More pregnant people in the US died of COVID in August than in any other month in the pandemic, the Centers for Disease Control and Prevention said Wednesday in a recommendation for “urgent action.” The CDC recommends pregnant people, those who were recently pregnant, people who are breastfeeding and everyone who wants to be pregnant in the future get a COVID-19 vaccine. The agency cites data that shows an increased risk for death from COVID-19 and pregnancy complications, which include preterm birth and ICU admission for newborns.
Only 31% of pregnant people in the US were vaccinated as of Sept. 18, according to the CDC. And while the total risk of death remains low, pregnant people have a 70% increased risk of dying from symptomatic COVID-19 compared with people who aren’t pregnant. Of pregnant people being hospitalized either from COVID-19 or labor and delivery, 97% weren’t vaccinated, the agency said.
The alert from the CDC comes about two months after it made an official recommendation that pregnant people get a COVID-19 vaccine, because of initial data showing that vaccines are safe in pregnant people and those who are breastfeeding. This is in line with recommendations from other agencies that serve pregnant people, such as the American College of Obstetrics and Gynecology and the Society for Maternal-Fetal Medicine.
Health officials have repeatedly said that COVID-19 vaccines do not hurt fertility, and continue to recommend that people get vaccinated against the coronavirus before trying to get pregnant.
The benefits of a coronavirus vaccine outweigh the risks for both the parent and the fetus and infant, the CDC said. Although vaccination in general among pregnant people remains low compared to the rest of the adult population, the newest CDC report found that there are “significant disparities” in vaccination coverage in different races and ethnicities that should be addressed.
But advice for pregnant people trying to make decisions about vaccines hasn’t always been so loud. Pregnant people are often left out of medical studies, so when vaccines initially became available to protect against COVID-19, pregnant people were absent from the early studies. While the COVID-19 pandemic has shone some light on pregnant and breastfeeding people’s age-old status as “vulnerable,” the lack of data collected about pregnancy in the clinical trials of may have left you sifting through conflicting advice on how best to protect you and your child. As new data emerges and illustrates how pregnancy increases risk of COVID-19 disease for parents, which also puts their child at risk, here’s what we know about COVID-19 vaccines in pregnancy.
I’m pregnant. Should I get the COVID-19 vaccine?
The CDC made its official recommendation in August that, yes, pregnant people, breastfeeding people and those who want to be pregnant in the future should get a COVID-19 vaccine. The ACOG and SMFM also recommended COVID vaccines for pregnant people at the end of July after reports from “tens of thousands” demonstrated the safety of COVID-19 vaccines in pregnancy.
Other vaccines are recommended or offered during pregnancy. Some vaccines, for other diseases, aren’t recommended for pregnant women because they contain (very small amounts) of a live virus. None of the coronavirus vaccines available in the US use a live virus.
Will the side effects be different?
Preliminary data on about 35,000 pregnant people who were vaccinated and volunteered information through the v-safe program shows that pregnant people have the same vaccine side effects as nonpregnant people — temporary injection pain in the arm, fatigue, headache, muscle aches and fever.
However, it’s important to note that fever from any cause has been associated with adverse pregnancy outcomes, and the CDC recommends pregnant people who experience fever after vaccination take acetaminophen to lower their body temperature.
Why are pregnant people at a high risk of COVID-19?
In May, I talked to Dr. Ella Speichinger, an OB-GYN at University of Missouri Health Care. She said it isn’t exactly known why pregnant people are at a higher risk, but that it may be because pregnant people’s immune systems are naturally depressed so their bodies don’t reject the growing fetus, or because pregnancy could alter the body’s way of mounting an immune response to COVID-19.
“I’ve had many patients who have had COVID while they were pregnant, and they’ve been just fine,” she said. “But there have definitely been severe cases where patients had to get delivered early because they could no longer oxygenate their fetus.”
In these cases, Speichinger said the patients usually improved after giving birth, but that it was delayed. It’s also impossible to know who will have a bad reaction to COVID-19 while pregnant.
“It’s really unclear who of the healthy pregnant cohorts is going to be the one that gets sick,” she said.
I’m skeptical of the vaccine. What are the risks of getting COVID-19 while pregnant?
Pregnant and recently pregnant people are at higher risk of severe illness from COVID-19, including death, according to the CDC, and they’re also at increased risk for preterm delivery (birth before 37 weeks) and other adverse pregnancy outcomes.
Although there is information available now about how risky COVID-19 can be for pregnant people, that wasn’t necessarily the case at the beginning of the pandemic, and pregnant people were not highlighted specifically as “high risk.” Speichinger said that is likely because people who get pregnant are usually generally healthy and under age 40.
