Abstract

Objective:

Due to the anatomical, physiological, and immunological changes associated with pregnancy, pregnant women are a population at risk of coronavirus disease-2019 (COVID-19) disease-related morbidity and mortality. There aren’t enough studies on the conditions of pregnant and puerperal women who are being followed up in intensive care. The goal of this study was to determine if there was a link between variant status, vaccination status, and mortality in pregnant and puerperal women who were monitored in the intensive care unit during the transition from the alpha to the delta variation.

Materials and Methods:

The study was designed as a 6-month prospective observational study that occurred between August 1, 2021, and February 1, 2022. Age, present comorbidities, vaccination status, gravida, parity, gestational age (for pregnant women), variant status, birth style (cesarean section or normal delivery), and COVID-19 medical therapies in the critical care unit were all recorded.

Results:

During the observation period, forty patients were enrolled in the study. The patients average age was 30.9±5.2. The pregnant patients’ median gestational week was 32 weeks and 2 days. While 30 of the patients had no concomitant conditions, two had gestational diabetes, four had hypothyroidism, three had chronic hypertension, and one had Wilson’s disease. In 37.5% of the patients, intubation was required. During the follow-up in intensive care, ten individuals died. The patients in the intensive care unit spent an average of 12.1±11.8 days there. While 7 (19.4%) of the 36 patients with alpha variants died, 3 (75%) of the 4 patients with delta variants died, a statistically significant difference (p=0.042).

Conclusion:

In the pregnant population admitted to the intensive care unit, the delta variant was associated with a greater mortality rate. In our research, we discovered that the vaccination rate among pregnant women admitted to the intensive care unit was quite low.

