Pregnant healthcare workers face a personal choice to receive a COVID-19 vaccine, although emerging evidence suggests contracting the virus outweighs the risk of immunization.

The CDC recommends lactating women can be vaccinated. However, the effects of the vaccines on pregnancy are unknown, though emerging trends look good.

“Pregnant people may choose to receive a COVID-19 vaccine. A conversation between the patient and their clinical team may assist with decisions about the use of a COVID-19 vaccine, though a conversation with a healthcare provider is not required before vaccination,” the CDC explained. “When making a decision, pregnant people and their healthcare providers should consider the level of COVID-19 community transmission, the patient’s personal risk of contracting COVID-19, the risks of COVID-19 to the patient and potential risks to the fetus, the efficacy of the vaccine, the side effects of the vaccine, and the limited data about the vaccine during pregnancy.”1

High Risk of Bad Outcomes

Contracting COVID-19 while pregnant is associated with bad outcomes. A recent study found case fatality rates in pregnant patients infected with SARS-CoV-2 were 13.6 times higher than similarly aged nonpregnant women with COVID-19.2

Tom Shimabukuro, MD, MPH, MBA, CDC Vaccine Safety Team Lead, reviewed pregnancy data at a recent CDC webinar. There were 30,000 self-reported pregnancies in a CDC vaccine safety system called V-Safe as of mid-February. The side effects seen in many vaccine recipients — sore arm, fatigue, mild fever — were no different in pregnant and nonpregnant women. This was seen in comparison of those who took the Pfizer or the Moderna vaccine.3

“If you look at pregnant women compared to nonpregnant women, it looks like there may even be a little less reactogenicity reported in pregnant women compared to nonpregnant women,” Shimabukuro said.

The CDC compared adverse pregnancy outcomes in 1,800 vaccinated women in the V-Safe pregnancy registry vs. unvaccinated pregnant women in the general population. The CDC studied miscarriage, stillbirth, gestational diabetes, pre-eclampsia or gestational hypertension, eclampsia, intrauterine growth restriction, and other outcomes.

In example results, the background rate for miscarriages in less than 20 weeks was 26%, compared to 15% in the V-Safe group. At 15%, pre-eclampsia in the V-Safe group was at the top of the background rate of 10%-15%. Stillbirth rates were 0.6% background, and less than 1% in the V-Safe. Gestational diabetes was 7%-14% background and 10% in the V-Safe group. Overall, the outcomes were similar in both groups.

“The take-home message here is that the rates of these outcomes in the V-Safe pregnancy registry are similar to background rates in general,” Shimabukuro said. “This should be reassuring information for pregnant women who have questions about getting vaccinated.”

Shimabukuro was asked whether pregnant women should take the vaccine. “I’ll give you my opinion,” he said. “I think one of the messages is that there is evidence that pregnant women are at increased risk for complications from COVID infection and increased risk for more severe disease. There is also some evidence that COVID infection may increase the risk of certain pregnancy and birth outcomes. In order to protect both the mother and the developing baby, I think it’s important that women get vaccinated. If they have specific concerns or general concerns, I think their healthcare provider should be the first person that they speak to, to get advice about vaccination.”

REFERENCES

  1. Lokken EM, Huebner EM, Taylor GG, et al. Disease severity, pregnancy outcomes and maternal deaths among pregnant patients with severe acute respiratory syndrome coronavirus 2 infection in Washington state. Am J Obstet Gynecol 2021;S0002-9378(21)00033-8.
  2. Evans G. Staggering COVID-19 mortality rates during pregnancy. Hospital Employee Health. April 1, 2021. https://www.reliasmedia.com/articles/147714-staggering-covid-19-mortality-rates-during-pregnancy
  3. Centers for Disease Control and Prevention Center for Preparedness and Response. What clinicians need to know about COVID-19 vaccine safety and effectiveness and how to address patient questions and concerns. March 9, 2021. https://emergency.cdc.gov/coca/ppt/2021/030921_slide_2.pdf