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22 September 2021

Why are so many pregnant women in hospital with Covid-19?

As the world reopens, vaccine hesitancy among pregnant people is having dangerous consequences.

By Katharine Swindells

Vaccine hesitancy and misleading information has led to an increase in pregnant people in critical care for Covid-19, with admissions among pregnant women now higher than their January peak.

Data from the Intensive Care National Audit & Research Centre’s (ICNARC) Covid-19 report, which tracks critical care units across England, Wales and Northern Ireland, found that in August, there were 127 Covid-19 patients admitted to ICUs who were currently or had recently been pregnant.

In July and August 2021 pregnant admissions rose higher than during the January Covid-19 peak. In fact, almost 40 per cent of all pregnant patients admitted to critical care during the pandemic were admitted in July and August.

Indexing these figures to January 2021 shows how pregnant critical care admissions compare to the overall picture. While pregnant admissions are now higher than the January peak, overall critical care admissions are currently just over a fifth of their January level.

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Among women aged 18-49, critical care admissions are still only 44 per cent of their January peak, far less of a spike than among pregnant patients.

In August a fifth of all women aged 18-49 admitted to critical care were pregnant.

Experts attribute this to low vaccine take up among pregnant people. In the early days of vaccination there was uncertainty about the safety of the Covid-19 vaccine, but the most up-to-date research recommends pregnant people get vaccinated with the rest of their age cohort.

“We now know that mothers and their babies are at far higher risk from Covid-19 infection than from having the Covid vaccine, and this is reflected in the number of unvaccinated pregnant and recently pregnant women in intensive care units across the country,” said professor Catherine Nelson-Piercy, a consultant obstetric physician at Imperial College Healthcare NHS Trust and Guy's and St Thomas' NHS Foundation Trust.

“If you are pregnant, the best thing you can do to protect yourself and your baby is to have your Covid-19 vaccine.”

But reproductive health experts fear the message isn’t cutting through. The most recent data from Public Health England’s Covid-19 Vaccine Surveillance Report recorded nearly 82,000 women who said they were or could be pregnant when they received their first dose. The British Pregnancy Advisory Service (BPAS) estimates that this number is only around 10 per cent of the pregnancies it would expect to see in a year, so assuming pregnancy rates have not radically changed, this means up to 90 per cent of pregnant women may not have had the vaccine.

As Covid-19 cases rose over the summer, the majority of the UK population was protected from serious illness and hospitalisation, but those unvaccinated were still at risk. Despite messaging that it is safe for pregnant people to be vaccinated, many are uncertain or nervous of potential risks – fears that are in some cases being fanned by healthcare professionals themselves.

Pregnancy Sickness Support, which runs a helpline for those suffering from severe nausea during pregnancy, told BPAS that it has received a high volume of calls from people unsure about being vaccinated or who have even been actively encouraged by their doctors to wait until the baby is born to get vaccinated.

BPAS said this can be partly attributed to pregnant people being excluded from clinical trials, leading to a lack of information about how new drugs interact with pregnancy. But Clare Murphy, the chief executive at BPAS, said it also speaks to a broader issue: a culture that discourages the most minor risk to a pregnancy, even at the risk of the pregnant person themselves.

“We have created a climate where women are expected to avoid any possible risk to their pregnancy,” Murphy said. “The challenges we are seeing with Covid vaccine uptake are an inevitable consequence of this climate.

“We need to really re-evaluate how we communicate risk to women in pregnancy, and ensure women’s own health needs are deemed as important – and indeed not mutually exclusive – from those of her foetus.”

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