Five stillbirths, two newborn deaths conclusively linked to Delta variant in unvaccinated mothers

The guidance, to be published by the HSE, recommends women with the virus be assessed with CTG monitors not just ultrasound scans in later pregnancy. Picture: Larry Cummins

Research from a team at Cork University Maternity Hospital has conclusively linked five stillbirths and two newborn deaths in Ireland late last year to the impact of the Delta variant of Covid-19 on unvaccinated mothers.

New guidance from the Institute of Obstetricians and Gynaecologists, in which these findings are quoted, cautions there is no clinical data yet on the impact of Omicron for pregnant women. It follows studies early last year linking a small number of stillbirths to the Alpha variant of the virus.

An update on pregnancy and Covid-19 for women in Ireland advises that vaccination appears to give protection against damage to the placenta caused by the virus.

Particular attention

The update recommends women pay particular attention to foetal movements if they contract the virus and to contact their maternity units.

Between September and December last year “five foetal deaths >20 weeks and two early neonatal deaths” have now been linked with the condition known as Covid placentitis, the update said.

“None of the mothers was vaccinated against Covid-19,” it adds.

These unpublished findings quoted in the guidance are from a team based at Cork University Maternity Hospital led by professor Keelin O’Donoghue.

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“It’s important to say this is an uncommon but real complication of Covid-19 in pregnancy. So far, across ours and international cases, affected pregnancies were unvaccinated, which makes a strong argument for vaccination in pregnancy,” Ms  O’Donoghue told the Irish Examiner.

“We hope by giving clear information and through closer monitoring of Covid-19-affected pregnancies, we may avoid future deaths.” 

The guidance, from the Institute of Obstetricians and Gynaecologists, states there is no clinical data yet on Omicron and pregnancy.

“(however) it is expected to have the same potential to cause placentitis at least in the unvaccinated population,” the update said.

The guidance, to be published by the HSE, recommends women with the virus be assessed with CTG monitors not just ultrasound scans in later pregnancy.

Risks to baby

Analysis of multiple studies found risks to the baby even when the mother’s Covid infection is mild, the guidance states. The risk of foetal death was found to vary from 0.5% to 2%.

“Since July 2021, the Netherlands has reported 13 stillbirths which are directly attributed to the placenta being damaged by the coronavirus,” it says.

“The researchers describe placental necrosis and inflammation akin to the placentitis described in the Irish and US cases. None of the mothers who had these stillbirths was vaccinated.” 

The studies indicate that stillbirths appear to happen within seven to 21 days of infection.

A recent American report also describes Delta-variant Covid placentitis in two stillbirths where neither mother was vaccinated.

Separate review

A separate review, led by Dr Brendan Fitzgerald, Department of Pathology in Cork University Hospital, examined six cases of stillbirth previously identified in early 2021.

Alpha was the dominant variant between January and May last year. Up to that point, early fears about links between the virus and stillbirths had proved unfounded.

This study focused on one-second trimester miscarriage and six stillbirths in Ireland which were linked to damage to the placenta.

They found Alpha “was associated with an increased risk of foetal death” when compared with the original strain from Wuhan.

This review notes the situation during the Alpha wave is “at odds” with what was seen during 2020.

Three of the women had a low platelet count which the study said may mean this condition could be used as a warning sign.

Meanwhile, yesterday the European Medicines Agency highlighted “growing evidence” mRNA vaccines do not cause pregnancy complications following a review of around 65,000 births.

“The review did not find any sign of an increased risk of pregnancy complications, miscarriages, preterm births or adverse effects in the unborn babies following mRNA Covid-19 vaccination,” the EMA said.

In Ireland the mRNA vaccine from Pfizer is offered to pregnant women.