- COVID-19 in Pregnancy: What’s the Risk to Mom and Baby?
- COVID-19 Vaccination in Pregnancy
- Protecting Yourself from SARS-COV-2 Infection in Pregnancy
Pregnancy is already a time of heightened concern and sense of responsibility – after all, we know that what we do has an impact on our own health – and our baby’s development, growth, and health. Certainly, for women around the globe, COVID-19 has added multiple new layers of concern, worry, and questions on so many aspects of healthcare and mothering: whether it’s safe to get pregnant during this time, where to have your baby (i.e., home vs. hospital), whether to get the vaccine, how much should you worry, should you be around friends and family while you’re pregnant, what about after baby is born?
During pregnancy we’re also fiercely protective of our health and naturally seek answers. It’s not easy to gain clarity when you're inundated with an overwhelming number of opinions about what you should or shouldn’t do, and information about variants, long-haul COVID-19 symptoms, the vaccine, and rumors about infertility or whether you can have a miscarriage just from standing near someone who got vaccinated (I’ll put that one to rest right now – no, you cannot).
And the data is constantly changing as new information emerges. In fact, this is why I am now updating the popular article I wrote on COVID-19 in pregnancy early in the pandemic; much has changed in the year plus since this virus made its presence known on our planet.
Making such significant decisions – and one that neither midwives and medical doctors nor pregnant women have had to deal with before – is a tough position to be in, and I know it can be scary. So, here’s what I’ll say first, before we delve into the science, that will hopefully bring you some comfort: Compared to last year this time, when I first published an article on COVID-19 in pregnancy, we know a whole lot more about this virus, how to protect ourselves, and about how to navigate pandemic life while pregnant. And I will continue to update the information I bring to you, as new information arises.
Let’s take a close look at what we’ve learned, starting with the biggest concern – contracting Covid-19 in pregnancy.
COVID-19 in Pregnancy: What’s the Risk to Mom and Baby?
At the beginning of the COVID-19 pandemic, when data was limited and it was all so new, it appeared that very few pregnant women were getting the virus compared to the general population; and when they did get it, they were getting mild cases that generally did not require intubation, the ICU, etc. The CDC’s official statement at the time was that the risk for pregnant women seemed to be the same as for non-pregnant women, or possibly even less, and many of us in maternal health care breathed a tremendous sigh of relief. When I first wrote about this issue, I cited a small Lancet study on 9 pregnant women in China – the only study available at the time – who experienced only mild to moderate symptoms and went on to have healthy babies, which was reassuring to hear. The initial data led to a huge, collective exhale among maternal care providers, with even the most atheistic whispering “Thank God.:
Now, two years, several variants, and nearly 500 million worldwide COVID-19 cases (and nearly 6 million deaths) later, we're all living in whole new “COVID-19 landscape: and there’s a lot more data to work with. For one, many more pregnant women have contracted SARS-COV-2, and have had asymptomatic and symptomatic COVID-19 cases. Additionally, a full-term pregnancy is a 10-month affair — we’ve gotten far enough out to many women from conception through birth and postpartum to get a good bead on the longitudinal impact, at least short term, on pregnancy, birth, breastfeeding and newborns. We've also now got substantial comparative outcomes data on vaccinated and non-vaccinated pregnant women. And finally, comprehensive monitoring and reporting efforts have been up and running for some time now, assessing the impact of the SARS CoV-2 virus in pregnancy, along with a sizable number of published research from around the world.
Even before COVID-19 was on the horizon, it was well-known that pregnant women are more susceptible to developing severe complications should they get the flu or, for example, H1N1, than are non-pregnant women, and this risk goes up for those who have co-morbidities such as asthma, diabetes, or heart disease. With COVID-19, while initial data was so reassuring, in recent months, a less rosy picture has emerged, and it seems that while pregnant women are not more likely to get COVID-19, and that very few pregnant women who contract the virus get very sick, just like with other viruses like the flu of H1N1, pregnant women who do get sick from COVID-19 can become very seriously ill – more so than was initially observed. We’ve also seen that COVID-19 can cause a small but still significant increase in pregnancy complications. more than had initially been anticipated based on early observations. As a result, the CDC has revised its official recommendations to include pregnancy as a risk factor for severe COVID-19.
