Answering questions about pregnancy and COVID-19

pregnancy vaccination

On Sept. 29, 2021, the Centers for Disease Control and Prevention (CDC) issued a health advisory urging people who are pregnant, lactating or may become pregnant to get vaccinated for COVID-19. As of Oct. 2, only 33% of pregnant people in the U.S. are fully vaccinated, despite being at higher risk for severe illness and death due to COVID-19 than people who are not pregnant.

To explain the benefits of COVID-19 vaccination and dispel common myths, Jodie Guest, professor and vice chair of the department of epidemiology at Emory’s Rollins School of Public Health, spoke with Denise Jamieson, professor and chair of the department of gynecology and obstetrics at Emory University School of Medicine. Jamieson is also chief of gynecology and obstetrics for Emory Healthcare and advises the American College of Obstetricians and Gynecologists (ACOG) on its guidelines for obstetric-gynecologic (OB-GYN) care during the pandemic.

Their conversation is part of an online video series hosted by Guest, who also leads the Emory COVID-19 Outbreak Response Team, addressing topics related to the COVID-19 pandemic. Watch the full conversation here.

Q: How does COVID-19 affect pregnant people?

A: Pregnancy is a risk factor for severe disease due to COVID-19, says Jamieson. Pregnant people with symptomatic illness are two times more likely to require intensive care unit admission or invasive ventilation for COVID-19 than people with symptomatic illness who are not pregnant.

Pregnant individuals also face a 70% increased risk of death from COVID-19. As of Oct. 6, there have been more than 22,000 hospitalizations and 171 deaths among pregnant people with COVID-19 in the U.S, says Guest.

We also have increasing accumulated evidence about adverse pregnancy outcomes, Jamieson says. Evidence shows that COVID-19 infection is associated with increased risks of complications such as preeclampsia, preterm birth and stillbirth.

Q: How does COVID-19 affect fetuses and newborns?

A: Although rare, there is evidence that COVID-19 can pass from pregnant person to fetus. Most viruses can be transmitted during pregnancy, so it’s no surprise that there were case reports of transmission from pregnant persons to their fetuses, Jamieson says. Luckily in the case of COVID, this seems to be relatively rare for a variety of reasons, including the fact that the virus does not tend to circulate in the blood stream at high levels.

While there is no evidence of the virus causing birth defects, Jamieson says that COVID-19 infection does indirectly affect the fetus because of the increased risks of preterm birth, stillbirth, low birth weight and preeclampsia.

Q: Are COVID-19 vaccines safe for pregnant people?

A: Pregnant people were excluded from COVID-19 vaccine trials, so there was limited information about the safety of COVID-19 vaccines during pregnancy when shots first became available. Public health officials now have much more safety data.

It’s amazing how much we’ve learned about the safety of the vaccines since they were first available, Jamieson says. In the U.S., over 160,000 pregnant persons have been vaccinated and have registered for v-safe, the CDC surveillance system for pregnant people. Based on data from v-safe and other national and global vaccine surveillance systems, there are no indications that the vaccine is not safe for pregnant individuals.

CDC, ACOG and other health agencies worldwide have now updated their recommendations to strongly urge COVID-19 vaccination for people who are pregnant. According to CDC data, only 31% of pregnant people have been vaccinated against COVID-19 and vaccination rates vary markedly by race and ethnicity, Guest says.

Q: What other vaccines are safe for pregnant people?

A: Vaccination recommendations for pregnant people are not new. We’ve got decades of information about vaccines in pregnancy, Jamieson says, noting that the U.S. surgeon general first recommended influenza vaccination for pregnant people in 1960.

Along with flu vaccines, health care providers routinely administer tetanus, diphtheria and pertussis (Tdap) vaccines during pregnancy. These can be administered at the same time as a COVID-19 vaccine.

Q: What are some common myths about COVID-19 vaccination and pregnancy?

A: The number one myth that I hear is that the COVID vaccine causes infertility, Jamieson says. There is no evidence that any vaccine currently available causes infertility.

Another common myth is that COVID-19 vaccines cause an increased risk of miscarriage. Jamieson says this is not true. I know of no vaccines that cause an increased risk in miscarriage, she says.

There have been some claims of a potential association between COVID-19 vaccination and menstrual pattern changes. The federal government is now funding studies to more closely investigate a potential link. Jamieson notes that menstrual patterns may be affected by many factors, such as stress, weight changes, infections and chronic diseases.

Q: Should people who are considering pregnancy get vaccinated?

A: The best time to get vaccinated is as soon as possible. For persons who are considering pregnancy, we would recommend that you have a visit with your OB-GYN or other care provider and really plan for the pregnancy, Jamieson says. Part of that planning would be to ensure that all your vaccinations—including COVID—are up to date. This ensures that you will be maximally protected prior to pregnancy.

Q: Should people who live and work with pregnant people be vaccinated?

A: Individuals who are around a pregnant person should be vaccinated for COVID-19. Not only are you protecting the pregnant person and the baby, but you’re helping drive down transmission, which will ultimately get us out of this pandemic, Guest says.

People who are around infants should also be vaccinated. Once that baby is born, that infant is more vulnerable to severe disease compared to older children, and they’re too young to get vaccinated, Jamieson says. It’s really important that those around the baby who are going to be interacting with the baby are also protected against influenza, Tdap, and—importantly—COVID.

Q: What is your message to pregnant people who are still undecided about COVID-19 vaccination?

A: As an obstetrician, I can understand the reluctance of people to take medications or receive injections during pregnancy. It’s a time when pregnant people want to do everything possible to protect their baby, Jamieson says, adding that people often make sacrifices during pregnancy such as reducing caffeine intake, eating healthier, and avoiding certain over-the-counter medications.

They really want to do everything possible for their baby, and I think it’s really important to realize that not getting vaccinated has important risks. We’re living in an unprecedented time. There are more deaths now from COVID than the 1918 influenza pandemic, and there are places like Alabama where deaths exceeded births for the first time in 2020.

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