The CDC says pregnant people are twice as likely to get admitted to the ICU with COVID-19, and have a 70% increased risk of dying from the disease if they have COVID-19 with symptoms compared to people who aren’t pregnant.
During what trimester should I get the vaccine?
Scientists who looked at people who got vaccinated earlier than 20 weeks pregnant didn’t find an increased risk of miscarriage compared to those who didn’t, according to a report from the v-safe pregnancy registry. Earlier data that was available reflected vaccination during the later stages of pregnancy.
Some people holding out on getting vaccinated during the first trimester may be due to the naturally high rate of miscarriage in the first three months, and patients being more cautious because of that. About 10% of known pregnancies end in miscarriage, according to the ACOG, but the risk also increases with age. About 80% of miscarriages happen in the first trimester.
“Most people feel concerned in the first trimester because there’s such a high risk of miscarriage in general,” Speichinger said. “Conflating the miscarriage with vaccine administration is what leads to vaccine hesitancy in the first trimester.”
Research shows that parents vaccinated during the third trimester of pregnancy may pass antibodies onto their newborns.
What if I’m breastfeeding?
“If a woman is uncomfortable doing it while pregnant, I absolutely think getting it while she’s breastfeeding is a good idea,” Speichinger said. “Because all of those antibodies can then cross through to the milk and protect baby while the mom is still producing those antibodies.”
There’s not enough data to show how long that protection lasts, but the CDC reports that breastfeeding people who have received an mRNA vaccine produce COVID-19 antibodies in their breast milk. In a small study on lactating health care workers who received a mRNA vaccine while breastfeeding, researchers from the University of Florida found that their breast milk had a “significant” amount of antibodies.
In its latest report, the CDC made a strong recommendation that breastfeeding people and those who were recently pregnant get a COVID-19 vaccine.
Does the vaccine type matter?
Moderna and Pfizer’s are mRNA vaccines, which use a new technology that delivers instructions to our immune systems on how to make protective proteins. Johnson & Johnson’s, the third vaccine available for emergency use in the US, uses viral vector technology by delivering a harmless virus into our bodies that triggers an immune response. Viral vector vaccines, notably the Ebola vaccine, have been studied in pregnant and breastfeeding people with no adverse effects found, according to the CDC.
The early research available now shows that mRNA vaccines are safe for pregnant women, and that miscarriage rates among women who received a COVID-19 vaccine are similar to miscarriage rates of women who didn’t get vaccinated. In a v-safe survey of 827 pregnant women who got a COVID-19 vaccine, about 14% experienced pregnancy loss — within the range that is naturally expected.
After the Food and Drug Administration lifted the pause that had been placed on Johnson & Johnson after reports of blood clots (the CDC identified 28 cases out of 8.7 million people vaccinated with Johnson & Johnson, the majority of them in women), the CDC issued a statement that women under age 50 should be aware of their increased risk of this still rare, but serious form of blood clots, and consider the other vaccines that don’t carry this risk. Given the demographic of the blood-clotting risk, Speichinger said her bias would steer her pregnant patients toward a Pfizer or Moderna vaccine.
“I still think the risk is exceedingly rare compared to the complications of COVID,” she said. “But if you had a choice, I would pick one of the other two.”
I want to be pregnant in the future. Will the COVID-19 vaccine make me infertile?
The fear people have regarding their fertility and vaccination isn’t exclusive to the COVID-19 vaccine, but that’s a conversation for another time. The specific fear about infertility and COVID-19 vaccines stems from a now-debunked post on Facebook that claimed the vaccine would make pregnant people’s bodies attack a protein needed for placenta formation in early pregnancy, because the spike protein in the COVID-19 vaccine is “similar.” Experts have disproved this, saying that not only do the two proteins have “almost nothing in common,” but even if they did, infection with COVID-19 would have the same outcome. There is no research to suggest people who have had COVID-19 will have a more difficult time getting pregnant, and many have since the beginning of the pandemic. Additionally, many people have become pregnant since getting vaccinated against COVID-19.
Speichinger said she “cannot think of a theoretical reason” COVID-19 vaccines would cause infertility, and many of her pregnant patients have received a vaccine. The only fertility advice she offers is that if you’re hesitant about getting a vaccine while pregnant, you should try to get fully vaccinated before you become pregnant.
“Delaying a cycle is absolutely worth it,” Speichinger said.
The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a physician or other qualified health provider regarding any questions you may have about a medical condition or health objectives.