COVID-19 during pregnancy means 10 times higher risk of ICU admission, Canadian data suggests

When Alex Carnio tested positive for the coronavirus in early August while pregnant with twins, she didn't anticipate how quickly her illness would progress.

The 28-year-old Kelowna, B.C., resident wasn't yet vaccinated, but aside from experiencing a higher-risk pregnancy, she has typically been healthy, with no underlying medical conditions. 

Even so, her initially mild symptoms worsened within days. 

"I started having chest pain, unable to really breathe easily, I started not being able to keep any liquids down," Carnio recalled. "That's when I knew, on about day six, that I needed to go to the hospital."

She wound up hospitalized briefly, went home for a day, then started struggling to just stand up. After heading back to her local emergency department, she was admitted to a COVID-19 isolation ward. 

"I was woken up by a nurse in the middle of the night who said my oxygen was getting a little bit concerningly low, so they put me on oxygen for two days — and that was something shocking to me," Carnio said.

But her experience isn't surprising to Canadian researchers who've been tracking the impact of COVID-19 during pregnancy, with data suggesting people who are pregnant face significantly higher risks of serious illness requiring hospitalization, ICU admission, or life support.

"We know that the infection has an impact both on the health and well-being of mom and the outcome of the pregnancy," said Dr. Wendy Whittle, a maternal fetal-medicine specialist at Mount Sinai Hospital in Toronto.

Higher risk of hospitalization in pregnancy

Whittle co-authored a new briefing document from Ontario's COVID-19 Science Advisory Table, which notes the risks of getting COVID-19 while pregnant include having a higher chance of needing a C-section or having a preterm birth, according to preliminary evidence.

The latest available Canadian data compiled by the Canadian Surveillance of COVID-19 in Pregnancy team (CANCOVID) also suggests people who are pregnant are nearly five times more likely to be admitted to hospital for COVID-19 than their non-pregnant peers — and 10 times more likely to be admitted to an ICU.

"Seven to 15 percent of pregnant individuals with COVID-19 will experience moderate to severe disease requiring hospitalization," the briefing document reads.

The advisory team did note that the increased risk of hospitalization could be explained in part by "a lower threshold" to provide care during pregnancy, meaning pregnant people may be admitted to hospital where a non-pregnant person with the same symptoms would not. But, they stressed people who are pregnant also showed a higher risk of needing mechanical ventilation in various studies, which is "indicative of clinically severe disease."

While both Canadian and international research suggests the bulk of infections during pregnancy are either asymptomatic or mild, Whittle said the higher risks of serious health outcomes are concerning, particularly since pregnant people typically have lower vaccination rates, as seen in data from Ontario and the U.S.

"That makes me absolutely petrified," she said.

WATCH | Why pregnant people are being prioritized for the COVID-19 vaccine:

Why pregnant people are being prioritized for the COVID-19 vaccine

4 years ago

Duration 2:00

Ontario has now joined 3 other provinces in prioritizing COVID-19 vaccinations for pregnant women.

6 pregnant Albertans sent to ICUs in August

In Alberta, which has the largest number of active COVID-19 cases across the country, those fears are already being realized.

An unvaccinated pregnant Alberta woman recently died from a COVID-related infection following admission into an ICU, while her baby was delivered and survived, sources told CBC News.

Provincial officials also announced last week that six pregnant Albertans, all unvaccinated, were admitted to ICUs with COVID-19 in August — a spike in admissions in one month that almost matched the seven seen in the whole first year of the pandemic.

"Not only has COVID had severe impacts on the parents' health, but also the child's," Alberta's chief medical officer of health Dr. Deena Hinshaw said during a press conference last Thursday.

"Five preterm births occurred as early as 29 weeks. If you are pregnant, trying to become pregnant or have recently delivered, please get both doses of the COVID-19 vaccine as soon as possible."

Speaking to CBC News by phone, Calgary-area mom-to-be Meggi Mah said she already got fully vaccinated to protect herself and her baby, and is taking precautions in her day-to-day life, but she worries it's not enough given the surging infection rates.

"It's been an increasingly scary time to be pregnant in Alberta," she said.

Mah added she'd heard the reports of a pregnant woman's death.

"You hope that it's not going to be you," she said. "There's only so much we can do to keep ourselves safe."

Vaccines proving safe, effective during pregnancy

Women's health experts say aside from basic precautions, getting vaccinated is the best way to prevent a serious COVID-19 infection. But navigating whether or not to get a shot has been a fraught process for many Canadian women.

"Even though we have real-life data, and it's very good quality data, that first message that COVID-19 vaccines were not tested in pregnancy is on people's minds," said CANCOVID collaborator Dr. Eliana Castillo, a clinical associate professor with the departments of Obstetrics and Gynecology and Medicine at the University of Calgary.

"And if you add all the inherent fears and uncertainties that are normal to any pregnancy, and the huge amount of misinformation that is in social media, we have just the combination that is very detrimental to moms and babies."

Yet the vaccines approved in Canada and the U.S. have proven both safe and effective during pregnancy, according to scientists and researchers on both sides of the border.

There are multiple large-scale analysis studies showing the effectiveness of vaccines alongside "no concerning safety signals reported among pregnant vaccine recipients," reads the Ontario COVID-19 Science Advisory Table's recent briefing note.

A U.S. Centers for Disease Control and Prevention (CDC) analysis of available data assessed vaccination in early pregnancy and didn't find any increased risk of miscarriage among nearly 2,500 pregnant women who received an mRNA-based vaccine before the 20-week mark.

Previous data from three safety monitoring systems also did not find any safety concerns either for pregnant people who were vaccinated late in pregnancy, or for their babies, according to the CDC.

"We have a vaccine that works in pregnancy, that is safe," Castillo stressed. "And very importantly, that is not only going to keep you safe, but actually we have good evidence that the protection you get will be passed on to your baby."

'I kept worrying'

After contracting COVID-19 last month, Carnio did wind up getting vaccinated, and wishes she'd gotten her shots earlier on. 

But she said making that decision is often tough for pregnant women, who've long heard mixed messaging about what's safe to put in their bodies. And in her case, she had complications early on in her pregnancy that led her to hold off. 

"I looked at my own experience, and the alternative of not getting vaccinated and winding up in a critical care ward in a hospital was a million times worse," she told CBC News during an interview on Tuesday.

Carnio is now staying at a Ronald McDonald House in Vancouver with her family, so she can be close to a large hospital capable of handling a higher-risk delivery if her twins — who are due in December — are born early.

While sitting at a picnic table near the building that she's calling home until her twins hit at least 30 weeks, Carnio said she wanted to come forward with her story to help other pregnant women avoid her harrowing COVID-19 experience.

"Being in that situation isn't something I would wish on anyone, especially if you are pregnant," she said. "I kept worrying: Are the kids inside of me going to be OK?"