In spite of indirectly linked litigation and a fear-induced paucity of data on the use of Covid-19 vaccines in pregnant women, clinical experts are urging those at high risk to be vaccinated.
This coincides with as-yet-unpublished findings of a Gauteng study showing a 30% increase in maternal deaths during the first Covid-19 surge to July 2020, compared to the same period in 2019.
Study leader Professor Priya Soma-Pillay, head of the department of obstetrics and gynaecology at Steve Biko Academic Hospital, says Covid‑19 is impacting pregnant women on several levels.
For those pregnant women with pre-existing comorbidities including obesity or high blood pressure or those aged 45 years and older, the risk of serious adverse outcomes if they got Covid-19 was the highest.
Soma-Pillay explains that any pregnant women who contracted Covid‑19 would have a higher risk than normal of a poor outcome, while the lockdown and fears of going out during the Covid pandemic meant less access to reproductive health services.
Stillbirths and unwanted pregnancies also rose during the study period as access to clinics and contraception were sharply reduced by lockdown and a general fear of infection.
Professor Salome Maswime, an obstetrician and head of the global surgery division at the University of Cape Town, said one of the only other studies available was from the US, where 400 000 pregnant women infected with Covid‑19 were found to have a 70% greater chance of death compared to those who weren’t.
Pregnant women infected with Covid-19 were also “significantly more likely” to require ICU treatment and or mechanical ventilation in comparison to women of the same age, she added.
Professor Jack Moodley, the head of the department of obstetrics and gynaecology at the University of KwaZulu-Natal, urged pregnant women at higher risk to be vaccinated when possible.
“If you have any of those pre-existing conditions, you should be offered the vaccination because otherwise, you’d be much more likely to get complications if infected,” he said.
Moodley confirmed the paucity of data on the subject, adding that one of the main reasons for this was that drug manufacturers shied away from including pregnant women in vaccine trials because they feared legal liability if problems occurred.
“There are plenty of published papers making a plea for vaccination. But many of the vaccine producers’ fears are based on the thalidomide tragedy of 1961, where that medication [for vomiting and nausea] led to the deaths of 2 000 children and serious birth defects in more than 10 000,” said Moodley.
Heavy global litigation followed, with $81-million paid out to 100 affected parents in Australia and New Zealand alone.
Professor Lynette Denny, head of the department of obstetrics and gynaecology at the University of Cape Town, also encouraged pregnant women to be vaccinated, “certainly after the first trimester”.
She explained that the first trimester was when women were most susceptible to any drug-induced birth defects. While the majority of pregnant women in South Africa were relatively young, they lived with heart disease, HIV, TB, diabetes and many other serious comorbidities — which put them at higher risk.
Denny said research on Covid-19 drugs “began fast and furiously and we’re still lacking sufficient information on such a severe disease — but we have to act.”
Local researchers are keeping a close eye on developments, with several studies using blood samples from vaccinated healthcare workers once they have developed immunity within a few weeks.