So while COVID-19 doesn’t specifically target pregnant women – like for example, the Zika virus that can lead to birth defects – we know now that that COVID-19 increases the risk of pregnancy complications and that being pregnant increases the risk for a severe case of COVID-19, particularly in women with co-morbidities. Without sugar-coating it, it’s also important to put risk into perspective.
When discussing risk, it’s important to look at actual numbers and percentages because, more often than not, they create a perspective that is far less terrifying than clickbait headlines would lead us to feel. What is often being discussed when risk is talked about in medical reports is generally something called “relative risk.” This is a comparison between two groups of people, or the same group of people, over time. Absolute risk is the number of people experiencing an event in relation to the population at risk. So, for example, while the results of one study were reported as COVID being associated with a 25-fold increased risk for mechanical ventilation, just 1.3% of women with COVID in that study were intubated. While that's still more than would otherwise be intubated without COVID-19, it's a low number, whereas a 25-fold increase sounds enormous.
While it’s clear that a COVID-19 infection increases the risk compared to no COVID-19 infection, remember that most pregnant women have none of the things I’m about to discuss happen to them, and that almost every pregnant women who becomes sick with COVID-19 comes through it safely.
Okay, here we go.
As of April 26, 2021, we’ve seen more than 87,818 coronavirus infections among pregnant individuals. Out of these, there have been 97 maternal deaths, which means the mortality rate is about 0.1104% for pregnant women as a whole in the United States. This data is based on a calculation from a CDC page updated daily on cases in the USA. According to another study published in JAMA Pediatrics that collected data from pregnant women from 18 different countries, the risk of death for pregnant women with a COVID-19 diagnosis was 1.6%, approximately 22 times higher than pregnant women who were not infected with COVID-19. That said, these deaths were highly concentrated in less developed regions where comprehensive ICU services may not be fully available.
Data collected over the past year have shown that pregnant women are less likely to experience symptoms when they contract COVID-19, but that if they do have symptoms, they are more likely to be severe, and pregnant women who develop COVID-19, compared to non-pregnant persons of the same age, are more likely to be admitted into an intensive care unit (ICU) and to require oxygen or mechanical ventilation. But let’s talk about exactly how much more.
According to a study that collected data from over 20,000 pregnant people who contracted COVID-19 from January to October of 2020, after adjusting for age, race/ethnicity, and underlying medical conditions, 10.5 pregnant women per 1,000 cases were admitted into the ICU versus 3.9 non-pregnant women per 1,000 cases. The same data showed that 2.9 pregnant women versus 1.1 non-pregnant women received invasive ventilation per 1,000 cases and 0.7 (pregnant) versus 0.3 (non-pregnant) were put on life support. One critique of these data however, and something important to consider, is that as a whole, physicians are much more likely to intervene aggressively when it comes to a pregnant woman who is sick because the stakes are high medically and legally.
Pregnant women who contract COVID-19 also appear to have an increased risk of adverse pregnancy outcomes, including miscarriage, pre-term birth, preeclampsia, and stillbirth as compared with pregnant persons without COVID-19. Women with a COVID-19 diagnosis also had a relative 7% increased risk of having a cesarean delivery, a 19% increased risk for preterm labor, and a 23% increased risk for stillbirth, a sixfold increased risk of going to the intensive care unit, and a 3.5-fold increased risk for venous thromboembolism. One study published in JAMA – which analyzed data from over 406,446 women, of whom 6,380 had COVID-19 at the time of birth – showed that 98.9% were discharged to home, 3.3% needed intensive care, 1.3% needed mechanical ventilation. The researchers concluded that, for women who gave birth with active COVID-19 infections, although in-hospital mortality was still low, it was significantly higher than in those without COVID-19 (141 versus 5 deaths per 100,000 women, which is a mortality rate of 0.14 percent, similar to what we see in women who get COVID-19 at any point throughout their pregnancy).
You might be wondering: Why does pregnancy put women at higher risk in the first place? One reason is because you’re working with decreased lung capacity as your baby grows. When you are pregnant, your heart also pumps 1.5 times harder than it would normally to provide adequate blood for the baby and the placenta; this can put you at risk for heart problems, which can be a risk factor for COVID-19. Beyond that, there’s also a tremendous amount that we still don’t know about this disease, let alone how it is affecting pregnancy’s complex physiology.
