At the beginning of the pandemic, when “COVID-19” had barely entered the public lexicon, there was a howling vacuum of information. The medical and public health communities puzzled over masks, effective treatments, spread and risk factors.
In those early days and weeks, in the absence of certainty, providers thought about COVID-19’s impact on pregnant women in the context of other viral illnesses. The flu could be more severe for moms-to-be, said Anna Euser, a maternal-fetal medicine specialist at UCHealth’s University of Colorado Hospital. Maybe COVID-19 would be, too. But early signs were promising.
“For a period of time, the initial data said, ‘We don’t think pregnant women are at higher risk,’ ” said Euser, who also teaches at CU’s School of Medicine.
“The early data, particularly out of China, was telling us that this was going to be not like what we’ve seen with others — H1N1 influenza was horrible in pregnant women,” added Meredith Alston, an OB-GYN for Denver Health. “We weren’t expecting anything terrible (with COVID-19).”
As the months wore on, though, the true image came into focus. By the end of summer 2020, it became clear that pregnancy was a significant risk factor for worse COVID-19 outcomes. Several providers who spoke to The Denver Gazette said even now, 21 months later, they were increasingly concerned about what they were seeing in unvaccinated pregnant patients. That population is large: In late September, the Centers for Disease Control and Prevention wrote that just 31% of pregnant women were fully vaccinated — 35 percentage points below the rest of the adult population.
“I’m very concerned,” Euser said. “I’m very concerned because the story has now become: Every time someone gets admitted to the hospital, they’re unvaccinated, and potentially it’s something we could’ve prevented.”
“We’ve had no pregnant patients who’ve been ill enough to require hospitalizations who were vaccinated,” said Bronwen Kahn, a maternal fetal medicine specialist at Presbyterian/St. Luke’s. “Zero.”
Dr. Bronwen Kahn, who specializes in obstetrics, gynecology and maternal-fetal medicine, poses for a portrait in a room in the labor and delivery unit on Thursday, Dec. 9, 2021, at Presbyterian St. Luke’s Medical Center in Denver, Colo. (Timothy Hurst/The Gazette)
The hesitancy, providers said, makes sense: Pregnant women were not included in vaccine trials, for ethical reasons. Mixed messages from regulators and the media fueled early concerns about fertility and side effects. Pregnant women have not only their own health to worry about but that of their unborn child. But vaccines have been flowing for a year, experts said, and research has demonstrated that inoculations are safe, for the pregnant and nonpregnant alike. Every provider said they recommended each of their patients be vaccinated.
Meanwhile, studies and research showing the dangers that COVID-19 poses to pregnant women continue to pile up: In September, the CDC wrote that pregnant women with symptomatic COVID-19 cases are twice as likely to be hospitalized and 70% more likely to die as nonpregnant women with the disease. Research has shown infected pregnant women are more at risk for pre-term births and pre-eclampsia, experts said. Women who are so ill they need to be placed on ventilators may have to give birth via surgery while sedated.
“That’s a worst-case scenario, to my mind,” said Mary Clare Weber, a Presbyterian/St. Luke’s nurse who works with high-risk pregnant patients. She is pregnant and received her booster dose in September, when she was about 23 weeks along. “It is something we’ve seen multiple times.”
Dr. Bronwen Kahn performs an ultrasound on AirLife Denver flight nurse Michelle Krumrey, who is 30 weeks into her pregnancy, on Thursday, Dec. 9, 2021, at Presbyterian St. Luke’s Medical Center in Denver, Colo. (Timothy Hurst/The Gazette)
A limited but landmark report published by the agency last month found increased likelihood for stillbirth by pregnant women who’d had COVID-19, particularly in the months since the delta variant has become dominant. Several providers — and the CDC itself — said the results were limited but support what physicians are seeing in real time.
Stillbirth remains rare, even in pregnant women with COVID-19, Alston stressed. But it’s significant enough now that, in the past week, her team has changed how it monitors pregnancies “that have been COVID-impacted, where we are evaluating for acute risk of fetal demise.”
“This is not doctrine,” she said, “but there is significantly increased risk. And I will tell you we are clinically seeing that. Pregnant women make us extremely nervous when they have COVID in pregnancy. … The risk of (fetal demise) is really alarming to us, and we’re clinically seeing it.”