Keywords: COVID-19 vaccine, COVID-19 variants, mortality, pregnancy, SARS-CoV-2

References

  1. Wei SQ, Bilodeau-Bertrand M, Liu S, Auger N. The impact of COVID-19 on pregnancy outcomes: a systematic review and meta-analysis. CMAJ 2021;193:540-8.
  2. Conde-Agudelo A, Romero R. SARS-CoV-2 infection during pregnancy and risk of preeclampsia: a systematic review and meta-analysis. Am J Obstet Gynecol 2022;226:68-89.
  3. Metz TD, Clifton RG, Hughes BL, Sandoval GJ, Grobman WA, Saade GR, et al. Association of SARS-CoV-2 Infection With Serious Maternal Morbidity and Mortality From Obstetric Complications. JAMA 2022;327:748-59.
  4. Martins I, Louwen F, Ayres-de- Campos D, Mahmood T. EBCOG position statement on COVID-19 vaccination for pregnant and breastfeeding women. Eur J Obstet Gynecol Reprod Biol 2021;262:256-8.
  5. Hantoushzadeh S, Shamshirsaz AA, Aleyasin A, Seferovic MD, Aski SK, Arian SE, et al. Maternal death due to COVID-19. Am J Obstet Gynecol 2020;223:109.
  6. Chen L, Li Q, Zheng D, Jiang H, Wei Y, Zou L, et al. Clinical Characteristics of Pregnant Women with Covid-19 in Wuhan, China. N Engl J Med 2020;18;382:e100.
  7. Rinaldi SF, Makieva S, Saunders PT, Rossi AG, Norman JE. Immune cell and transcriptomic analysis of the human decidua in term and preterm parturition. Mol Hum Reprod 2017;23:708-24.
  8. Kiriakopoulos N, Grigoriadis S, Maziotis E, Philippou A, Rapani A, Giannelou P, et al. Investigating Stress Response during Vaginal Delivery and Elective Cesarean Section through Assessment of Levels of Cortisol, Interleukin 6 (IL-6), Growth Hormone (GH) and Insulin-Like Growth Factor 1 (IGF-1). J Clin Med 2019;8:1112.
  9. Halasa NB, Olson SM, Staat MA, Newhams MM, Price AM, Boom JA, et al. Effectiveness of Maternal Vaccination with mRNA COVID-19 Vaccine During Pregnancy Against COVID-19-Associated Hospitalization in Infants Aged <6 Months - 17 States, July 2021-January 2022. MMWR Morb Mortal Wkly Rep 2022;71:264-70.
  10. T.C. Sağlık Bakanlığı Halk Sağlığı Müdürlüğü. COVID-19 (SARS-CoV-2 Enfeksiyonu) Erişkin Hasta Tedavisi. Available from: URL: https://covid19.saglik.gov.tr/Eklenti/43095/0/covid-19rehberieriskinhastayonetimivetedavi-12042022pdf.pdf. Accessed: April 12, 2022.
  11. Sahin D, Tanacan A, Anuk AT, Sinaci S, Besimoglu B, Oluklu D, et al. Comparison of clinical features and perinatal outcomes between pre-variant and post-variant periods in pregnant women with SARS-CoV-2: analysis of 1935 cases. Arch Gynecol Obstet 2022;306:1939-48.
  12. Adhikari EH, SoRelle JA, McIntire DD, Spong CY. Increasing severity of COVID-19 in pregnancy with Delta (B.1.617.2) variant surge. Am J Obstet Gynecol 2022;226:149-51.
  13. Shook LL, Brigida S, Regan J, Flynn JP, Mohammadi A, Etemad B, et al. SARS-CoV-2 Placentitis Associated With B.1.617.2 (Delta) Variant and Fetal Distress or Demise. J Infect Dis 2022;225:754-8.
  14. Ellington S, Strid P, Tong VT, Woodworth K, Galang RR, Zambrano LD, et al. Characteristics of Women of Reproductive Age with Laboratory-Confirmed SARS-CoV-2 Infection by Pregnancy Status - United States, January 22-June 7, 2020. MMWR Morb Mortal Wkly Rep 2020;69:769-75.
  15. Adhikari EH, Moreno W, Zofkie AC, MacDonald L, McIntire DD, Collins RRJ, et al. Pregnancy Outcomes Among Women With and Without Severe Acute Respiratory Syndrome Coronavirus 2 Infection. JAMA Netw Open 2020;3:e2029256.
  16. Vousden N, Ramakrishnan R, Bunch K, Morris E, Simpson N, Gale C, et al. Impact of SARS-CoV-2 Variant on the Severity of Maternal Infection and Perinatal Outcomes: Data From the UK Obstetric Surveillance System National Cohort. medRxiv 2021.
  17. Vousden N, Bunch K, Morris E, Simpson N, Gale C, O'Brien P, et al. he incidence, characteristics and outcomes of pregnant women hospitalized with symptomatic and asymptomatic SARS-CoV-2 infection in the UK from March to September 2020: A national cohort study using the UK Obstetric Surveillance System (UKOSS). PLoS One 2021;16:e0251123.
  18. Rangchaikul P, Venketaraman V. SARS-CoV-2 and the Immune Response in Pregnancy with Delta Variant Considerations. Infect Dis Rep 2021;13:993-1008.
  19. Allotey J, Stallings E, Bonet M, Yap M, Chatterjee S, Kew T, et al. Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis. BMJ 2020;370:m3320.
  20. Khalil A, Kalafat E, Benlioglu C, O'Brien P, Morris E, Draycott T, et al. SARS-CoV-2 infection in pregnancy: A systematic review and meta-analysis of clinical features and pregnancy outcomes. E ClinicalMedicine 2020;25:100446

Copyright and license

Copyright © 2023 The Author(s). This is an open access article distributed under the Creative Commons Attribution License (CC BY), which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited.

How to cite?

1.
Alay GH, Gülen D, Öztaş A, Turan G. Evaluation of Variants and the Effect of Vaccine on Mortality in Pregnant and Postpartum Women Infected with COVID-19. Turk J Intensive Care. 2023;21(1):48-54. https://doi.org/10.4274/tybd.galenos.2022.56823