Pregnant women hospitalized because of COVID-19 had secret advantage - study

A new study revealed advantages found for pregnant women who were hospitalized with COVID-19 in the ICU, requiring them to give birth before the condition deteriorated.

Pregnant woman receives the coronavirus vaccine in the US (photo credit: REUTERS/HANNAH BEIER/FILE PHOTO)
Pregnant woman receives the coronavirus vaccine in the US

There is an advantage to pregnant women who are hospitalized in an intensive care unit because of a COVID-19 infection, to give birth before their condition deteriorates to the point where they need ventilation, a new study has found.

The research was led at the Hadassah-University Medical Center in Jerusalem’s Ein Kerem by Prof. Yehuda Ginosar, director of the maternal and child anesthesia unit, and has just been published in the journal Lancet Respiratory Medicine under the title “Outcome predictors and patient progress following delivery in pregnant and postpartum patients with severe COVID-19 pneumonitis in intensive care units in Israel (OB-COVICU): a nationwide cohort study.”

The world of medicine faced many questions and dilemmas regarding the treatment of people infected with the new coronavirus, especially at the beginning, when there was no prior information and no protocol that provided answers and methods of action.

“During the epidemic, especially when the Delta variant arrived, we recognized that the course of the disease in pregnant women is more severe than in non-pregnant women,” explained Ginosar. “The number of pregnant women who came to hospitalization in intensive care units and needed supportive care was greater than the number of women who came to intensive care and were not pregnant.”

 Illustrative image of a pregnant belly.  (credit: PIXABAY) Illustrative image of a pregnant belly. (credit: PIXABAY)
Pregnancy in the ICU

The arrival at the intensive care unit of pregnant women with the virus raised many questions in the clinical aspect and how to treat them, and one of the big questions was whether it was worth it for them to give birth and whether that would improve their condition or worsen it, Ginosar continued.

“During pregnancy, pressure occurs on the diaphragm and the lungs and we know that childbirth will lower the abdominal pressure and thus the patient’s lung functions may improve,” he said. “On the other hand, we know that in the first days after birth there is an increase in blood volume and, in women suffering from cardiac damage, this may cause heart failure. The COVID-19 patients who were in serious condition also suffered from impaired cardiac function and this raised concerns that because of the birth their condition would worsen.”
Working with Dr. Elena Fatnic, a senior physician in the hospital’s anesthesiology department, and Prof. Vernon Van Heerden, the director of its intensive care unit, Ginosar launched the study for which almost all Israeli hospitals in Israel were also recruited.
“For two years, we examined the condition of all pregnant women hospitalized in intensive care units due to the coronavirus and followed their condition throughout the days of hospitalization in intensive care,” recalled Ginosar.“After collecting all the data, we focused especially on the period of five days before the birth and 10 days after delivery,” he said.

“After analyzing all the data, we saw a clear distribution between the groups of women. The day of birth was a turning point that differentiated among the women. The condition of those who were ventilated or had indicators that they were about to be attached to a respirator became more serious after giving birth, compared to the women who were hospitalized in intensive care only with supportive care and were not close to the need for ventilation and who improved very quickly after the birth.

“Our findings prove unequivocally when we must intervene” he concluded. “When a pregnant woman comes to the intensive care unit with acute pneumonia due to the coronavirus and her blood-oxygenation level does not improve despite the supportive treatment, delivering the baby as soon as possible – usually by cesarean section – should be seriously considered, rather than waiting for her condition to deteriorate until she urgently has to be ventilated.
“We hope our research will help many medical teams make decisions regarding the treatment of pregnant women all over the world who have been infected by the virus.”