Pregnancy has its own unique challenges and stresses. Throw in a COVID-19 pandemic and the situation becomes even more challenging for pregnant people and their families.
How has information about COVID-19 and pregnancy changed?
Bottom line: We now know that pregnancy is a significant risk factor for COVID-19. Pregnant people are at an increased risk of experiencing severe or critical illness. And if they have severe illness, they are more likely to have pregnancy complications, including pre-term birth and cesarean delivery. Data from the CDC also suggest there may be an increased risk of stillbirth in pregnant people who have COVID-19.
We also know that COVID-19 vaccines are safe during pregnancy and breastfeeding. Vaccines are a critical tool for protection of mothers and babies.
What is known about COVID-19 vaccines during pregnancy and while breastfeeding?
Here's what we know:
- Vaccination during pregnancy reduces the risk of hospitalization, admission to the intensive care unit, or death.
- Vaccination is safe during any trimester of pregnancy. Sooner is better, since it means earlier protection for mom and baby.
- COVID-19 vaccination at any time during pregnancy results in transfer of COVID-19 antibodies to the fetus.
- COVID-19 vaccination during breastfeeding results in transfer of COVID-19 antibodies to babies through breastmilk.
Why were pregnant people not included in the first clinical trials of COVID-19 vaccines?
There's a lot of controversy over why pregnant people weren't included in the trials. A lot of people have since advocated for this group to be included so providers know how to counsel them. Pregnant people are usually excluded from initial clinical trials because people want to protect them, their fetuses, and their children to come. There's controversy whether that's the right approach.
Since then, several studies evaluating COVID-19 vaccines in pregnant people have found the vaccines to be just as safe for pregnant people and their babies as they are for non-pregnant people. The CDC, the American College of Obstetricians and Gynecologists, and the Society for Maternal-Fetal Medicine recommend COVID-19 vaccination for pregnant and breastfeeding individuals.
Are COVID-19 antibodies passed from mother to baby?
Data shows COVID-19 antibodies are passed to the fetus through the placenta from mothers who have either been vaccinated during pregnancy or who were infected with the virus during pregnancy. But babies had higher COVID-19 antibody levels from mothers who were vaccinated during pregnancy. COVID-19 antibodies are also passed to baby through breastmilk. These antibodies may help protect newborns from COVID-19 infection.
Do side effects from COVID-19 vaccines impact pregnant people differently?
Pregnant people have the same side effects from the vaccine as non-pregnant people. They also seem to have the same benefits from vaccination.
However, pregnant people infected with COVID-19 are twice as likely to be admitted to the hospital and to require intensive care compared to non-pregnant people infected with the virus, according to studies. They also have an increased risk of death. Vaccination is a critical tool to decrease these risks.
If someone already had COVID-19 before pregnancy, are they at greater risk of getting infected again during pregnancy?
It's not known if pregnant people are at greater risk of reinfection with COVID-19. We do know that pregnant people are generally more vulnerable to viral infections due to changes to their immune system during pregnancy.
The best protection from reinfection is through vaccination. While it's still possible to be infected after vaccination, vaccines can help reduce the risk of severe disease, hospitalization, and death.
How can pregnant people who decide not to get vaccinated stay safe from contracting COVID-19?
Rigorous mask wearing is encouraged. It's also important to wear a mask that fits well and offers good protection, such as a multi-layer surgical mask, a KN95, or an N95. If these masks are not available to you, any mask is better than none.
Also, continue to practice physical distancing and frequent hand washing. We are all fatigued in this pandemic, but we need to remember that the pandemic isn't over and unvaccinated pregnant people remain at risk.
What are some myths about COVID-19 vaccines and pregnancy?
- There is no "wrong time" to get vaccinated. Vaccination in every trimester of pregnancy is safe. Sooner is better.
- COVID-19 vaccines do not cause infertility or hormone problems. There's no data whatsoever, either theoretically or observationally, that the vaccine impacts fertility or other reproductive functions.
- COVID-19 vaccines do not cross the placenta. Instead, the body makes antibodies in response to the vaccine to help fight off infection. Protective COVID-19 antibodies are then passed to the fetus across the placenta.
- The vaccines do not cause COVID-19. People often experience side effects after getting a COVID-19 vaccine, but this is a normal sign of a person's body building protection. These side effects go away in a few days.
How can a newborn be safely introduced to family members who live outside the household?
There is no single answer to this question. People need to decide for themselves what is right for them and their family. Some people are waiting for the introduction to occur later, or are doing it via Zoom, or at a safe distance outside. Other people are making introductions in an indoor setting while masked and encouraging vaccination.
How do providers help undecided pregnant women make a decision to get vaccinated or not?
There is now strong data that support the benefits of COVID-19 vaccination during pregnancy and breastfeeding. I'm always careful to point out to pregnant patients that they are not weighing risk of vaccination versus no risk. They are weighing risk of vaccination versus risk of COVID-19 infection in pregnancy.
When I talk to pregnant people and their families about vaccination, this is how I approach it:
- I talk about what we know and what we don't know. I emphasize that available data suggests that the risks of vaccination are far less than the known risks of COVID-19 in pregnancy.
- I point out that we all bring different "baggage" to the conversation. I admit my bias as a health care worker who sees the sickest patients with COVID-19. We also acknowledge their experiences and potential biases.
- At the end of the conversation, I make sure that they feel my enthusiasm for protecting them through vaccination. It is one of the things that I can do as their physician to increase the chance of a healthy pregnancy and healthy baby.
- Finally, I reassure my patients and their families that we will support their decision, to vaccinate or not to vaccinate, and continue to take excellent care of them no matter what they decide to do.