Interestingly, even an asymptomatic case of COVID-19 can increase risk during pregnancy. For example, one study that assessed 706 pregnant women who were diagnosed with COVID-19 found that 60% of the infected women were asymptomatic. That said, asymptomatic women were still at about a 1.5-times higher risk for maternal morbidity and preeclampsia.
That risk rises further if additional factors like higher maternal age and having a high BMI, chronic hypertension, and pre-existing diabetes are also part of the equation. These numbers also indicate the impact of structural racism on overall maternal mortality rate. The risk of contracting COVID-19 and of developing a severe case is higher for Black and Latinx mothers-to-be, in whom these comorbidities are much more frequently seen, again as a result of structural racism.
If you think you've been infected…
First, don’t panic. Remember, yours and baby’s risk, based on all we know right now, is still extremely low. If you have mild or moderate symptoms of COVID-19, call your primary pregnancy care provider (Midwife, OB-GYN, Family Physician) and let them know. Just like you would with any other virus, stay home, rest, and stay well-hydrated.
If you have underlying medical conditions that increase your risk of complications from COVID-19, make sure you are working with a healthcare provider who is skilled in meeting your medical needs should complications arise. Don’t delay seeking medical care should you experience difficulty breathing or moderate to severe symptoms. Inform your care provider should you feel unwell or have a known or suspected COVID-19 exposure, so you can get instructions on what to do. Should you need to be seen by a healthcare provider, call ahead before you go to the clinic, office, or hospital and let them know you’re sick and might have COVID-19 so they can direct you to the right place, while protecting other pregnant women and staff. If you do experience any severe symptoms or complications, seek medical help immediately.
Will you pass the infection to your baby?
If you’ve tested positive for COVID-19 and you’ll be giving birth soon, it’s possible – but unlikely – that you will pass the infection onto your baby. A recent review showed that about 1-in-10 babies (12.1%) born to women who tested positive for COVID-19 also tested positive for the virus, and even amongst these, illness has been rare.
COVID-19 and Breastfeeding
Being exposed to the virus or getting diagnosed with COVID-19 while you’re breastfeeding can be a scary experience, so let’s get to the bottom line: With the rare exception of severe infection in mom, breastfeeding is recommended even if you are symptomatic.
Currently, the primary concern is not whether the virus can be transmitted through breast milk, but rather whether an infected mother can transmit the virus through respiratory droplets during the period of breastfeeding. If you have confirmed COVID-19 or you’re symptomatic, the most important thing you can do is take all possible precautions to avoid spreading the virus to baby. This can be done by washing your hands before touching your baby, and wearing a mask, if possible, while you’re feeding your baby. If you express your breast milk manually or with a breast pump, you should wash your hands before touching any pump or bottle parts, follow recommendations for proper pump cleaning after each use, and if you have COVID-19, consider having someone who is uninfected feed the baby expressed milk with a bottle – though this is not considered a strict recommendation.
If you're well now and can pump, I do recommend “stockpiling” some breastmilk in the freezer, so that if you do get COVID-19 while breastfeeding, feel exhausted, or want to distance yourself from baby for your own peace of mind, then you have milk on hand for someone to feed baby from a bottle. Rest-assured, the age-old worries about nipple confusion from bottle to breast have been put to rest – babies can nimbly switch back to breast after a few days of bottle feeding. Breastfeeding itself is not dangerous for you if you're sick. You do have to be willing to ask for help and rest as much as possible.
There is one benefit for breastfeeding with COVID-19, as you may be able to transfer antibodies to your baby. For example, one study found immunoglobulin A (sIgA) immune response against the COVID-19 virus found in 12 of 15 breastmilk samples from mothers with COVID-19. And while we don’t know how complete the protection is, especially against new variants, or how long it lasts, it will still offer some amount of protection.
COVID-19 Vaccination in Pregnancy
I have so many women asking me “Should I get the vaccine?” I wish I could give you an easy answer, but the reality is that even though it’s now being given more liberally to pregnant women, without years of clinical data to rely on, we just don’t know for sure how safe and effective it is for pregnant women, or if there are any drawbacks to consider.
