Pregnancy is often a time of sweet anticipation. But the ongoing pressure to make the right decisions for the health and well-being of both the pregnant person and the unborn child tempers this excitement.
And undoubtedly, the decision-making around COVID-19 vaccination adds another layer of stress.
The relative novelty of COVID-19 in our lives, fear of the unknown and abundant misinformation often complicate these decisions. Advice comes during pregnancy from many directions, including well-meaning friends and family, and sometimes even from strangers. It’s worth noting that the decisions a person makes during pregnancy stem from the desire to avoid doing anything that could cause complications in the pregnancy or be harmful to the fetus.
At the same time, it is also important that a parent do everything possible to protect the well-being of the pair.
In making the decision about getting vaccinated against COVID-19, pregnant people must consider the potential risks of the vaccine, as well as any potential harm from becoming infected with SARS-CoV-2, the virus that causes COVID-19. These two sides of the same coin are important in the discussion and the ultimate decision the patient makes.
Simply avoiding action is not the answer. Each pregnant person should carefully consider the decision and not passively accept doing nothing as the safer option, since the choice to do nothing is likely a choice to accept the risk of preventable harm.
COVID-19 has caused serious illness requiring hospitalisation in over 30,000 pregnant people in the United States, with 292 deaths as of mid-March 2022. The risk for severe disease is higher in pregnancies that are complicated by advanced age, high body mass index, hypertension and diabetes.
Pregnant people infected by COVID-19 are three times more likely to need critical care than people who aren’t pregnant. Death is rare in pregnant people, but COVID-19 causes a significant increase in that risk.
Health disparities have become more evident during the pandemic. Black and Latino populations have disproportionately experienced COVID-19 infection, serious illness and death.
This disparity remains in pregnant people, with the infection rate in pregnant Latino people nearly twice that of white counterparts. Vaccinations to protect against serious illness from COVID-19 are recommended for all pregnant people or those considering pregnancy by leading health organisations, including the Centers for Disease Control and Prevention, the American Academy of Family Physicians and others.
The mRNA vaccines developed by Pfizer and Moderna are recommended for people who are pregnant in an initial two-dose series followed by a booster immunization five months later. The immunity produced has been shown to reduce severity of illness, pregnancy complications, stillbirth and maternal death.
Additionally, vaccination during pregnancy provides important protection for newborns. Pregnant people who are vaccinated pass antibodies in blood through the umbilical cord to the fetus, and this has been shown to provide protection from serious illness from COVID-19 for the newborn for up to six months.
The ripple effects of COVID-19 go well beyond the person with the infection, particularly in pregnancy. It’s clear that the vaccine can help prevent serious illness in pregnant people and that it is one way to prevent newborns from going home without their mothers, either temporarily or permanently.
