggested that infection during pregnancy increases the risk of intensive care for the baby.

“The study provides the most comprehensive evidence to date suggesting that COVID-19 is a threat during pregnancy,” the study’s lead author said in a press release. “Our results underscore the importance of vaccination against COVID-19 for all women of childbearing age.” While it was difficult to piece together the evidence in the past, she added, this meta-analysis now provides “clear, consistent and compelling results”.

This, of course, is not the first warning about the risks of COVID-19 during pregnancy, nor of neglecting the vaccine.(2) Data from numerous studies have indicated that COVID infection during or before pregnancy increases the risk of mortality, ICU admission, preterm birth, stillbirth, pre-eclampsia and admission to neonatal care. But according to this latest report, these studies have often been small, difficult to synthesize and heterogeneous in design. However, this latest meta-analysis, which pooled individual patient data from 12 eligible studies involving 13,136 pregnant women, sought to avoid such anomalies. Almost all of the COVID infections in the study were confirmed by PCR tests, with 11,194 women negative during pregnancy and 1,942 positive.

The results of the comparison showed that COVID-19 during pregnancy increased the risk of maternal death, admission to intensive care, mechanical ventilation, intensive care, pneumonia or thromboembolic disease. In some of them, the relative risks with non-infection were very high: maternal mortality RR 7.68; ICU RR 3.81, ventilation RR 15.23; all critical care RR 5.48; and RR pneumonia 23.46. Newborns born to infected women were also more likely to be admitted to intensive care, RR 1.86. However, unlike some findings from other studies, infection in this analysis was not related to stillbirth.

The authors note that the results were intended to provide “robust, high-quality” estimates of the impacts of SARS-CoV-2 infection during pregnancy compared to uninfected pregnancies. And as such, they conclude that the findings “underscore the need for global efforts to prevent COVID-19 in pregnancy through targeted delivery of vaccines and non-pharmaceutical interventions.” This is taken further in a summary box added to the study report in which access to preventive and therapeutic measures is described as “an urgent priority”.

Indeed, the authors’ press release – if not the published study report – calls on “all countries” to prioritize COVID vaccines during pregnancy “in order to save lives and prevent health problems”. To support her case, the first author adds that, despite the well-established serious health risks, more than 80 countries still do not recommend that all pregnant and breastfeeding women get vaccinated against COVID. This is evident in many national guidelines still in force where vaccines are generally included in a range of mitigation strategies – and indeed the joint IFFS/ESHRE statement on vaccines in pregnancy, albeit from 2021 , concluded that “the decision to receive or refuse the vaccine is based on individual risk, the availability of the vaccine, and the concerns of potential recipients about the unknown risks of new vaccines.”(3) Recent studies have somewhat dispelled any concern that vaccines may negatively affect ovarian function, at least in an IVF model.(4)

Meanwhile, despite the 80 vaccine-hesitant countries identified by the study authors, major health regulators all seem to recognize the risks posed by COVID infection during pregnancy; “Getting the COVID-19 vaccine can help protect you and your baby from serious health problems,” the CDC advises; UK Department of Health ‘strongly recommends’ vaccination during pregnancy; France “recommends” a full panel of vaccinations for pregnant women; and in Germany, after much deliberation, authorities in 2021 issued a recommendation for pregnant and breastfeeding women to get vaccinated. However, as the meta-analysis authors note, many women of childbearing age are still unvaccinated and this latest evidence “underscores the importance of COVID-19 vaccination for all women of childbearing age. procreate”.

1. Smith ER, Oakley E, Grandner GW, et al. Adverse maternal, fetal, and newborn outcomes in 1942 SARS-CoV-2 infected pregnant women, compared to 11194 negative pregnancies: a meta-analysis of individual participant data. BMJ Global Health 2023; 8:e009495.
doi.org/10.1136/bmjgh-2022-009495
2. See https://www.focusonreproduction.eu/article/News-in-Reproduction-COVID-vaccinations
3. Ory S, Veiga A, Horton A, Gianaroli L. Joint IFFS/ESHRE statement on COVID-19 vaccination for pregnant women and those planning pregnancy. Hum Reprod Open 2021, hoab016. https://doi.org/10.1093/hropen/hoab016
4. Dahdouh EM, Balayla J. SARS-CoV-2 vaccines and IVF results: so far so good! Fertil Steril 2023;
doi.org/10.1016/j.fertnstert.2023.01.016

. new meta-analysis reaffirms serious risks for health related infection COVID19 during pregnancy

. metaanalysis reaffirms health risks COVID19 infection pregnancy

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