What we do know is that COVID-19 vaccination reduces the risk of developing COVID-19 and reduces the severity of disease if a breakthrough infection occurs. All available evidence supports the safety of administering currently available SARS-CoV-2 vaccines before, during, and after pregnancy.
Whether to receive this vaccine is a matter for deep personal consideration and decision-making, weighing personal concern and lifestyle, risks, and a very real and very serious global pandemic. Therefore, I cannot say what I think you should do.
What I will do is review the information we do have so that you can make the most informed decision possible for both you and your baby. And I will be very personally transparent and tell you that I have received two doses of the Pfizer vaccine. Those of you who know my work, including my book, Vaccinations: A Thoughtful Parents Guide, know that I am not your typical doctor spouting the party line. I’m a deep critic and questioner of medical practices, and I do not exclude families who choose not to vaccinate from my medical practice. I can also tell you that I am excited to know that I can now safely hug my family members without fear, at least for now. Of course, I am not pregnant.
With a vaccine coming to market so quickly, lack of FDA approval at the time of its release for use (it is still not FDA approved; it is just approved with emergency use authorization status). there are inevitable uncertainties, especially since pregnant people were excluded from the clinical trials and only limited human data on safety during pregnancy were available at the time of emergency use authorization. The information collected on pregnant women who have received the vaccine is still limited, and hasn’t been fully amalgamated and analyzed yet.
Two COVID-19mRNA vaccines have emergency use authorization from the Food and Drug Administration (FDA) and have been used on pregnant women. When I initially posted about the COVID-19 vaccine on Instagram, the day the first vaccine was administered in the United States, the FDA had cautioned against pregnant and breastfeeding women receiving the vaccine due to lack of data unless it was absolutely medically necessary. As a result, being pregnant disqualified you from receiving the vaccine in many places.
Soon after the vaccines became available, some pregnant women – especially healthcare workers who were at high risk of being exposed to the virus at work – began lobbying for the right to get the vaccine. Organizations, such as the American College of Obstetrics and Gynecology, released statements saying the vaccine should not be withheld from pregnant women. Now, months later, the data that has been collected on pregnant women who have received the vaccine, is largely drawn from healthcare workers; approximately 90% of the over 4000 women in the v-safe population of the recent study in the NEJM below were healthcare workers.
A very recent and important study, published on April 21, 2021 in the New England Journal of Medicine, analyzed data from a total of 35,691 participants 16 to 54 years of age identified as pregnant. Short-term reactions to the vaccine, including injection-site pain, nausea, and vomiting after the second shot, were reported more frequently among pregnant than among non-pregnant persons, while headache, myalgia, chills, and fever were reported less frequently after the vaccine in pregnant women versus non-pregnant women.
Among a subset of 3958 in women in this study, (enrolled in the v-safe pregnancy registry, which I discuss later in this article) 86.1% resulted in a live birth; the most common reason for pregnancy loss was miscarriage. Adverse outcomes included preterm birth (9.4%) and small size for gestational age (3.2%); no neonatal deaths were reported. According to the researchers, these incidences are similar to those pregnant women might experience pre-pandemic.
The bottom line is that we still don’t have enough data in pregnancy, and no long-term data at all to definitively say that the COVID-19 vaccines are safe in pregnancy. Overall the number of pregnant women who will get very sick with COVID-19 or die as a result is extremely small. But it is not zero, and it can impact pregnancy outcomes.
What we can say right now, and I’ll just directly share the latest CDC statement, is that “People who are pregnant and part of a group recommended to receive the COVID-19 vaccine may choose to be vaccinated.” This ‘group recommended to receive the vaccine’ includes those at high risk of contracting the infection (though keep in mind community spread means you can be exposed anywhere and without knowing it) such as healthcare workers or other frontline service industry workers with a high volume of human contact, and those in high risk pregnancy populations in whom severe disease is more likely due to comorbidities. The CDC also states that “Based on how mRNA vaccines work, experts believe they are unlikely to pose a specific risk for people who are pregnant. However, the actual risks of mRNA vaccines to the pregnant person and her fetus are unknown because these vaccines have not been studied in pregnant women.” The World Health Organization similarly states: “we don’t have any specific reason to believe there will be specific risks that would outweigh the benefits of vaccination for pregnant women.” And the American College of Obstetricians and Gynecologists states that COVID-19 vaccines “should not be withheld from pregnant individuals who meet criteria for vaccination based on ACIP-recommended priority groups.”
