Thread by @FionaMattatall

This morning's grand rounds were an update from University of Calgary Reproductive Infectious Diseases (Drs. Kuret and Castillo)
This was a comprehensive review of both Canadian data on #COVID19 cases in #pregnancy and #COVIDVaccines in pregnancy
... wanted to share some of it 🧵

Cases of COVID-19 in pregnancy across the country 👇🏻
(note that the data lags in some provinces more than other)

So far Alberta and Manitoba have the highest rates of COVID-19 infection in pregnancy - these numbers are expected to shift as we see provincial differences in case numbers and vaccination

And timely @SOGCorg statement yesterday 👇🏻
As a reminder, pregnant patients are not treated equally across the country when it comes to vaccination.
Keep following along to see why we need to prioritize this vulnerable population..

https://twitter.com/SOGCorg/status/1383043770195804169?s=20

Back to Alberta data, hot off the presses from yesterday, this is how our cases break down by zone.
Calgary has the most cases (boy do we know it) and just over half are still pregnant.

Putting this in perspective, you can look at health zone cases for the overall AB population 👇🏻
This is the work of @CBCFletch (he has tirelessly been helping us understand the data by translating to visuals through the pandemic cbc.ca/news/canada/ca…)

The Reproductive Infectious Diseases team here at @UCalgaryMed have been tracking all cases of COVID-19 in pregnancy from the beginning of the pandemic.
Looking at the numbers over time we see a familiar trend 📈
(Dr. Kuret noted that the last data point is incomplete)

This certainly mirrors population data presented by @CBCFletch (pay attention to the reproductive ages in his graph)

Now to look at complications related to COVID-19 infection:
Preterm birth is higher.
Thankfully we aren't seeing many cases of extreme preterm birth.
Early review of the data shows ~ 40% of these were iatrogenic.

Note: background rate of preterm birth in AB is 8%

This is what scares us 👇🏻
Canadian data shows that being pregnant increases your risk more than 5 times of needing hospitalization or ICU level of care

My own editorial note:
We all have many questions on other possible complications of COVID-19 infection in pregnancy.
The data is emerging in real time and most of it we will only know in retrospect.
I am so grateful for my academic colleagues who are collecting what they can.

As a reminder, the symptoms of COVID-19 infection in pregnancy are not that different from non-pregnant patients 👇🏻

Onto vaccines...
I included a few slides as much of the deep dive into the data would likely not interest most of you (and the rest of you already know the data)
mRNA vaccines are the most studied to date.
Pfizer and Moderna elicit an immune response just like non-pregnant people

One of a number of small studies (n=131), but this is what we have and what is guiding our experts.
Fortunately we are seeing studies like this repeated with data that confirms current understanding.
Again, so grateful for the researchers and patients for their data.

Important data on vaccine safety 👇🏻
To date over 4k patients enrolled in safety monitoring (cdc.gov/coronavirus/20…)
Great that we are not seeing increased risk in pregnancy outcomes for vaccinated patients!

There was a lot of discussion on the well publicized risk of blood clot with the viral vector vaccines (AstraZeneca, J&J)
This was an interesting perspective balancing risk of harm with COVID-19 infection and risk of vaccine with respect to clot (non-pregnant data)

So we don't have data on pregnancy and VITT/VIPIT risk but consider that in pregnancy:
- similar condition HIIT is rare
- cerebral thrombosis is higher risk in pregnancy
... so in theory hard to know if the risk would be higher for VITT/VIPIT for pregnant vs. non-pregnant patient

We offer 2 other vaccines (influenza and Tdap) in pregnancy and timing of vaccines should be considered.
This is based on expert opinion as there is no data to guide us:
- 2 weeks after other vaccine for COVID-19 vaccine
- 4 weeks after COVID-19 vaccine for other vaccine

Audience questions:
Which pregnant patients are at risk of complications from COVID-19?
Alberta data shows:
1. age over 35
2. diabetes (pre-existing or gestational)
3. hypertension

(so pretty much all of my patients)

Like everything this is a risk/benefit discussion...
Risk of exposure to COVID-19
Paucity of data on first trimester exposure (both infection and vaccine exposure)
Benefit of gaining protection from infections

Short answer: YES!

Thanks for following along!
If you made it this far, you may want to check out these resources:
🇨🇦sogc.org/en/-COVID-19/e…
🇺🇸cdc.gov/coronavirus/20…
🇬🇧rcog.org.uk/en/guidelines-…