Society 09/09/2021

ICU admissions of pregnant women with covid in the fifth wave have exceeded those of the previous four waves

This increase has resulted in more premature births

3 min
A doctor performing an ultrasound on a covid -19 positive pregnant patient at the Vall d'Hebron hospital during the third wave

The fifth wave of the coronavirus has not only hit young people, it has also affected pregnant women more, which is why the Department of Health has called for vaccination of this group because unvaccinated pregnant women are at greater risk of becoming seriously ill, as confirmed by data from the Hospital de la Vall d'Hebron, a reference centre for pregnant women with covid-19. Since July 1, 120 pregnant women have been admitted with coronavirus and around half, 60, have required admission to the intensive care unit (ICU), of which around thirty have had to be intubated. The number of ICU admissions during this fifth wave has already exceeded that of the previous four waves combined. "In total, in the four previous waves about fifty pregnant women were admitted to intensive care and now we have approximately sixty", explains the head of the Vall d'Hebron's obstetrics section, Anna Suy.

This increase has also resulted in more premature births, since when the covid pathology worsens and the oxygenation of the mother and fetus worsens, the solution is to induce labor. In most cases, however, it has been done at the end of gestation, between the 33rd and 36th week, which are considered late preterm babies, although there have also been some births in the 28th week. "They are children of mothers who have been in the ICU in a very serious condition and to improve their state of health they have had to terminate the pregnancy because they had already exhausted all the measures that could be taken to improve oxygenation with the baby inside", says Suy. Both mothers and babies evolved, for the most part, well. The fifth wave is already decreasing but Suy recognises that it has been the one that "has affected" pregnant women the most. "These have been very hard months", she admits. According to data from the Department of Health, today there are eight pregnant women admitted, two of them in the ICU.

More premature births

Fèlix Castillo, head of the neonatology service at Vall d'Hebron, says the same thing: "We had a kind of outbreak in the summer with weeks of two or three premature babies being admitted every day", which forced us to expand spaces. These babies suffered the effects of sedative drugs taken by the mother, with severe covid, and "were born in apnea or with a more shallow breathing" that required admission to the neonatal unit, in addition to the consequences of prematurity they could suffer depending on the age of gestation. "Without covid these babies would have been born in their term and would not have been admitted for 15 days or a month. And, in a normal situation, a late preterm baby, if it weighs two kilos, we would leave it with the mother, but we could not do it because the mother was intubated or sedated and because the children were suffering the effects of the treatment that the mothers had received", Castillo insists. However, there have been no cases of vertical transmission of coronavirus - inside the womb - although there have been once outside.

While in case of mild covid babies are not separated from their mothers, in these cases in which both mother and baby were admitted to intensive care, mother and child have not met until the mother has left the ICU. "If the mother was in the ICU and the father was also covid positive, another family member would enter the neonatal ward. If the father was negative, he would enter", explains Fèlix Castillo. Some mothers have seen their child for the first time by telematics. "The social problems of the family with severe covid is terrible", says this neonatologist.

More complications

Since the beginning of the pandemic, information regarding the impact of covid on pregnant women as well as vaccination recommendations has been contradictory and has arrived in dribs and drabs, partly due to the lack of data, since pregnant women have not been included in the trials. As in any other pneumological pathology, pregnant women are more severely affected, which is attributed to the physiological changes that occur during pregnancy. They also tolerate lower blood oxygen levels less well, since oxygen has to be delivered to the fetus. And they are at greater risk of requiring mechanical ventilation and suffering adverse effects related to the disease.

As for vaccination, Anna Suy explains that the decision to be vaccinated is up to the pregnant woman. "The information we have now is the same as two months ago. We inform about what we know and what we don't know, and the pregnant woman decides whether to be vaccinated". According to Health, six out of ten pregnant women have started or completed the vaccination schedule.

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