Thread by @DrEmilyRSmith

Our new work is out in @GlobalHealthBMJ today. This is the work of dozens of teams across 12 countries. Here we show the clear excess risk associated with COVID-19 in pregnancy. Here’s what we found and how we did it.🧵

gh.bmj.com/cgi/content/fu…

@GlobalHealthBMJ Yes, there are many studies about COVID in pregnancy. But this individual patient data meta-analysis tries to address some limitations & heterogeneity between previously published work. Plus, we include unpublished & re-analyzed data, including substantial data from LMICs. 2/x

We include >13 000 pregnancies in 12 countries & find COVID-19 during pregnancy was linked to big increases in the risk of
▪️maternal mortality,
▪️ICU admission,
▪️mechanical ventilation or any critical care,
▪️ diagnosis w pneumonia, preeclampsia, thromboembolic disease. 3/x

Infants born to infected pregnant women were more likely to be admitted to the neonatal intensive care unit & to be born too small (low birthweight) or too soon (preterm). 4/x

What makes us confident in our results? We have strict exposure definitions, we consistently define outcomes, & uniformly analyze data for each study. Plus we find consistent elevated risks from one country to the next. 5/x

I have so many other methods things to chat about w #epitwitter. (Prospective meta-analysis! Problems w pooling binomial proportions. Value of absolute risks here.) Here’s the protocol paper.

But let’s stick with public health implications for now. journals.plos.org/plosone/articl…

So what’s this all mean? Yes COVID in pregnancy can be serious, but you can take steps to reduce your risk.

First, stay up-to-date on vaccines & boosters. Is it worth it? Yes! Meta-analysis showing benefits of vaccines in pregnancy is linked here. 7/x
nature.com/articles/s4146…

And pregnant people should consider other precautions like wearing a mask when you’re in crowded public places. 😷

If you do get sick, both patients and providers should consider treatment in pregnancy as needed. Anecdotally, pregnant women are undertreated. 💊

Lastly, vaccinations policy in pregnancy remains equivocal in more than 80 countries. Researchers, advocates, and policy makers need to take action to ensure fair access for drugs & vaccines in pregnancy globally.
comitglobal.org/explore/public…

A heartfelt congratulations & thank you to collaborators & steering committee including @uwdrwaldorf @yafshar @DrJustinBrandt @broutet_n @ConryJeanne @FatimaCrispi @crovetto_franci @DrCGale @GratacosEduard
@kalafaterkan_md @Marianfknight
@kirstyledoare @Christoph_Lees @ELokkPhD

Thank you! @ShabirMadh @LauraAMagee1
@whitehead_cl @Raigam_Martinez @MetzTorri
@EmilySMillerMD
@money2_dmoney @ewsmullins
@AlicePanchaud @LionaCPoon @lregan7
@SaninBlair @pvondadelszen @anecdatally
@fouziafarooq01 @skhagayi @MamaDaktari @KEMRI_Kenya