It is also not considered necessary to get pregnancy tested before you get the vaccination, nor wait to try to conceive after you’ve received it.
That said, I have received a number of anecdotal reports from women who have miscarried within a few weeks of receiving the vaccine, especially the second dose (of which vaccines I do not know). Miscarriage is incredibly common, occurring in at least 1 in 10 known pregnancies, so these isolated reports could be coincidences; however, at least a few have occurred in women who have had full-term pregnancies, with no prior history of miscarriage. In my practice I am recommending, if at all possible, to wait until after your first trimester to receive the vaccines, if you plan to during pregnancy, and are not at otherwise high risk. Much of the data on pregnancy loss, from the now much cited NEJM article, does focus on those women who received the vaccination in the third trimester. I’m also suggesting that if you can, wait 6 to 12 weeks post vaccine to start trying to conceive or doing fertility treatments. Why not wait a little longer in the face of the unknown?
I will just say one brief word about the Johnson and Johnson single dose vaccine. It was stopped because it increased women’s risk of developing blood clots. Blood clot risk is already heightened due to normal physiologic changes of pregnancy. I was recommending women not get this vaccine prior to its use being halted as I felt there wasn’t enough safety data yet. I recommend that even if it goes back into use, it not be used by pregnant or postpartum women. That’s just my two-cents specifically about the J&J. If you are in other countries than the US, I cannot speak to other vaccines.
COVID-19 Vaccination in Breastfeeding
There is absolutely no data yet on the safety of COVID-19 vaccines in breastfeeding women or on the effects of mRNA vaccines on the breastfed infant or on milk production/excretion. However, according to the CDC “mRNA vaccines are not thought to be a risk to the breastfeeding infant.” Similar to their stance on the vaccines in pregnancy, the CDC states that “People who are breastfeeding and are part of a group recommended to receive a COVID-19 vaccine, such as healthcare personnel, may choose to be vaccinated.”
Will Getting Vaccinated Protect Your Baby?
There is one additional factor to consider when making your decision about the vaccine. We’ve recently learned that getting vaccinated while pregnant or breastfeeding seems to allow you to pass on COVID-19 antibodies to your baby.
New Israeli research found that COVID-19 antibodies pass robustly from mothers to their infants in breast milk for 6 weeks after vaccination. In one study published in JAMA, all participants received two doses of the Pfizer/BioNTech coronavirus vaccine while breastfeeding and no mother or baby had serious adverse events over the study period. There have also been reports that getting the vaccine while pregnant can pass antibodies to your baby. The CDC states, on this matter, that” vaccination might pass antibodies to the fetus. Recent reports have shown that people who have received COVID-19 mRNA vaccines during pregnancy (mostly during their third trimester) have passed antibodies to their fetuses, which could help protect them after birth.” So it is possible that your baby could be protected from the virus for the first several months of their lives. We’ve seen this with other vaccines and it’s something to think about, especially since infants may be more vulnerable to infection than children of other ages.
For some, the known benefits of the vaccine will outweigh the potential risks. For others, enhanced vigilance to hand hygiene, mask-wearing, social distancing, and avoiding crowds may be the choice that sits best with you. These practices should still be observed by pregnant women in high exposure settings; we don’t know how long immunity – even with vaccinations – lasts at this point, and while serious illness and death risk is reduced by about 90% and 100% respectively if you’ve been vaccinated, we still don’t know the risks of being infected and being asymptomatic, and no vaccine provides 100% protection against becoming infected.
If you do decide to get the vaccine before, during, or after a pregnancy, I encourage you to enroll in the V-safe program, which is a CDC smartphone-based program that tracks symptoms and outcomes after the vaccine for both mom and baby. Totally voluntary, V-safe sends text messages to participants with web links to online surveys that assess for adverse reactions and health status (of you and your baby!) for 12 months after the vaccine. We can thank this data collection system for the information we have so far about the vaccine and pregnancy and it will help us continue to learn more.
