Throughout the summer, Missouri was an early hot spot for the delta variant of the coronavirus. This led to more unvaccinated young people becoming severely ill, and as more young people got sick, more expectant mothers did too.
Now, many obstetricians and gynecologists across the state are worried. They say they are seeing more severe pregnancy complications in women who have or had COVID-19 — a rise in miscarriages, emergency pre-term deliveries and even stillbirth.
Dr. Rebecca Hamel, an OB-GYN at St. Luke’s Women’s Health North in Kansas City, said that when it comes to COVID-19 and expectant parents, it’s simple: Folks are scared.
“They’re just scared,” Hamel said. “And I so very understand that. On a personal level, I am a pregnant obstetrician. I’m in my third trimester. I understand the urge and desire and fundamental need to make sure you’re making the best decision you can for your health and for that of your baby.”
Hamel added that right now, considering the continued rise in COVID-19 in younger people throughout the state, those fears might be justified. Maternal and fetal health doctors are starting to see worrisome new complications arise from COVID-19 infections during pregnancy.
“Fortunately, most of my moms have uncomplicated infections,” Hamel said. “They do OK without long-term complications, but unfortunately, we are absolutely seeing the rare exception to that and hospitalized patients at all gestational ages.”
She said in the first trimester, OB-GYNs are seeing a rise in miscarriages. Then in the second and third trimesters, they’re seeing severely ill pregnant women with an increased need to be ventilated or get respiratory support.
“If we have to focus on keeping mom alive, at that point, we keep mom as stable as possible, but we’re doing preterm deliveries, we’re doing unplanned emergency C-sections to save mom,” Hamel said. “Because we’ve got to get baby out so baby can be taken care of.”
So, doctors are sometimes delivering babies as young as 32, 28, 24 weeks of gestation, so that the mothers have the best chance of surviving severe COVID symptoms.
Hamel warned that while this is a necessary step, premature birth can also lead to an increased risk of complications throughout a child’s life.
On top of all these complications, doctors are also worried about a dramatic increase in the stillbirth rate in pregnant women with COVID-19 infections. This comes from some limited early data and anecdotes from OB-GYNs throughout the state.
Cases in Springfield
One of the areas that has noticed this increase is Springfield, Missouri. Earlier this summer, Springfield was the epicenter of delta variant COVID-19 cases.
According to the Centers for Disease Control and Prevention, stillbirth affects about 1 in 160 births. But in August, at Mercy Hospital in Springfield, 23 of the 222 women who gave birth had COVID, and six of those 23 had stillborn babies.
That’s a rate of 1 in 37 births, compared to the average rate of 1 in 160.
The data is limited in scope and preliminary, but maternal and fetal doctors in almost every major population center in Missouri — Columbia, St. Louis, Kansas City and Springfield — said they’re seeing something similar.
Dr. Chandria Johnson, an OB-GYN at Mercy Hospital in Springfield, said more mothers are testing positive for COVID-19 almost every day.
“Some have been basically asymptomatic and just tested positive as part of scheduling an induction or C-section, and some have been very ill — all the way up to being in the ICU,” Johnson said.
Mercy Hospital began to see more of these concerning negative outcomes when the case peak hit in early August, Johnson said. More stillbirths were occurring, as well as more infants who had severe complications, “all of whom had very abnormal placentas.”
These placentas were showing evidence of vasculitis, essentially inflammation and restriction of blood flow to the placenta, and, therefore, the baby.
“Unfortunately, we don’t really have a way to predict that, but there definitely is an association with COVID affecting the placental blood flow and circulation and that has resulted in some very bad outcomes,” Johnson said.
A safeguard: Vaccinations
Dr. Geeta Swamy is an OB-GYN at Duke University who isa specialist in maternal and perinatal infectious diseases and immunization during pregnancy. She’s also a member of The American College of Obstetricians and Gynecologists’ COVID-19 OB Expert Work Group, which looks at the impact of COVID on pregnancy.
“Thankfully, we’re not seeing those kind of things widespread, but to be honest, with how aggressive the delta variant is, and how sick we are seeing young people become, I would not be surprised to find that we start seeing more signs of how those viruses impacted pregnancy,” Swamy said.
She added that it’s still too early to draw any broad conclusions or make any recommendations nationally and that more data is needed.
Missouri is not the only state seeing this troubling trend. Earlier this month, in a Sept. 9 news conference, Mississippi State Health Officer Thomas Dobbs said the state has not only seen a rise in the number of pregnant women who don’t survive COVID-19 infection, but they have also seen an increase in fetal deaths, as well.
“With COVID, we’ve seen a doubling of the rate of fetal demise, or the death of the baby in the womb after 20 weeks,” Dobbs said. “It’s been a real tragedy.”
In Missouri, every single one of the maternal and fetal health doctors KBIA spoke with agreed that the vast majority of these severe complications are happening to unvaccinated pregnant women, and they highly encouraged vaccination.
Hamel said it’s been heartbreaking to watch families experience these severe outcomes. She recommends that all of her pregnant patients get the vaccine— especially as there is no evidence of increased risk of miscarriage, infertility or stillbirth complications in your pregnancy linked to the vaccine.
“In my opinion, one extra maternal death, one extra stillbirth is too much. That’s unacceptable,” Hamel said. “And so, it comes back to safety profile. The vaccine carries minimal risk to it, but (COVID-19) infection and pregnancy carries substantial risks to it.
“What’s safe? Vaccination — hands down.”