When it arrived in June, the delta variant was a “game changer,” added Saskia Thompson, an OB-GYN with Banner Health. The clinic saw new cases daily, and low-risk pregnant patients infected with COVID-19 started needing ventilators.
“It was also the time when we started experiencing stillbirths from COVID, with no other indication of stillbirth,” she said.
Kahn’s practice, the Obstetrix Medical Group of Colorado, has experienced a more troubling, but exceedingly rare, spurt of incidents recently.
“In the last month, we have seen a new manifestation, a new twist on COVID in pregnancy,” she said. “We thought we had a good handle on it.”
Four pregnant women, all unvaccinated and with “relatively mild” cases of COVID-19, expressed concerns about their fetuses. Their heart rates were “very, very abnormal,” Kahn said of the fetuses. They were hypoxic — meaning they had low oxygen levels. Three of the babies were successfully delivered via emergency c-sections. The fourth was stillborn.
She and her partners had not seen anything like those cases. The first arrived at the end of October. The most recent patient was being moved into the operating room as Kahn spoke Tuesday.
She stressed again the rarity of these events: Four cases in her practice, perhaps a dozen nationwide that she’s aware of. None of the other providers who spoke to The Denver Gazette for this story said they’d seen anything similar. Kahn said she wasn’t trying to fear monger. But she wanted to raise awareness about the myriad risks COVID-19 poses for pregnant women, particularly those who are unvaccinated.
Other providers also said they weren’t trying to scare unvaccinated women. They all said they understood patients’ hesitancy, given the natural concerns mothers have for their children.
“It makes people uncomfortable,” Denver Health’s Alston said of the vaccine’s recent arrival. “And I do believe it comes from a place of patients trying to do the right thing. But we really do believe that women who get vaccinated will do better if they get COVID. “
“These are women who want nothing more than the health of their future children,” agreed Thompson, of Banner Health. “Or women struggling with infertility — they want to make sure they’re doing the right thing. The general public is getting a lot of information from the media and wondering, ‘Is this the safe thing to do?’ For the general public, it seemed very new and very fast. It was. And because there wasn’t a lot of data, it just left people with unanswered questions.”
But those fears, the providers stressed, have been addressed by the research, which shows the safety and efficacy of the vaccine.
“I want them to understand that like everybody else, I don’t know who’s going to get a severe case of COVID or not,” said Euser of UCHealth, “but the risks of COVID could be much greater to them than someone else and could change the risks of their pregnancies from their babies’ standpoint. Since the vaccine, we now have a way to dramatically decrease those risks by getting vaccinated.”
Euser was pregnant last year and received her first dose at 32 weeks. When it appeared pregnant women would not be approved to receive vaccines early on, she was “all hot and agitated and writing a statement” in protest. When she was inoculated in the early days of distribution, she was “giddy.”
Jamie Haak found out she was pregnant with her third child in fall 2020, shortly before the vaccine became available. She was a little concerned about getting inoculated, she said, but she had friends who worked at the bedside of COVID-19 patients and told her about the risks of the virus. That helped.
“I’ve just heard too many horror stories now from friends in health care about pregnant women not doing good at all,” she said.
Mahala Chumaceiro was a little nervous, too. She’d relocated from Sacramento to Colorado Springs with her husband, who’s in the Air Force. They’d been trying to get pregnant when she got her first dose last spring, and the couple consulted a doctor beforehand.
“As soon as she told us, ‘It’s a really good idea to get it, it’s safe, we’re not seeing any more side effects with pregnant women than we are with anyone else’ — that really helped reassure us,” she said. She got her booster dose Wednesday, and the couple’s first child is due “any day now.”
After being assuaged by her friends, Haak’s anxiety went up a bit as she got closer to actually getting her vaccine. Ultimately, though, she wanted to protect not just herself but her three kids — the two out in the world and the third waiting to join them. She got her first dose in March, when she was near the end of her second trimester, and her second in April. Seamus, her second son, was born in June.
“He’s a happy, healthy little guy,” she said. “He’s growing, he likes to eat, he’s very smiley. I think he seems about as normal as they come.”
Correction: Anna Euser is a maternal-fetal medicine specialist at UCHealth’s University of Colorado Hospital. A previous version of this story misspelled her first name.
This content was originally published here.