Add pregnancy to the list of factors increasing the risk of death from covid

[Corraleno]

NYT article says that pregnant women have a 70% higher risk of death from covid than nonpregnant women, and they are "significantly more likely to require intensive care, to be connected to a specialized heart-lung bypass machine, and to require mechanical ventilation than nonpregnant women." The article describes the case of a 33 year old woman with no underlying conditions who was hospitalized with covid three days before giving birth, and who died 18 days later without ever getting to hold her baby. She also left behind a 1 year old daughter and a traumatized husband and family. 😥  

https://www.nytimes.com/2020/12/08/us/coronavirus-pregnancy-erika-becerra.html

[bookbard]

I remember it was similar for Swine Flu in 2009 - one of the most high risk groups, and some tragic stories of loss. What a stressful time to fall pregnant, along with the stress of perhaps giving birth without support from a partner etc. 

[Tenaj]

Thank you for sharing this.  I've been concerned for some time about my dil who is due the last week of January. She works in a clinic giving ultrasounds and the last time we talked about it screening wasn't happening very consistently and masking was haphazard.  She only works one day a week but it still seems quite risky 😟

[Pawz4me]

A pregnant (due in about a month) family member tested positive last week. So far she only has very mild symptoms. But it is very worrisome.

[PrincessMommy]

Thank you for sharing.  I have a pregnant daughter-in-law and another one hoping to get pregnant.  

 

[TravelingChris]

I have also read where there have been an increase in heart issues with kids born to pregnant women who had COVID.  It was an addendum to the main story about pregnancy being a new risk factor so I do not have any more info about that.

[Scarlett]

And add to that I heard on the news this morning a baby boom is expected.  I can only hope the worst of this is over before the majority of those babies and moms are harmed.

[Dmmetler]

I am on a group for HELLP syndrome research (we're all patients being followed long-term. 2022 will be 20 years for me) and apparently the doctors are seeing HELLP develop in COVID-19 positive women. Whether this is due to the fact that women who have pre-eclampsia are probably being monitored more closely and therefore are more likely to be exposed to COVID, and some percentage of PE cases progress to HELLP, so the two are unrelated, or whether COVID is actually triggering the complication isn't yet known. 

 

There are also HELLP survivors experiencing hemolysis and elevated liver enzymes with COVID, years after HELLP, usually with relatively mild COVID symptoms. Again, no idea why. 

 

[purpleowl]

That's concerning. 

Does anyone know whether the vaccines have been tested for safety in pregnant women? 

[PrincessMommy]

1 minute ago, purpleowl said:

That's concerning. 

Does anyone know whether the vaccines have been tested for safety in pregnant women? 

no, they have not.  There is some serious concern about the vaccine for pregnant and women hoping to become pregnant.  Something about antibodies attacking the placenta.  I will see if I can find the article.

Also, in thinking about this.  The article says 70% *increase*.  What is the overall rate of serious complications/mortality in women of childbearing age with Covid?  Multiply that by the 70 percent you get a better feel for their actual chance of getting something serious.  

[mom2scouts]

2 hours ago, Scarlett said:

And add to that I heard on the news this morning a baby boom is expected.  I can only hope the worst of this is over before the majority of those babies and moms are harmed.

Interesting. I've heard over and over that socialogists are expecting the birth rate to be extremely low next year.

[Scarlett]

2 minutes ago, mom2scouts said:

Interesting. I've heard over and over that socialogists are expecting the birth rate to be extremely low next year.

I am not sure that the report I heard was talking about the US.  I had previously heard it was going to be low.  Oh, I do remember this was taking specifically about Catholics in whichever country it was.

[wathe]

1 hour ago, PrincessMommy said:

no, they have not.  There is some serious concern about the vaccine for pregnant and women hoping to become pregnant.  Something about antibodies attacking the placenta.  I will see if I can find the article.

Also, in thinking about this.  The article says 70% *increase*.  What is the overall rate of serious complications/mortality in women of childbearing age with Covid?  Multiply that by the 70 percent you get a better feel for their actual chance of getting something serious.  

Yes, relative risk is very different than absolute risk.  Media like to report relative risk because it always sounds more impressive - either scarier, as in this case, or better, as in cases of relative risk reduction for therapeutics. 

The worst is when media falsely compare RR with AR:  report absolute risk for one aspect and relative risk for another, such as reporting benefits in relative terms, and harms in absolute terms, to make a therapy sound more impressive and less risky than it really is.   Canadian Family Physician had a really good article on this in a recent issue, on how the media reports on preventive care.  Table 1 is really informative. (Nothing to to with covid, but a great tool for improving one's media literacy with respect to medical reporting in general)

Edited December 10, 2020 by wathe

[wathe]

An example (from the article linked above) of mixing RR with AR to make a therapy look better than it really is:

(ETA nothing to do with covid)

Reporting benefits in relative terms and harms in absolute terms

Time article about SPRINT SPRINT reported a 38% reduction in heart failure and a 43% reduction in deaths from heart problems (relative risk) with a 1% to 2% increase of side effects apart from falls (absolute risk)33

The published SPRINT results The absolute reduction for heart failure was 0.8% and for cardiovascular mortality was 0.6%3

Edited December 10, 2020 by wathe

[Sneezyone]

Relative risk and actual risk often coexist. This is especially troubling as those having babies in the US are more likely to be black and brown.

[1234]

Yes, I’ve been concerned about a cousin who is due in about a month. She is a a nurse and the doctor she works for actually died from Covid in the very beginning of this. She actually already had Covid in the early stages, pre pregnancy, so I’m hoping she will be safe from getting it again right now. 

