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UAB Hospital ICU population includes ‘alarming’ number of pregnant women

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By Tyler Greer

UAB News

Physicians in UAB Medicine’s Division of Maternal-Fetal Medicine report that 39 unvaccinated pregnant women have been admitted to UAB Hospital this month. Of those, 10 are in the intensive care unit and seven of them are on ventilators as of August 24.

These are extraordinary numbers of pregnant women for UAB’s ICU, says Dr. Steve Stigler, director of UAB Hospital’s Medical Intensive Care Unit. None of the pregnant women in UAB’s ICUs is vaccinated.

“Truly, we’ve never had this number of pregnant women in my ICU,” said Stigler, an associate professor in UAB’s School of Medicine since 2012. “It is alarming. In a typical month, we may have one or two pregnant women who require our care in a medical intensive care unit; but those are very rare circumstances.”

Unfortunately, these pregnant COVID patients – especially those in the ICU – have had to have their babies delivered prematurely. In some cases, babies have been born at week 26 of a woman’s pregnancy. Full term is considered 37 weeks, and 40 weeks is ideal.

“At any given point, when we have women who are exceptionally ill, it does increase the rate of pre-term birth quite a bit,” said Dr. Akila Subramaniam, associate professor in UAB’s Division of Maternal-Fetal Medicine. “What has been more heightened over the past two months is nearly all of these women are delivering pre-term – not because they are laboring pre-term, but because we are effecting a pre-term birth because the virus is doing so much damage to these women.”

UAB doctors advise pregnant women to receive a COVID vaccine to help prevent health issues that could endanger a fetus. (Getty Images)

“If a mom is not oxygenating her body well, she is not oxygenating the baby well, either,” added Dr. Audra Williams, assistant professor in UAB’s Department of Obstetrics and Gynecology. “That’s what may lead us to deliver the baby. And there are lots of risks associated with prematurity – long-term neurological or gastrointestinal complications, among others. It’s not just the acute risk of the COVID infection these babies are facing, but long-term, lifetime risk.”

To date, two COVID-positive women have died while pregnant at UAB. Another six COVID-positive women have lost their babies during their second trimester. Three other COVID-positive women have lost their babies during their third trimester.

Subramaniam says that in some cases, doctors must perform cesarean delivery in the ICU because they cannot safely labor the women in an ICU unit, especially when women need to be placed on a ventilator or an extracorporeal membrane oxygen (ECMO) machine. ECMO is similar to the heart-lung bypass machine commonly used in open-heart surgery. It pumps and oxygenates a patient’s blood outside the body, allowing the heart and lungs to rest.

“If the mother needs to be intubated, it doesn’t necessarily mean the baby has to be delivered. But, often, what we are seeing is that there is a high rate of intubation failure and worsening immediately of maternal status after intubation,” Subramaniam said. “We’re often having to do this under the pressure of placing patients on ECMO and then effecting delivery. And in some cases, if things deteriorate very quickly, we’re finding ourselves doing a bedside delivery in the ICU in order to protect the infant while taking care of the mom as well. It’s not ideal to do a surgical treatment in an ICU setting.”

According to data from the Centers for Disease Control and Prevention, pregnant women are among the highest groups of people who identify as vaccine-hesitant. Only 23 percent of pregnant women are currently vaccinated, according to the CDC.

Williams says she talks to her pregnant patients all the time about vaccination and its safety. She also understands that the decision is not easy. Subramaniam understands as well. No mother-to-be wants to do anything that can harm her baby.

“The good news is that we have a vaccine that has been tested on more humans than any other vaccine in history,” Subramaniam said. “The vaccine is safe for pregnant women regardless of the trimester they are in, and it is safe for breastfeeding moms. The data is convincing in this.

“You can put your faith in medicine that you are protecting yourself and your child based on the extensive data that has been collected,” she said. “They are very hard decisions, but we have so much more data now than we did in December. We can definitively say, yes, these vaccines are safe for women and their babies.”

This story originally appeared on the UAB News website.