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In late December, as the second Covid wave crashed over the country and hospitals were flooded with patients, paediatric nurse Kate Blaney returned to the wards after maternity leave. “It was quite scary,” she says. “I felt very exposed.”
And Blaney, 34, wasn’t the only one in harm’s way; she was already 20 weeks pregnant with her second child. At the time, official advice did not suggest pregnant women were at particular risk from Covid. Behind the scenes, however, two men were working on a study that challenged this narrative. After nine months of work, they collated a unique set of data from 18 countries and, unveiled here for the first time, found that Covid has potentially devastating effects on pregnant women and their babies.
The study, called INTERCOVID, was led by Aris Papageorghiou, professor of fetal medicine at the University of Oxford, with his colleague José Villar, professor of perinatal medicine and co-director of the Oxford Maternal and Perinatal Health Institute, and overseen by Stephen Kennedy, professor of reproductive medicine at the University of Oxford. By a twist of fate, Kennedy just happens to be Blaney’s father.
From March to October last year the INTERCOVID team tracked data on 2,130 pregnant women across the world from Argentina to Russia, including the UK, US, France, Italy and Japan.
The results are stark: women with Covid during pregnancy were found to be over 50 per cent more likely to experience complications such as premature birth, pre-eclampsia, admission to intensive care and death compared with pregnant women unaffected by the disease.
While the consequences of such complications were more serious in lower-income countries, the elevated risk of complications in the first place were the same everywhere.
The impact of Covid was not limited to mothers, either. The babies of infected women the study followed were almost three times more likely to face “severe medical complications, such as admission to a neonatal intensive care unit – mostly due to premature birth.”
Such findings confirmed the team’s initial fears. “The Sars and Mers outbreaks had very bad effects during pregnancy and were also coronaviruses,” says Papageorghiou. “Our immediate concern was, would Covid be as bad?”
Their effort to find out began just as the pandemic erupted across the world, when they started to gather data on pregnant women infected with Covid worldwide. Critically, instead of comparing their fates with those of non-pregnant women, as other, smaller, studies have done, the team compared them with uninfected pregnant women in the same hospitals at the same time, allowing them to compare like with like. The result is the largest, most robust international study of Covid’s effect on pregnancy.
What the numbers say
The study was reassuring in that it found pregnant women with Covid who did not have any symptoms were at no greater risk than those without the virus. But for those with symptoms the consequences could be dramatic. They were 46 per cent more likely to suffer hypertension; 76 per cent more likely to develop pre-eclampsia; 70 per cent more likely to endure foetal distress; 59 per cent more likely to deliver preterm; with babies 58 per cent more likely to have low birth weight. “And we know preterm delivery has long-term consequences,” says Kennedy.
Three times as many infected mothers developed infections requiring antibiotics; five times as many ended up in intensive care. Of the 12 mothers who died, 11 were infected.
Women faced two principle problems after catching Covid. “There were the direct risks of the virus itself – needing to go to intensive care and have respiratory support,” says Papageorghiou, “and then there were the effects of medical interventions required because of the disease.” Essentially, as mothers-to-be, whose bodies are already under stress, struggled to cope with Covid too, doctors were often forced to deliver babies early to save them.
“The effects tend to be in the second half of pregnancy, when there’s more weight to carry around, stress on the diaphragm, and it can be harder to breathe,” says Papageorghiou. “One of the ways we can improve that is by delivering the baby to optimise the health of the mother.
“The respiratory aspect is important,” he adds. “But the coronavirus causes multi-system abnormalities, it affects circulation and blood pressure, disturbing the normal balance. Not getting the virus is the absolute key.”
“Our aim,” adds Kennedy, “is not to scare women. Our aim is to inform. There are only three choices for pregnant women: Self-isolate, which is bloody miserable and for most pregnant women, especially those with other children, almost impossible. Have the vaccine. Or accept the risk of getting Covid. That’s it. Given that the medical profession is failing in its responsibility to give good advice, our paper should help families to make the decision. We know [now] that getting Covid in pregnancy is harmful. All pregnant women should get vaccinated.”
What the study means for official advice
Back on the wards in December, that was not the message Blaney was getting from the Government. The Joint Committee on Vaccination and Immunisation (JCVI) recommended only that vaccines should be “considered” if pregnant women were at high risk of complications or if they “could not avoid” exposure to the virus.
Blaney felt official advice was vague and unhelpful “[at a time] when you’re unsure anyway. You don’t see [outside hospital] how sick people can get from Covid.” Even though she knew she was exposed, “I still took convincing that I should be vaccinated.”
As the results of their study began to emerge, her father and Papageorghiou both desperately tried to persuade her. Despite – or perhaps even because of – their efforts, Blaney continued to vacillate, caught between maternal precaution and medical imperative – hesitation and vaccination. “I knew what the right thing to do was, but hesitancy creeps in,” she says.
Her uncertainty was compounded by the fact that, as is standard, pregnant women were excluded from vaccine safety trials, so she had no confirmation that jabs were specifically safe for mothers-to-be and their foetuses. “That definitely weighed on me,” she says.
This absence of data has understandably weighed on the JCVI in the last months too. Last week, it finally updated its advice – but only to suggest that pregnant women are vaccinated when their age groups are “eligible”, rather than as a matter of course.
The new advice remains insufficient, the study team says. “They’re saying pregnant women are at the same risk as everyone else, which is not true,” says Papageorghiou. “Pregnant women with Covid are more at risk of severe complications than non-pregnant women of the same age who have Covid.”
The good news about vaccines
Despite the absence of pregnant women from trials, the INTERCOVID team says women can today be reassured about the safety of the Pfizer and Moderna vaccines, which US regulators have allowed to be widely rolled out to pregnant women. As a result, 78,000 pregnant women have been vaccinated in the US, with rates of complications and miscarriage no higher than normal. Today, UK regulators say pregnant women should only get these jabs, rather than AstraZeneca’s. “Given the known effects of Covid, and no evidence of harm from a vaccine, I would advise my pregnant wife or daughter to get vaccinated,” says Papageorghiou.
Finally, in early February, Blaney decided to go for it: “It was only when a female consultant told me that if she was pregnant she would have the jab that I went ahead,” she recalls.
Today, despite looking forward to the birth of her baby in May, and having had no side effects from her second jab (she felt under the weather for a couple of days after the first), she still struggles to convince her pregnant friends. “They are very uncertain.” A midwife and nurse she knows both waited until after they gave birth, then had the vaccine “straight after”.
“They were not fully aware of the risks [to pregnant women] of catching Covid,” she says. Thanks to the work of Blaney’s father and his colleagues, however, there is no room for doubt any more.
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