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KBIA’s Health & Wealth Desk covers the economy and health of rural and underserved communities in Missouri and beyond. The team produces a weekly radio segment, as well as in-depth features and regular blog posts. The reporting desk is funded by a grant from the University of Missouri, and the Missouri Foundation for Health.Contact the Health & Wealth desk.

Missouri OBGYNs Are Worried About Rise in Severe Complications, Stillbirths in COVID-19 Positive Mothers

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Rebecca Smith
/
KBIA

Throughout the summer, Missouri was an early hotspot for the delta variant of the coronavirus. This led to more unvaccinated young people getting severely ill, and as more young people got sick – more expectant mothers did too.

Now, many OBGYNs across the state are worried as they are seeing more serious pregnancy complications in women who have or had COVID-19. Things like a rise in miscarriages, emergency pre-term deliveries, and even stillbirth.

Dr. Rebecca Hamel, an OBGYN at St. Luke’s Women’s Health North in Kansas City, said that when it comes to COVID-19 and expectant parents – it’s simple: Folks are scared.

“They're just scared, Hamel said. “And I so very understand that. On a personal level, I am a pregnant obstetrician. I'm in my third trimester. I understand the urge and desire and fundamental need to make sure you're making the best decision you can for your health and for that of your baby.”

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Provided by Saint Luke's Health System
Dr. Rebecca Hamel is an OBGYN at Saint Luke's Women's Health North in Kansas City. She said she understands the fear and uncertainty her pregnant patients feel - as she is, herself, in the third trimester of pregnancy.

Hamel added that right now – considering the continued rise in COVID-19 in younger people throughout the state – those fears might be justified. Maternal and fetal health doctors are starting to see some worrisome new complications arise from COVID infections during pregnancy.

“Fortunately, most of my moms have uncomplicated infections,” Hamel said. “They do okay without long term complication, but unfortunately, we are absolutely seeing the rare exception to that and hospitalized patients at all gestational ages.”

She said in the first trimester, OBGYNs are seeing a rise in miscarriages. Then in the second and third trimesters, they’re seeing severely ill mothers who have an increased need for being ventilated or getting respiratory support.

“If we have to focus on keeping mom alive, at that point, we keep mom as stable as possible, but we're doing preterm deliveries, we're doing unplanned emergency C-sections to save mom,” Hamel said. “Because we got to get baby out, so baby can be taken care of.”

So, doctors are sometimes delivering babies as young as 34, 32, even 28 weeks of gestation – so that the mothers have the best chance of surviving severe COVID symptoms.

Hamel warns that while this is a necessary step, premature birth can also lead to an increased risk of complications throughout the child’s life.

On top of all these complications, doctors are also worried about a dramatic increase in the stillbirth rate in pregnant women with COVID-19 infections. This comes from some limited, early data and anecdotes from OBGYNs throughout the state

“In my opinion, one extra maternal death, one extra stillbirth is too much. That's unacceptable, and so, it comes back to safety profile... What’s safer? Vaccination – hands down.”
Dr. Rebecca Hamel, OBGYN at Saint Luke's Women's Health North in Kansas City

One of the areas that has noticed this increase is Springfield, Missouri. Earlier this summer, Springfield was the epicenter of delta variant COVID-19.

According to the Centers for Disease Control & Prevention, stillbirth affects about 1 in 160 births. But in August, at Mercy Hospital in Springfield – 23 out of the 222 Moms who gave birth had COVID – and 6 of those 23 had stillborn babies.

That’s a rate of 1 in 37 births. Compared to that average rate of 1 in 160.

The data is limited in scope and preliminary, but maternal and fetal doctors in almost every major population center in Missouri – Columbia, St. Louis, Kansas City and Springfield – said they’re seeing something similar.

Dr. Chandria Johnson, an OBGYN at Mercy Hospital in Springfield, said that more mothers are testing positive for COVID-19 nearly every day.

“Some have been basically asymptomatic and just tested positive as part of scheduling an induction or C-section and some have been very ill – all the way up to being in the ICU,” Johnson said.

Johnson said Mercy started to see more of these concerning negative outcomes when they hit their case peak – due to the delta variant – in early August. She said they noticed more stillbirths, as well as more infants with severe complications “all of whom had very abnormal placentas.”

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Provided by The American College of Obstetricians and Gynecologists
Dr. Geeta Swamy is a part of the COVID-19 OB Expert Work Group for The American College of Obstetricians and Gynecologists, and specializes in maternal and perinatal infectious diseases

These placentas were showing evidence of vasculitis – essentially inflammation and restriction of blood flow to placenta, and, therefore, the baby.

“And so something about COVID seems to be affecting blood flow in the placenta in some of our COVID patients,” Johnson said. “And unfortunately, we don't really have a way to predict that, but there definitely is an association with COVID affecting the placental blood flow and circulation and has resulted in some very bad outcomes.

Dr. Geeta Swamy is an OBGYN at Duke University who focuses on maternal and perinatal infectious diseases and immunization during pregnancy. She’s also a member of The American College of Obstetricians and Gynecologists' COVID-19 OB Expert Work Group – a national group looking at COVID’s impacts on pregnancy.

“Thankfully, we're not seeing those kind of things widespread, but to be honest, with how aggressive the delta variant is, and how sick we are seeing young people become, I would not be surprised to find that we start seeing more signs of how that viruses impacted pregnancy,” Swamy said.

She adds that it’s still too early to draw any broad conclusions or make any recommendations nationally – as more data is needed.

Missouri is not the only state seeing this troubling trend. Just earlier this month, in a September 9th press conference, the Mississippi State Health Officer Thomas Dobbs said the state has not only seen a rise in the number of pregnant women who don’t survive COVID-19 infection, but they have also seen an increase in fetal deaths, as well.

"With COVID, we've seen a doubling of the rate of fetal demise, or the death of the baby in the womb after 20 weeks," Dobbs said. "It's been a real tragedy."

"Something about COVID seems to be affecting blood flow in the placenta in some of our COVID patients, and unfortunately, we don't really have a way to predict that."
Dr. Chandria Johnson, OBGYN at Mercy Hospital in Springfield

Back in Missouri, every single one of the maternal and fetal health doctors KBIA spoke with agreed that the vast majority of these severe complications are happening to unvaccinated pregnant women, and they highly encouraged vaccination.

Back in Kansas City, Dr. Rebecca Hamel said it’s been heartbreaking to watch families experience these severe outcomes. She recommends that all of her pregnant patients get the vaccine – especially as there is no evidence of increased risk of miscarriage, infertility or stillbirth complications in your pregnancy linked to the vaccine.

“In my opinion, one extra maternal death, one extra stillbirth is too much. That's unacceptable,” Hamel said. “And so, it comes back to safety profile – the vaccine carries minimal risk to it, but [COVID-19] infection and pregnancy carries substantial risks to it. What’s safer? Vaccination – hands down.”