324 - Increased numbers of COVID-19-related maternal and neonatal deaths during the Delta wave of SARS-CoV-2 infection in the United Kingdom

Poster Number: 324
Publication Number: 324.439

Chris Gale, Imperial College London, London, England, United Kingdom; Marian Knight, University of Oxford, Oxford, England, United Kingdom; Maria Quigley, University of Oxford, Oxford, England, United Kingdom; Alessandra Morelli, University of Oxford, National Perinatal Epidemiology Unit, Oxford, England, United Kingdom; Shohaib Ali, Imeprial College London, London, England, United Kingdom; Don Sharkey, University of Nottingham, Nottingham, England, United Kingdom; Cora B. Doherty, Cardiff University, Vale of Glmaorgan, Wales, United Kingdom; Elizabeth S. Draper, University of Leicester, Leicester, England, United Kingdom; Jennifer J. Kurinczuk, National Perinatal Epidemiology Unit, University of Oxford, Oxford, England, United Kingdom; Helen Mactier, NHS Greater Glasgow and Clyde, Bearsden, Scotland, United Kingdom

Background: Where COVID-19 vaccine coverage is high SARS-CoV-2 related mortality has generally decreased compared to earlier waves of infection despite evidence of higher transmissibility and more severe disease with the Delta variant. Pregnant women were excluded from early COVID-19 vaccine trials and changing vaccination recommendations have resulted in vaccine hesitancy and relatively low vaccine uptake in pregnancy

Objective: We compared maternal and neonatal SARS-CoV-2 related mortality across three periods corresponding to the dominant variant in the UK: 1 March 2020 to 30 November 2020 (‘wildtype’), 1 December 2020 to 15 May 2021 (Alpha), 16 May 2021 to 31 October 2021 (Delta)

Design/Methods: Between 1 March 2020 and 31 October 2021 prospective data were collected on all pregnant women admitted to hospital with confirmed SARS-CoV-2, hospitalised neonates with SARS-CoV-2 and babies admitted for neonatal care born to mothers with COVID-19, through the UK Obstetric Surveillance System and British Paediatric Surveillance Unit respectively; national surveillance of maternal and perinatal deaths continued through MBRRACE-UK. Neonatal deaths were attributed directly to SARS-CoV-2 if the treating paediatrician reported that SARS-CoV-2 contributed to the baby’s death, and indirectly if maternal SARS-CoV-2 infection was reported to have contributed to neonatal death. Vital registration of live births in 2020 were used as denominators for estimating rates

Results: There were 37 deaths among UK women who acquired SARS-CoV-2 infection during pregnancy or within six weeks after pregnancy, including 3 deaths assessed to be unrelated to SARS-CoV-2 infection. Of the remaining 34, 7 died in the wildtype period, 10 in the Alpha period, and 17 in the Delta period respectively. 15 of 17 women (88%) who died in the Delta period were known to be unvaccinated, no women who died were double vaccinated. There were 7 neonatal deaths related to SARS-CoV-2 infection. 3 babies died after extreme preterm birth related to maternal COVID-19 (1 Alpha, 2 Delta), 1 death during Delta was attributed to neonatal SARS-CoV-2 infection and 3 others (all Delta) were attributed to both maternal and neonatal infection. No mothers of babies who died were known to be vaccinated.Conclusion(s): Using population level surveillance data we describe maternal and neonatal deaths directly and indirectly attributable to SARS-CoV-2 infection during three pandemic periods. Although absolute numbers of maternal and neonatal deaths are low, these data suggest increased mortality in both pregnant and postpartum women and neonates associated with the Delta period
Maternal and neonatal mortality in association with SARS-CoV-2 infection in the United Kingdom, 01/03/2020-31/10/2021*Data for 2020 used to estimate live births in 2021 which are not yet available