Pregnant women in Washington state were infected with COVID-19 at a rate 70% higher than others of similar ages, with non-white women bearing a disproportionate burden, according to a study published yesterday in American Journal of Obstetrics & Gynecology.
Noting that population estimates of coronavirus infections in pregnancy are unreliable due to incomplete registration of pregnancy status or inclusion of hospitalized patients only, a team led by researchers at the University of Washington in Seattle analyzed data from 240 pregnant patients with COVID -19 to 35 years old health systems, capturing 61% of the state’s annual births, from March 1 to June 30, 2020.
They estimated that women who gave birth to 13.9 of every 1,000 newborns had COVID-19, compared with 7.3 out of 1,000 state residents aged 20 to 39 years (rate ratio [RR], 1,7). After excluding 45 coronavirus cases detected by asymptomatic screening, the infection rate in pregnant women dropped to 11.3 per 1,000 cases (RR, 1.3).
Prioritizing pregnant patients for vaccine
Women of the majority of non-white ethnicities had rates of COVID-19 infection two to four times higher than the expected racial and ethnic distribution of pregnant women in Washington in 2018, with the greatest disparities found among Hispanics, American Indians / Alaska Natives and native Hawaiians / Pacific Islander women. Likewise, the proportion of pregnant women who prefer to receive care in a language other than English was 30.4%, against 7.6% who are estimated to have limited English proficiency in the state. The majority of women in the study (70.7%) belonged to minority racial and ethnic groups.
“Pregnant women were not protected from COVID-19 in the first months of the pandemic, with the highest infection burden occurring in almost all racial / ethnic minority groups,” wrote the authors. “These data, together with a broader recognition that pregnancy is a risk factor for serious illnesses and maternal mortality, strongly suggests that pregnant women should be given high priority for the allocation of the COVID-19 vaccine in the USA, similarly to some states ”.
Specifically, study co-author Kristina Adams Waldorf, a physician, said in a University of Washington press release that vaccination plans vary widely by state, “and pregnant women are eliminated from allocation prioritization in about half of the states. Many states are not even linking their COVID-19 vaccine allocation plans to the high-risk medical conditions listed by the US [Centers for Disease Control and Prevention] —That include pregnancy. “
Risk-driven public health messages
The authors said that the 70% higher rate in pregnant women cannot be entirely explained by universal screening in childbirth, but may be due in part to exposures of children in daycare centers, their role as caregivers in an extended family, residing in larger homes or other factors.
“The higher rates of infection in pregnant patients may be due to over-representation of women in many professions and sectors considered essential during the COVID-19 pandemic – including health, education, service sectors,” said lead author Erica Lokken, PhD in the statement.
The researchers asked for messages aimed at public health.
“Understanding the geographic, racial / ethnic and linguistic distribution of SARS-CoV-2 infections among pregnant patients would allow directing the public health response to pregnant women at increased risk of SARS-CoV-2 infection and associated adverse maternal-fetal outcomes “, they concluded.