Understanding the impact of COVID-19 on pregnancy in Scotland

Public Health Scotland’s Dr Rachael Wood, Consultant in Public Health Medicine, discusses the pioneering work and findings of the ongoing COVID-19 in Pregnancy in Scotland (COPS) study, which seeks to understand the effects of COVID-19 on pregnancy-related issues in Scotland.

Public Health Scotland jointly leads, with the University of Edinburgh, the COPS study (external website) which links health data, including COVID-19 test results and COVID-19 vaccination records, to pregnancy records. This helps us understand the risks of COVID-19 infection in pregnancy and contributes to the growing international evidence confirming the safety and effectiveness of vaccination in pregnancy.

Since the start of the pandemic, 144,548 pregnancies to women in Scotland have been studied and 5,653 confirmed cases of COVID-19 in pregnancy identified. In the most recent month, October 2021, around 1 in 60 pregnant women had confirmed COVID-19 over the course of the month.

Although most pregnant women with COVID-19 experience mild illness, they have a higher risk of severe disease requiring admission to critical care than non-pregnant women of a similar age. Most COVID-19 infections in pregnancy still occur in unvaccinated women. Since the start of the vaccination programme to October 2021, 77% of all infections in pregnancy have occurred in unvaccinated women and almost 100% of COVID-19 infections admitted to critical care were in unvaccinated pregnant women. Vaccination is key to preventing this and can make a real difference in protecting against severe COVID-19.

Unfortunately, there is also increasing evidence that COVID-19 infection in pregnancy can be very serious for the baby as well as the mother. To date, we have identified 684 babies who have been born within 28 days of their mother having COVID-19 during pregnancy. The rate of stillbirth or neonatal death among these babies was 20.5/1,000 births (14/684) which is considerably higher than the 6.3/1,000 births usually seen in Scotland.

We routinely monitor the outcomes of babies following maternal vaccination in pregnancy, and have confirmed that there is no evidence of an increased risk of stillbirth or neonatal death following vaccination. Despite these facts, only 43% of women who delivered their baby in October 2021, had received any COVID-19 vaccination before delivery. This in stark contrast to the 85% uptake of any COVID-19 vaccination in all women aged 18 to 44 years for the same period.

It is essential that we address this gap; vaccination is the safest and most effective way for women of all ages and backgrounds to protect themselves and their babies against COVID-19 infection.

Women should take confidence knowing that organisations representing doctors and midwives who care for pregnant women strongly recommend vaccination in pregnancy (external website). Furthermore, the Joint Commission on Vaccinations and Immunisations (JCVI) – an independent expert group who advise the United Kingdom health departments on vaccine safety – recommended on 16 December 2021 that pregnant women should be included among the groups considered particularly vulnerable to COVID-19, and therefore should be prioritised for vaccination (external website).

I therefore strongly encourage all women who are pregnant, or planning to become pregnant, to ensure they are fully vaccinated as soon as possible.

If you have not yet received your first or second vaccination, you can attend a drop-in clinic (external website), call 0800 030 8013 to book an appointment or register to receive your first dose (external website).

If you have had your first two doses, you can get a booster dose from 12 weeks after your second dose. You can book an appointment online (external website) to receive your booster or by calling 0800 030 8013.

More information about COVID-19 infection and vaccination in pregnancy, including links to helpful leaflets, is available on the NHS Inform website (external website).

Results from the COPS study are regularly published in the Public Health Scotland COVID-19 Weekly Statistical Report.