The Centers for Disease Control and Prevention (CDC) recently released a health alert recommending urgent action to increase coronavirus disease (COVID-19) vaccination among people who are pregnant, were recently pregnant or are trying to become pregnant now or in the future.
Approximately 31 percent of pregnant individuals have been vaccinated against COVID-19, with rates varying by race and ethnicity, according to the alert. The highest vaccination rate is among Asian individuals and is 45.7 percent, with lower rates occurring among Latinx and Black individuals, with rates of 25 percent and 15.6 percent, respectively.
"Through Sept. 27, there were more than 125,000 confirmed cases of COVID-19 in pregnant people including more than 22,000 hospitalized and 161 deaths; of which, 22 deaths occurred in the month of August alone," according to the alert. "Cases of COVID-19 in symptomatic, pregnant people have a two-fold risk of admission into intensive care and a 70 percent increased risk of death."
Justin Brandt, an assistant professor in the division of maternal and fetal medicine at the Rutgers Robert Wood Johnson Medical School, said the CDC now directly recommends vaccination in pregnant and lactating individuals, which is based on accumulated evidence suggesting the vaccine is safe for those populations.
“This alert and the statements of other professional societies now recommending (COVID-19) vaccination in pregnancy may help some people feel more comfortable getting the vaccination, but it also lends support to strengthen the guidance of doctors and advanced care clinicians who continue to talk about the safety profile of the vaccine with pregnant patients,” he said.
Reynold Panettieri, vice chancellor for translational medicine and science, said the data recently made available shows that the CDC’s recommendation should be followed, especially due to the increased virulence of the delta variant, which poses a significant risk to pregnant and lactating people.
Although he wishes the recommendation could have been made sooner, Brandt said that it took time for the CDC to feel confident in the data from pregnant and lactating people receiving the vaccine, especially since pregnant people were excluded from early research.
“Early in the pandemic, the risks/benefits discussion was informed by an incomplete understanding of risks in pregnancy,” he said. “Even though the vaccine platform had a theoretical safety profile that was reassuring for pregnancy, the exclusion of pregnant people from early research and vague guidance from professional societies resulted in many people worrying about exaggerated risks.”
Brandt said that other factors that contributed to low vaccination rates for pregnant people included misinformation and the worry that vaccine developers took shortcuts to expedite the approval of the vaccine.
“Even though we are living through a pandemic and the delta variant (is) so infectious, many people have not seen the catastrophic effects of (COVID-19) that have killed so many people, including many young people without significant medical problems,” he said. “All of this has led to a real sense of ambivalence, where many pregnant people incorrectly think that the risks of the vaccine in pregnancy are greater than or at least comparable to the risks of (COVID-19) in pregnancy.”
Panettieri said that COVID-19 vaccine coverage has also remained low for pregnant individuals because there has traditionally been a stigma behind taking any medication during pregnancy.
Brandt said he spends a lot of time talking with patients about the COVID-19 vaccine, which he said was created quickly by developers in order to prevent more infections and deaths, and has been shown through several studies to demonstrate its safety and effectiveness.
He said the data shows that the vaccine does not cause birth defects, miscarriages or other birth complications, and does in fact prevent most virus infection and almost all cases of severe illness. In addition, he said that healthcare professionals are also now much more comfortable with recommending COVID-19 vaccination.
Meredith Civico, Rutgers field hockey head coach, was one of many women who discovered she was pregnant during the pandemic and had to face the decision of whether or not to receive the vaccine.
“I did not get vaccinated while pregnant,” she said. “My doctors at the time recommended that I wait until I delivered just because they didn’t have a lot of information yet on patients who were pregnant and getting vaccinated.”
Since she wasn’t working in a healthcare profession where she was immediately at risk for virus exposure, Civico said that she chose to wait until after delivery and received her first dose about two weeks after giving birth in April.
Brandt said that pregnant individuals who are still hesitant about getting the vaccine should speak with their doctors, who will likely recommend receiving the vaccine due to the overwhelming evidence in its favor.
He said that he encourages his own patients to stop avoiding vaccination by waiting for the pandemic to be over, especially since COVID-19, like other respiratory diseases, is particularly harsh to pregnant people, even those without other medical complications.
“It’s clear that there really are just two options: vaccination or natural infection,” Brandt said. “The former is much preferable in pregnancy and lactation.”
Both Panettieri and Brandt expressed their support for pregnant people to receive both doses of the vaccine as soon as possible. Brandt said that vaccination is the fastest way to restore normalcy to people’s lives.
“We are all part of the global ecosystem, and reaching herd immunity is the best strategy to protect individuals who are immunocompromised or who have real contraindications to vaccination,” he said.