Pfizer recently began a clinical trial on 4,000 pregnant women, which means that soon we’ll know more about the vaccine and how it works in a larger and more diverse pregnant population. This trial will follow women 18 years of age or older who get vaccinated during 24 to 34 weeks of gestation. The study will evaluate the safety, tolerability, and effectiveness and follow each woman for approximately 7 to 10 months.
What About Fertility Effects?
There’s a good chance you’ve read or heard something about the vaccine causing infertility and miscarriage. It seems to be everywhere, especially on social media. Understandably, people have a lot of questions and there’s a lot of fear surrounding this topic. I’ve done a lot of research on this and from what I’ve gathered, this wave of concern comes from a theory online that because the coronavirus's spike protein and a protein found in the placenta have a similar genetic code, getting the vaccine will cause your immune system to attack the placenta, making pregnancy impossible. But here’s what I’ve explained to many rightfully concerned women (including my daughter, who asked me about this a few months ago!) and what I’ll say to you, too: A lot of things share genetic code, but that doesn’t make them an exact match. (In fact, on average, we share about 85 percent of our DNA with mice). You can think of the similarities between these two proteins like two people having two of the same digits in their phone number – it doesn’t mean much in the grand scheme of things, especially when it comes to calling the right person.
So far, I haven’t seen any evidence that convinces me that this theory has weight to it. If it did, women who have contracted the live COVID-19 virus would also be experiencing these fertility problems. But we know from research from the millions of people who have been infected with the natural virus that it does not seem to cause any long-term significant changes in fertility status, though many women are reporting short-term changes in their menstrual cycle, both during and after COVID-19 infection, and a vaccination. I discuss this here. Therefore, as I told my own daughter, based on what is known now, I am not personally worried that infertility will be a side-effect of the vaccine. If iI did, I’d be shouting it from the rooftops! But again, we don’t know exactly what the effects are on women’s reproductive health – it’s just not been studied yet, a fact that can be stated for many infections, medications, and vaccinations due to a long history of research bias in medicine; hopefully this will bring a sea change to that problem.
We also have some data from women who have received the vaccine in the last six months to lean on. In the same NEJM study mentioned above, the researchers narrowed in on participants that had been pregnant when they received the vaccine or became pregnant shortly thereafter. By the end of the study period, 827 had completed their pregnancies, 86.1% of which resulted in a live birth and 12.6% resulted in miscarriage – 92.3% of which occurred before 13 weeks of gestation – and stillbirth in 0.1%. As the researchers explained, these numbers are the same as you would have observed in a population of pregnant women before the pandemic. This study offers some comfort but it’s important to recognize that it is also limited not just in the number of women but also in their diversity. About 94% of the participants in the study identified as health care personnel and 79% identified as non-Hispanic white. As we know, disparities and biases in our healthcare system can affect healthcare outcomes.
There are also rumors circulating online that if you are pregnant you shouldn’t get near vaccinated people, but you cannot shed the virus if you get the vaccine because it is not a live virus. The Moderna and Pfizer-BioNTech vaccines are mRNA vaccines that do not contain the live virus that causes COVID-19 and therefore cannot give someone COVID-19. Additionally, mRNA vaccines do not interact with a person’s DNA or cause genetic changes because the mRNA does not enter the nucleus of the cell, which is where our DNA is kept. You do not need to be concerned that close contact with someone who has had the vaccine will cause you to miscarry or cause you any medical problems. Given the science of the vaccine, that is just not possible.
Getting Vaccinated is a Personal Choice. Regardless, Stay Safe
It’s been over a year since my first patient called to tell me that she’d have to give birth in the hospital – alone. Since then, I’ve held space for many overwhelmed mamas to be who are scared for their health and the health of their babies. The stress of the pandemic itself has had adverse effects on women during pregnancy. One review paper analyzed research from 40 studies on over 6 million pregnancies in 17 countries and found that overall, the odds of stillbirth were up 28% in 2020 and that the maternal mortality rate increased by one-third. The results also showed that there was a sixfold increase in surgery for ectopic pregnancies, which is likely attributed to women waiting too long to get care. The study also revealed an increase in postpartum depression and anxiety, also likely attributed to isolation, worry about the virus, and delaying care.
