COVID-19<b>–</b>Associated Deaths After SARS-CoV-2 Infection During Pregnancy — Mississippi, March 1, 2020–October 6, 2021

Kasehagen, Laurin; Byers, Paul; Taylor, Kathryn E.; Kittle, Theresa; Roberts, Christine L.; Collier, Charlene; Rust, Britney; Ricaldi, Jessica N; Green, Jamilla; Zapata, Lauren B.; Beauregard, Jennifer L.; Dobbs, Thomas

doi:10.15585/mmwr.mm7047e2

Cited by 53 publications

(48 citation statements)

References 4 publications

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“…During the first 9 months of the pandemic, there was a rapidly evolving body of evidence regarding the SARS CoV-2 virus and COVID-19 illness 4 , 19–22 which made it challenging for pregnant people to stay up to date with regards to risks for themselves and their newborns. Concerns raised by respondents primarily focused on avoiding viral exposure generally, and specifically due to receiving prenatal care or during their delivery hospitalizations.…”

Section: Resultsmentioning

confidence: 99%

“…1 This was an important transition for prenatal services as pregnant people represent an especially vulnerable population during viral outbreaks, 2 , 3 and emerging research suggests that COVID-19 infection during pregnancy is associated with comparatively high rates of severe maternal morbidity, intensive care admissions and mortality, as well as poor obstetric outcomes. 3 , 4 …”

Section: Introductionmentioning

confidence: 99%

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Prenatal telemedicine during COVID-19: patterns of use and barriers to access

2022

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Lay Summary To protect pregnant patients from infection during the COVID pandemic, maternity care providers turned to video and phone visits (“telemedicine”) to provide as much prenatal care as possible. To evaluate this change in our prenatal care program, we surveyed 164 pregnant people who had participated in a virtual prenatal visit about their care. Participants reported both positive and negative experiences, ranging from appreciation for having a safer option than in-person visits during the pandemic, to problems due to poor internet connection, lack of privacy, and lack of access to necessary equipment. Although 77.4% of respondents indicated they would recommend telemedicine to a friend, our program evaluation highlights the fact that the ability to participate in virtual care is not equally distributed. Unless steps are taken to address this problem, relying on telemedicine for a significant portion of prenatal care could result in widening disparities in prenatal care and outcomes. Policymakers and healthcare systems which provide telemedicine must address issues of access to technology and connectivity to avoid adding to maternal health disparities. Objective To evaluate patient experience with a prenatal telemedicine visit and identify barriers to accessing telemedicine among rural pregnant people in northern New England during the beginning of the COVID-19 pandemic. Materials and Methods We conducted a post-visit electronic survey of pregnant people who successfully participated in a prenatal telemedicine visit at a rural academic medical center in Northern New England. Nineteen questions were included in five domains; 1) engagement with prenatal care; 2) barriers to telemedicine and in person healthcare; 3) experience of prenatal care; 4) remote pregnancy surveillance tools; 5) sources of COVID-19 information. Results Responses were obtained from 164 pregnant people. Forty percent of participants had participated in an audio-only telemedicine visit, and 60% in a video telemedicine visit. The visit was easy or somewhat easy for 79% of respondents and somewhat difficult or difficult for 6.8%. The most common barrier to accessing telemedicine was poor internet or phone connectivity, followed by childcare responsibilities, lack of equipment and lack of privacy. Participants also engaged in additional remote prenatal care including phone calls with registered nurses (7.6%), communication with the obstetrics team through a secure health messaging portal (21.1%) and home health monitoring (76.3%). Discussion and Conclusions In this survey evaluating the experience of pregnant people participating in a prenatal telemedicine visit during the COVID-19 pandemic, respondents had a positive experience with telemedicine overall, but also identified significant barriers to participation including issues with connectivity and lack of equipment for the visit. Most participants used telemedicine in combination with other tools for remote self-care.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prenatal telemedicine during COVID-19: patterns of use and barriers to access

2022

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“…A case series in which seven of nine patients from Iran resulted in mortality is presented [ 20 ]. The Centers for Disease Control and Prevention (CDC), on the other hand, reported that there was an increase in the mortality rates of pregnant COVID-19 in the delta period (25%) compared to pre-delta period (5%) [ 21 ]. Rangchaikul and Venketaraman also declared that the delta variant may be 2.8 times more mortal [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Effects of SARS-CoV-2 Variants on Maternal Infection and Severity: A Single-Center Experience

