Death of three pregnant women from Covid-19 sparks urgent calls to immunize this group in Spain

Specialists in gynecology and obstetrics from Spain’s large public hospitals have called on regional authorities to speed up the Covid-19 vaccination drive of pregnant women following three deaths in the last month and a rise in intensive care unit (ICU) admissions.

“We are in the worst moment of the pandemic for these patients,” said Óscar Martínez Perez, from Puerta de Hierro Hospital in Madrid and a leading researcher at ObsCovid, a registry for maternity healthcare workers who assist patients with suspected or confirmed Covid-19.

The ICUs are under great strain. We have to vaccinate, vaccinate and vaccinate pregnant women and do it quickly

Guillermo Antiñolo, head of the obstetrics and gynecology department at Virgen del Rocío Hospital in Seville

According to specialists, three pregnant women died from Covid-19 in the last month in Barcelona, Málaga and Murcia. But experts warn the real figure could be higher as the registry system is “not exhaustive.” “What’s more, there have been fetal deaths in at least Madrid and Mallorca, and numerous urgent C-sections due to the worsening state of the expectant mothers,” says Martínez Pérez. “We are saving many women because we have a very capable healthcare system, but in some cases, we are cutting it close and we will have to see what the scars are of the long-term admissions in ICUs.”

Guillermo Antiñolo, the head of the obstetrics and gynecology department at Virgen del Rocío Hospital in Seville, agrees. “We are at a very fragile moment,” he says. “The ICUs are under great strain. We have to vaccinate, vaccinate and vaccinate pregnant women and do it quickly.”

According to Martínez Pérez, pregnant women are in “the middle of a perfect storm” that has formed in the last months due to the “lukewarm” recommendations on the vaccination of this group. This hesitant support is despite the fact that several studies have shown that the vaccine is safe for the fetus, and that the coronavirus increases the risk of pregnancy complications by 50%.

Martínez Pérez says the message that pregnant women should be vaccinated has not been strong enough. “They are not always given the most appropriate information. And when they finally could get vaccinated, they have had to fight to get an appointment with all the other people in their age group, among whom the virus is spreading massively,” he explains.

Emma, who preferred not to give her surname for work reasons, is 40 years old and lives in Barcelona. She is 31 weeks pregnant and has not yet been vaccinated. When she was called to make a vaccination appointment at the beginning of June, she discussed the issue with her midwife. “I was told that the instructions from the regional government were not to do it unless you had an underlying health condition or worked with at-risk groups. That was on June 11 and three days later I asked my family doctor, who told me the same thing,” says Emma. “The message was that nothing would happen if you did it, but those were the guidelines because there were not enough studies yet.”

Not long after, Emma went to Sant Pau Hospital for an ultrasound. “The doctor then told me that I should have been vaccinated with my age group, but just afterward I went to my gynecologist and she told me what they had said at the beginning,” says Emma. “That was a month ago and they told me if there was any change they would call me, which they haven’t done. In the end, I haven’t been vaccinated.”

These recommendations go against Spain’s vaccination strategy, which has been approved by the Health Ministry and the regions. The seventh update to the document, released on May 11, backs the safety of Covid-19 vaccines to the fetus and pregnant women, and recommends that expectant mothers be immunized with the Pfizer-BioNTech or Moderna vaccines, which are both based on RNA technology. According to the strategy, pregnant women should be vaccinated “according to the priority group they belong to.”

The Catalan government has not explained what happened. But on Thursday of last week, regional health chief Josep Maria Argimon publicly admitted that “we are seeing many more pregnant women with Covid,” and insisted that this group should get vaccine appointments. The Catalan government is planning to hold a news conference in the coming days focusing specifically on pregnant women.

Most pregnant women are not vaccinated and this is a serious problem

Guillermo Antiñolo, head of the obstetrics and gynecology department at Virgen del Rocío Hospital in Seville

Antiñolo says that information on this issue has been “fragmented and often contradictory.” “It is true that at the beginning of the year, there was no conclusive scientific evidence, especially since pregnant women did not take part in vaccination trials,” he explains. “But there began to be as of the second quarter and it was clear that they were safe. The consequence of all this is that now most pregnant women are not vaccinated and this is a serious problem.”

Specialists are now urging the regions – which are in charge of the Covid-19 vaccination drive as well as containing the pandemic in their territories – to vaccinate pregnant women as soon as possible. According to the experts, the biggest risk is in the third trimester, and “it is crucial that they are fully vaccinated when they are at 28 weeks.”

The complication of most concern is preeclampsia due to Covid-19. This is a serious disorder that can lead to increased arterial pressure and liver and kidney problems. This endangers the life of the mother and fetus, and if it is not controlled, the pregnancy has to be interrupted with a cesarean delivery, which increases prematurity, the specialists explain.

One of three pregnant women who died was a 40-year-old patient with prior health conditions who was admitted into the ICU at Virgen de la Arrixaca Hospital in Murcia. She was admitted two weeks ago after going into labor and died on Wednesday, as confirmed by the Murcia regional government.

English version by Melissa Kitson.