INDIANAPOLIS — More than 160,000 pregnant American women have contracted COVID-19, according to the CDC. Recent studies are detailing increased complications during pregnancy for women who are not vaccinated.
Dr. Tovah Buikema, Director of Maternal Fetal Medicine at Ascension St Vincent, discusses the latest.
Q: How is COVID-19 and pregnancy right now, during this latest surge? How would you classify it? What would you want to tell people?
A: “We have more patients on our floor that have COVID in pregnancy then we don't. Each wave of COVID has been different. The first wave of COVID that came through looks totally different than the second variant that came through that looks totally different than the variant that we're seeing now. The omicron variant has changed the face of COVID and pregnancy in such that almost every patient that we're caring for is COVID Positive. The Delta wave that came through brought in moms that were very ill on ECMO [and] on mechanical ventilators. We're seeing a much higher risk of stillbirth, a much higher risk of devastating outcomes for the fetuses and the babies, very devastating effects on the moms and the pregnancies. It's been a very, very difficult disease to deal with in pregnancy.”
Q: What do we know right now when it comes to vaccines?
A: “Absolutely, 100%, you should be vaccinated, you should get your booster; there's no question. All of the medical boards and governing bodies out there in medicine are recommending that all of our pregnant patients and all of our patients that are trying to conceive and breastfeeding should be vaccinated and boosted against COVID. We have great studies that are showing the safety profile of the vaccine in pregnancy. We have resources that can that we can utilize to help guide our patients to all of those studies that have been done in the pregnant population.”
Q: How can COVID can impact a baby?
A: “Certainly we have seen that the virus can be passed on to neonates and newborns now. We're seeing an increasing number of babies and children being admitted to hospitals now with COVID, which we have not seen with previous variants. Getting COVID-19 in pregnancy we are now seeing can have devastating effects on the placenta, leading to an increased risk of stillbirth and increased risk of other complications in pregnancy that affect the placenta like placental abruption. We're seeing moms presenting with significant abnormalities with their lab profiles, which can lead to significant bleeding and pregnancy and ultimately leading to stillbirth, so we're seeing just absolute devastating effects on the fetal outcomes and neonatal outcomes in these pregnancies that are affected by COVID."
Q: Some are saying if they take a vaccine, it'll make them infertile. Is there any truth to that?
A: “No, there's absolutely been no proof of infertility with the vaccine at all. In fact, there's been plenty of studies that have shown that the vaccine has not impacted fertility rates at all for patients that have received the vaccine.”
Q: Others believe if you get a vaccine, it's harder to conceive. Is there any truth behind that?
A: “No, absolutely no truth to that at all. I would say that the only thing that we have shown with the vaccine is that the vaccine may impact the menstrual cycle that immediately follows the administration of the vaccine, but not that it actually impacts fertility or the ability to conceive immediately after the vaccine is administered.”
Q: What are you seeing in the hospital right now when it comes to pregnancy and COVID?
A: “We see our triage unit filling up with patients that are presenting with the upper respiratory infections. I think that is something that we have gotten used to seeing, I think the fetal effects, the moms that are presenting with the decreased fetal movement, and the really devastating field demises. And stillbirth is something that that that is really taking us and hitting us harder at this point, because the devastating fetal outcomes are not something that we saw early on with COVID. We, at the beginning of COVID, started seeing an increase in miscarriages, or at least we thought that that's what we were seeing. But it really takes a long time before we can tell whether we're drawing conclusions too early or not. But we're seeing more and more moms come in that are symptomatic, we're seeing more and more moms come in saying that they have maybe mild or moderate maternal symptoms, meaning that they maybe don't feel so good, but they have decreased fetal movement, then we put them on the monitor and their babies just look devastating on the monitor. We end up having to do preterm deliveries because we just have to intervene on behalf of their babies. And like I said, every wave of COVID that comes in is different. We just don't know what we're going to get with the next variant. And so just when we think that we have it figured out, you know, we think that we've figured out how to treat COVID, the new variant comes out and it's a whole new package and just keeps reinventing itself. And so in obstetrics, that's very difficult for us."
Q: How should pregnant women keep safe during their pregnancy against COVID-19?
A: “First and foremost, you have to get vaccinated, there's no other way to protect yourself. I fear that because of the omicron variant, people are going to say, well, the vaccine's not working. People who are vaccinated are still getting infected. I would caution you to not think that because the people who are vaccinated, who are getting infected, are not getting nearly as sick as our patients who are unvaccinated. The vaccines are keeping patients out of the hospital. They're keeping patients off of the ventilator. We have not had one vaccinated patient who has required mechanical ventilation or ECMO in pregnancy. If you contract COVID-19 in pregnancy, you need to call your OB provider. You need to seek out the appropriate treatments to try and prevent the progression of mild to moderate COVID. Pay attention to the baby's movements and just most importantly, keep in touch with your OB provider so that you can get the appropriate treatment for COVID-19 and pregnancy."
Q: What treatments are available for pregnant women?
A: “It's ever changing. Right now, the treatments that we are offering ... there's inpatient treatment with the use of remdesivir for patients that are admitted for things other than COVID-19 so if patients are admitted for things like preterm labor, or their bag of water is broken and they just happen to be diagnosed with COVID-19, we are offering treatment with room remdesivir. We also are supporting the use of axlovid , which is the oral medication for treatment of mild to moderate COVID and pregnancy, as well as sotrovimab, which is the monoclonal antibody that has been proven to work against the newest variant, the omicron variant.”
Q: For women who are unvaccinated and pregnant — are they taking a gamble?
A: “Absolutely. They're taking a gamble.”
