Research continues to show the adverse effects of COVID-19 during pregnancy and the benefits of vaccination for both the mother and child.

A new study by Vousden and colleagues found that severe disease increased the risk of pre-labor cesarean delivery, preterm birth, stillbirth and admission to a neonatal unit. These findings support existing data showing that COVID-19 was associated with higher risk for preterm birth.

Although other studies have confirmed greater risks for adverse maternal and neonatal outcomes in women who contract COVID-19 during pregnancy, including preeclampsia, some studies have found no correlation between COVID-19 and adverse pregnancy outcomes.

Despite conflicting findings on the impact of the disease itself, studies on vaccine efficacy in pregnancy have shown positive results. Researchers found that women who received an mRNA vaccine during pregnancy developed antibodies against SARS-CoV-2, which were passed to newborns. Vaccination also reduced severe disease in pregnant women and lowered the risk for COVID-19 hospitalization in infants.

Given the current data, ACOG, the CDC, the Mayo Clinic and others have advocated for COVID-19 vaccination during pregnancy.

As of Jan. 15, 2022, the CDC reported that 42.6% of pregnant women had been fully vaccinated before, during or after their pregnancy, and 21.1% received at least one dose during pregnancy. The rates of vaccination remained higher in the general population: 65% of the U.S. is fully vaccinated, according to CDC data.

Healio spoke with Jeanne Sheffield, MD, director of the division of maternal-fetal medicine at The Johns Hopkins Hospital and professor of gynecology and obstetrics at The Johns Hopkins University School of Medicine, to learn why vaccination rates remain low and how to boost vaccine uptake in the pregnant population.

Healio: Why are the rates of vaccination so low in the pregnant population?

Sheffield: This has been a recurring theme for all recommended vaccinations during pregnancy. Pregnant patients are concerned about harm to the pregnancy and the unborn child from the vaccine itself or from the potential side effects (eg, fever). Patients express another layer of concern regarding the COVID-19 vaccines as they were developed quickly and without pregnant women initially enrolled in the safety studies; there is now a concern regarding a current lack of long-term safety data. Two of the current vaccines in use — the mRNA vaccines from Moderna and Pfizer-BioNTech — were developed using a platform that had not been widely studied in pregnancy previously.

Healio: What has current research determined about vaccine safety and efficacy in pregnant women?

Sheffield: There is now extensive safety and efficacy data in reproductive age and pregnant women who received the COVID-19 vaccine series. COVID-19 vaccination decreases the risk for ICU admissions, ventilation requirements, extracorporeal membrane oxygenation (ECMO) and death, and there have been no reports of increased complications from the COVID-19 vaccine during pregnancy compared to the nonpregnant population.

Healio: How does the vaccine affect the unborn child?

Sheffield: Data to date has not shown a significant negative effect on the unborn child. In fact, there are several positive effects, such as decreased neonatal admissions in the first 6 months of life in infants born to mothers who received the COVID-19 vaccine series during pregnancy. A recent study in MMWR reported that in more than 40,000 pregnant women, there was no association with preterm birth or small for gestational age at birth.

Healio: How can clinicians encourage vaccine uptake in pregnancy?

Sheffield: Clinicians should be educated themselves so they can educate patients. Stay current with the research and safety/outcomes data in order to reassure patients and their families. Stress the increased morbidity and mortality of COVID-19 infection during pregnancy compared with the lack of vaccine safety concerns identified to date.

Editor’s note: Healio recently published a COVID-19 vaccine discussion guide, written and peer-reviewed by practi cing clinicians, as a resource to build confidence in vaccination. Visit www.Healio.com/Confidence for more information.

References:

• COVID Data Tracker: COVID-19 vaccination among pregnant people aged 18-49 years overall, by race/ethnicity, and date reported to CDC – Vaccine Safety Datalink, United States. https://covid.cdc.gov/covid-data-tracker/#vaccinations-pregnant-women. Updated Jan. 15, 2022. Accessed March 1, 2022.
• COVID-19 Vaccination and Case Trends by Age Group, United States. https://data.cdc.gov/Vaccinations/COVID-19-Vaccination-and-Case-Trends-by-Age-Group-/gxj9-t96f. Updated Feb. 25, 2022. Accessed March 1, 2022.
• COVID Data Tracker: COVID-19 Vaccinations in the United States. https://covid.cdc.gov/covid-data-tracker/#vaccinations_vacc-total-admin-rate-total. Updated March 1, 2022. Accessed March 1, 2022.
• Lipkind HS, et al. MMWR Morb Mortal Wkly Rep. 2022;doi:10.15585/mmwr.mm7101e1.
• Vousden N, et al. Acta Obstet Gynecol Scand. 2022;doi:10.1111/aogs.14329.

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