Pregnant women are being urged to get the covid vaccine after an expert group found that “confused messaging and vaccine hesitancy” may have contributed to the deaths of 27 women during the pandemic in the UK.
The women who died from covid-19 pneumonitis had not been vaccinated although they were eligible and could have received two doses of vaccine before they died. Some declined, and in some cases there was no documentation that vaccination had been discussed. Only one of the women who died had received a single dose and two other women who died from influenza had not received a flu vaccine during pregnancy.
The new analysis from the MBRRACE-UK collaboration, co-led by Oxford Population Health’s National Perinatal Epidemiology Unit, examined the circumstances of women who died during or up to a year after pregnancy, between 2019 and 2021.1
Data published earlier this year and in previous MBRRACE-UK reports show how persistent disparities in maternal health adversely impacted women from black and Asian backgrounds and those from disadvantaged backgrounds.2
Infection with covid-19 was the leading cause of maternal deaths between 2019 and 2021, and these women were primarily from ethnic minority backgrounds. Of the 33 women who died from covid-19 during pregnancy or up to 6 weeks after pregnancy, 14 were Asian and five were black.
The MBRRACE-UK coalition said that the pandemic exposed gaps in the healthcare system and re-ignited conversations about vaccination in pregnancy.
Its latest report said, “The confused messaging because of a lack of research evidence and consequent widespread vaccine hesitancy among clinicians and pregnant and postpartum women, notably among those from disadvantaged backgrounds and ethnic minority groups, has been well documented.
“These women’s deaths are evidence of the consequences. It is not clear, however, that plans are in place to prevent similar problems occurring in the future.
“This is not unique to covid-19—women are still dying of preventable diseases such as flu—and this highlights the need for consistent, clear messaging on vaccination in pregnancy.”
Among the group’s key recommendations is “the need to prepare a route for the rapid delivery of advice and data on new vaccines and treatments, alongside a sustained focus on the risks of flu, covid-19, and sepsis,” and to ensure that pregnant and breastfeeding women are not excluded inappropriately from new vaccine and treatment research.
The MBRRACE-UK collaboration found clinical staff were not always equipped to discuss with women the benefits and risks of taking medications during pregnancy, undermining women’s ability to make an informed choice. A lack of training for staff meant that in the postnatal period in particular many women at severe or multiple disadvantage did not have their care needs met.
Pregnant women were often denied basic care such as access to treatments for covid-19 that were proven to reduce the risk of death, including tocilizumab and steroids, and heart-lung bypass support, “simply because they were pregnant.”
Medical teams were uncertain about how to diagnose and treat pregnant women appropriately.
The report said that training resources must be developed to promote shared decision making and counselling on medication use during and after pregnancy.
Marian Knight, professor of maternal and child population health at Oxford Population Health and maternal reporting lead, said, “This report shows persistent inequities impacting the care of pregnant, recently pregnant, and breastfeeding women. Improvements in care may have been able to change the outcome for 52% of the women who died during or up to a year after pregnancy. This demonstrates an even greater need to focus on the implementation of the recommendations within this report to achieve a reduction in maternal deaths.”
The Royal College of Midwives urged all pregnant women to get vaccinated against covid to protect them and their babies. “All of us involved in maternity care—midwives, obstetricians, and the system itself—must do more to understand and tackle the difference in outcomes for black and Asian women and those from the most deprived backgrounds,” said RCM chief executive Gill Walton.