This year has been a tough one, and the decisions we have to make about COVID-19, the COVID-19 vaccine, and pregnancy can feel overwhelming and scary. Overall, though, what we’ve learned in the last year is still reassuring. The number of pregnant women getting sick or very sick is still very small. The number of stillbirths and micarraige is extremely small, but it’s still higher than the average population. My mission here is simple: to help you feel empowered and informed to make decisions about your health. As we continue to learn more about COVID-19 and the vaccines, I’ll continue to be here to help you make sense of it all.
How do you make the best decision for yourself about the vaccination? You weigh the known risks (risks of COVID-19 exposure, infection, and severe infection to you and your baby, and the risks of the vaccines – which are still not fully known) and benefits to yourself of being vaccinated (less worry about getting sick, being able to engage in more activities you enjoy, being able to see family and friends, and having help postpartum) and you reflect on what you’re most comfortable with .
Protecting Yourself from SARS-COV-2 Infection in Pregnancy
While we’re at a moment of erduced transmssion and deaths, with mask regulations becoming more relaxed, travel opening back up, and most of us feeling a certain fatigue about remaining vigilant, at risk of being a Debbie-downer, I want to encourage you to remain cautious and practical in the face of SARS-COV-2 transmission if you are pregnant. It’s just not worth exposing yourself to unnecessary risks at this time.
What we’ve learned so far about pregnancy and breastfeeding and COVID-19 is reassuring, but it should also motivate you to be diligent about your exposure throughout your pregnancy, which means taking precautionary measures like social distancing, and masking seriously. In the coming months, this may get more difficult as more states ease restrictions, cases drop, and many friends and family members get the vaccine and return to “normal” life.
Even if the people you want to see are fully vaccinated, it doesn’t mean the chance of transmission is zero. As a rule of thumb, continue to limit the number of people you’re exposed to and avoid large gatherings, continue to spend as much time together outdoors when around others and if around vaccinated individual indoors, wear masks; avoid poorly ventilated spaces, and if the people in your life are not vaccinated, I recommend following the same precautions experts have been recommending all year – which means masks and six feet of distance – to protect yourself from contracting the virus.
I could go on and on about the many challenges pregnant women and new moms have faced this year. One thing I can say is this: I have hope. Cases in the United States are again lower, most medical professionals have been vaccinated, which means that healthcare settings are no longer hotspots for virus transmission the way they were last year this time. Another thing I can say with certainty is that pregnant women – and women in general – are fierce and powerful and the most important advocates for their own health and their own babies. You can and will make the best decision for yourself, and you’ll continue to monitor and evaluate the changing data, as will I. You have options. You can make the decision to get vaccinated, or you can choose not to. The choice is yours to make. There’s no right or wrong answer, and the decision is your business and your business alone.
Centers for Disease Control and Prevention (CDC). Information about COVID-19 Vaccines for People who Are Pregnant or Breastfeeding. Updated Apr. 28, 2021.
Chen H et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. The Lancet. Volume 395, Issue 10226, 7–13 March 2020, pp. 809-815.
Galang RR, et al. Risk factors for illness severity among pregnant women with confirmed SARS-CoV-2 infection – Surveillance for Emerging Threats to Mothers and Babies Network, 20 state, local, and territorial health departments, March 29, 2020 -January 8, 2021.
Shimabukuro T, et al. Preliminary Findings of mRNA Covid-19 Vaccine Safety in Pregnant Persons. The New England Journal of Medicine. April 21, 2021.
Villar J, et al. Maternal and Neonatal Morbidity and Mortality Among Pregnant Women With and Without COVID-19 Infection The INTERCOVID Multinational Cohort Study JAMA Pediatr. Published online April 22, 2021.
Woodworth KR, et al. Birth and Infant Outcomes Following Laboratory-Confirmed SARS-CoV-2 Infection in Pregnancy — SET-NET, 16 Jurisdictions, March 29–October 14, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1635–1640.
Zambrano LD,, et al. Update: Characteristics of Symptomatic Women of Reproductive Age with Laboratory-Confirmed SARS-CoV-2 Infection by Pregnancy Status — United States, January 22–October 3, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1641–1647.