Since the COVID-19 pandemic began, contracting the virus during pregnancy has been a major concern of patients and medical providers alike. Pregnancy, on its own, creates a type of immunocompromised state, making even healthy pregnant people more susceptible to illness. Data collected over the past year shows that COVID-19 is very risky for those who are pregnant and their unborn babies.
"There have been at least four studies now that have shown that people with COVID-19 during pregnancy have a three times higher chance of having to be in an ICU type of setting and a three times higher chance of having to be intubated than someone similar—similar age, similar background—who's not pregnant," says Julie A. Braga, MD, Obstetrics & Gynecology, Dartmouth-Hitchcock Medical Center (DHMC). "Three to five percent of pregnant people who get COVID-19 infection will have a severe course of disease."
"Severe COVID-19 infection can actually alter the placenta in some ways. Probably to some extent because of the body's immune response that is so revved up as a result of fighting infection," explains Gynecologic Oncologist Ilana Cass, MD, chair of Obstetrics & Gynecology, DHMC. "Unfortunately, there've been many reports of individuals losing their pregnancies, even if they survive their course of COVID-19."
Now that COVID-19 vaccines are widely available, deciding whether to be vaccinated while pregnant, lactating (breastfeeding) or trying to become pregnant has added to patient concerns. Braga and Cass recently held a virtual event to share information about the safety and efficacy of the vaccines.
Scientific findings and data-driven recommendations
The major organizations that create health guidelines for pregnancy, including the American College of Obstetricians and Gynecologists and the American Society for Reproductive Medicine (ASRM), recommend that those who are pregnant get COVID-19 vaccinations. The ASRM's fertility and vaccination data also finds that COVID-19 vaccines do not interfere with conception.
Approximately 140,000 pregnant people have already had the COVID-19 vaccine, according to the Vaccine Adverse Event Reporting System (VAERS). Cass describes this as a "watchdog organization" with ongoing data separate from pharmaceutical manufacturers. Along with VAERS, international databases (including Israel's) and individual institution data, she says data on vaccinated pregnant people shows no increased risk for miscarriage, birth defects or fetal growth anomalies. In addition, "One of the large databases suggested that there's actually fewer [COVID-19 vaccine] side effects in people who were pregnant, compared to people who aren't pregnant," Cass shares. The New England Journal of Medicine recently published a study detailing post-vaccine data on pregnant people.
COVID-19 vaccines do not change DNA, alter sperm and eggs or cross the placenta into a fetus. However, they do pass some protective antibodies to nursing babies through breast milk. Overwhelmingly, the data shows COVID-19 vaccines are safe during pregnancy, nursing and while trying to become pregnant, with the only exception being those who have had anaphylactic reactions to other similar vaccines.
COVID-19 booster shots (third doses) are not currently recommended during pregnancy. Braga and Cass urge all pregnant people to become vaccinated as soon as possible, as the highly transmissible Delta variant is mostly affecting the unvaccinated at a rate of 96-98 percent of patients.