[KatieJ]

It’s very true. My neighbors daughter tested positive and was induced two days later with high blood pressure. Baby ended up in NICU and she didn’t see him for about two weeks. I have no idea if baby issues was because of covid or not, I didn’t ask. Hubby was able to spend time with baby when Mom’s symptoms eased. She has been admitted back to the hospital twice since his birth for preeclampsia...high blood pressure and heart racing. Everyone is home together now, but grandparents have stepped in to help with the older kids, and they are also recovering from Covid. Grandpa  was hospitalized same week baby was born.

[wathe]

11 hours ago, Sneezyone said:

Relative risk and actual risk often coexist. This is especially troubling as those having babies in the US are more likely to be black and brown.

Not sure what you mean?

If what you mean is that the risk is real, and higher for some groups than others, ITA with you.

Relative risk and absolute risk are different ways of expressing the same risk - both are actual risk.  Reporting only relative risk can make small differences in risk seem big and important, when in absolute terms the difference might be really small, and maybe even clinically meaningless.  Without knowing the absolute numbers, one can't know if the increase in risk is from really, really tiny to slightly less tiny,  (say, and I'm totally making up numbers here,  0.0000005 to 0.000001 % of cases - a relative increase of 100%, but an absolute change of 0.0000005% points) or if it is much bigger and meaningful (from 5 to 10% of cases, say, also a relative increase of 100%, but an absolute change of 5 percentage points from 5% to 10%).  Absolute numbers really do matter.

 

 

[Ausmumof3]

20 hours ago, PrincessMommy said:

no, they have not.  There is some serious concern about the vaccine for pregnant and women hoping to become pregnant.  Something about antibodies attacking the placenta.  I will see if I can find the article.

Also, in thinking about this.  The article says 70% *increase*.  What is the overall rate of serious complications/mortality in women of childbearing age with Covid?  Multiply that by the 70 percent you get a better feel for their actual chance of getting something serious.  

Yes I was thinking this.  70pc increase sounds scary but if it’s 70pc increase on like .01pc it’s still pretty low.  I guess maybe if you were an older mum it might be more worrying though.

[PrincessMommy]

20 hours ago, wathe said:

Yes, relative risk is very different than absolute risk.  Media like to report relative risk because it always sounds more impressive - either scarier, as in this case, or better, as in cases of relative risk reduction for therapeutics. 

The worst is when media falsely compare RR with AR:  report absolute risk for one aspect and relative risk for another, such as reporting benefits in relative terms, and harms in absolute terms, to make a therapy sound more impressive and less risky than it really is.   Canadian Family Physician had a really good article on this in a recent issue, on how the media reports on preventive care.  Table 1 is really informative. (Nothing to to with covid, but a great tool for improving one's media literacy with respect to medical reporting in general)

Thank you!  

In addition.  Dr. John Campell in England went through the data in a YT video.

Data on Pregnant women with Covid

bottom line: yes, it does increase the risk of intervention, but the overall numbers are small. 

[Not_a_Number]

8 hours ago, wathe said:

Not sure what you mean?

If what you mean is that the risk is real, and higher for some groups than others, ITA with you.

Relative risk and absolute risk are different ways of expressing the same risk - both are actual risk.  Reporting only relative risk can make small differences in risk seem big and important, when in absolute terms the difference might be really small, and maybe even clinically meaningless.  Without knowing the absolute numbers, one can't know if the increase in risk is from really, really tiny to slightly less tiny,  (say, and I'm totally making up numbers here,  0.0000005 to 0.000001 % of cases - a relative increase of 100%, but an absolute change of 0.0000005% points) or if it is much bigger and meaningful (from 5 to 10% of cases, say, also a relative increase of 100%, but an absolute change of 5 percentage points from 5% to 10%).  Absolute numbers really do matter.

Thanks! You’re absolutely right. 

 

20 hours ago, wathe said:

An example (from the article linked above) of mixing RR with AR to make a therapy look better than it really is:

(ETA nothing to do with covid)

Reporting benefits in relative terms and harms in absolute terms

Time article about SPRINT SPRINT reported a 38% reduction in heart failure and a 43% reduction in deaths from heart problems (relative risk) with a 1% to 2% increase of side effects apart from falls (absolute risk)33

The published SPRINT results The absolute reduction for heart failure was 0.8% and for cardiovascular mortality was 0.6%3

Yikes. That is statistical malpractice is what it is!!

[Dmmetler]

A lot of the pregnancy complications that have a really high risk of death are very rare. My probability of getting Class A HELLP, sudden onset, in the second trimester, as (at the time) a 29 yr old white woman who had none of the known markers for it, was, as my perinatologist put it, about like winning the super jackpot in the lottery with a ticket picked up on the sidewalk. So two women having sudden onset HELLP and also testing positive for COVID while being asymptomatic or very mildly symptomatic  is potentially statistically significant-but also could be complete coincidence. 
 

In the US, for all women age 20-35, maternal mortality hovers at about 18 deaths per 100,000, and disproportionately women of color and lower income women, who are less likely to have complications noted and treated. In comparison, 683 women out of over 22 million in the same age group have died due to COVID
 

So, yes, it’s probably a pretty small number. However, even low probability events do happen. And even a completely normal pregnancy usually requires in person visits regularly, increasing exposure. A complicated one can lead to multiple visits a week, if you are able to stay out of the hospital, so exposure seems far more likely, even if you never leave your house otherwise.