Kosovalı¹,

Tezcan²,

Mutlu³

2022

Cureus

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Background and aims Pregnant women are one of the vulnerable groups affected by COVID-19. With the mutation of the virus, the severity of the disease in this vulnerable group may vary in different waves of COVID-19 subtypes. The aim of this study is to define the demographic, clinical, laboratory, and mortality results of pregnant COVID-19 patients according to three time frames (March to December 2020, January to June 2021, and July to November 2021). Materials and methods The data of patients admitted to the ICU between March 23, 2020, and November 30, 2021, were retrospectively scanned. Pregnant patients with SARS-CoV-2 PCR test positivity or pregnant patients with COVID-19 who have a negative PCR test but symptoms of COVID-19 and radiological findings consistent with COVID-19 on thorax CT who need intensive care were included in the study. The patients were divided into three groups according to the dates when the Ministry of Health of the Republic of Turkey reported the variants of COVID-19 in Turkey. The nonvariant type was dominant in the first period (March to December 2020), alpha and beta variants were dominant in the second period (January to June 2021), and the delta variant appeared in the last period (July to November 2021). Demographic, clinical, and laboratory findings at the first admission to the ICU and mortality rates of the patients were recorded. Results PCR test was performed in all 109 patients, of whom 101 were PCR test positive. In other eight patients, despite the negative PCR test, thorax CT findings were typical of COVID-19 pneumonia, and other bacterial and viral agents were also excluded. The mean age of the patients was 30.53 years, the mean APACHE II score was 9.68, and the mean gestational age was 28.55 weeks. Around 72.5% of the patients were in the third trimester. Of the 101 PCR-positive patients, 20.2% were delta variants, 16.5% alpha or beta variants, and 63.3% were of unknown variants. Five of the patients were vaccinated. The most common symptom was dyspnea (94.5%), and the most common comorbidity was hypothyroidism (9.17%). Invasive mechanical ventilation (IMV) was needed in 44.95% of pregnant patients. The distribution of pregnant patients admitted to the ICU according to the periods March to December 2020, January to June 2021, and July to November 2021 was 16.5%, 21.1%, and 62.4%, respectively (p<0.001). Two groups of patients were compared: those that survived versus those that deceased. Variables predicting mortality were APACHE score, IMV requirement, length of stay in the ICU, prone positioning, Anakinra treatment, and ECMO (extracorporeal membrane oxygenator) requirement, which were significantly higher in the deceased group than in the living group (p<0.001, p<0.001, p=0.001, p<0.001, p<0.001, and p=0.001, respectively). There was no significant difference between the patients' age, gestational age, variants, treatments other than Anakinra, and the number of patients admitted to the ICU in the three per...

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“… 20 In Mississippi in the United States, an apparent increase in COVID‐19–associated deaths among pregnant women was observed after the Delta variant became the predominant strain (pre‐Delta period, five deaths per 1000 infections during pregnancy; Delta predominance period, 25 deaths per 1000). 21 Similarly, the authors of a recent Brazilian study hypothesized that increased maternal mortality rates in 2021 relative to 2020 may be related to the rise of the Gamma variant. 22 During the period of Gamma variant predominance, a higher risk of death and severe COVID‐19 outcomes among pregnant and postpartum women was observed in Brazil.…”

Section: Epidemiology and Outcomes Of Covid‐19 During Pregnancymentioning

confidence: 99%

COVID‐19 disease and vaccination in pregnant and lactating women

Sáfadi

Spinardi²,

Swerdlow

et al. 2022

American J Rep Immunol

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Background More than 325,000 cases of coronavirus disease 2019 (COVID‐19) have been reported among pregnant women in the Americas. Aims This review examines the impact of COVID‐19 in pregnant women and describes available evidence on the safety, effectiveness, and immune response(s) to vaccination among pregnant and lactating women. Content Multiple studies indicate that pregnant women are more susceptible to adverse COVID‐19 outcomes, including hospitalization, intensive care unit admission, and invasive ventilation than non‐pregnant women with COVID‐19. Furthermore, COVID‐19 in pregnancy is associated with adverse maternal and neonatal outcomes. Adverse COVID‐19 outcomes appear to disproportionately affect pregnant women from low‐ and middle‐income countries, likely reflecting inequities in access to quality healthcare. Despite the absence of safety and efficacy data from randomized clinical trials in this subpopulation, observational studies and data from pregnancy registries thus far have demonstrated that vaccination of pregnant or lactating women against COVID‐19 is safe, effective, and results in robust immune responses including transfer of antibodies to the newborn via the placenta and breast milk, respectively. Implications These data support vaccination recommendations intending to help protect these vulnerable individuals against COVID‐19 and its sequelae. Randomized clinical studies will further evaluate the safety and immunogenicity of COVID‐19 vaccines in these populations. This review examines the impact of COVID‐19 in pregnant women and describes available evidence on the safety, effectiveness, and immune response(s) to vaccination among pregnant and lactating women.

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COVID-19–Associated Deaths After SARS-CoV-2 Infection During Pregnancy — Mississippi, March 1, 2020–October 6, 2021

Cited by 53 publications

References 4 publications

Prenatal telemedicine during COVID-19: patterns of use and barriers to access

Prenatal telemedicine during COVID-19: patterns of use and barriers to access

Effects of SARS-CoV-2 Variants on Maternal Infection and Severity: A Single-Center Experience

COVID‐19 disease and vaccination in pregnant and lactating women

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