COVID-19 patients who are pregnant are twice as likely to require admission to the intensive care unit (ICU) and 70 percent more likely to die than individuals who aren’t pregnant, according to the CDC. A record number of pregnant women — 22 — died of COVID-19 in August, the CDC reported in September 2021. Despite these risks, just 31 percent of pregnant women in the United States have been fully vaccinated, the CDC reported. And vaccination rates are even lower for pregnant women of color, at 25 percent for Hispanic mothers and 16 percent among Black mothers. Nearly all the COVID-19 cases among pregnant women to date have been among unvaccinated individuals, the CDC said. “In addition to the risks of severe illness and death for pregnant and recently pregnant people, there is an increased risk of pregnancy complications and poor pregnancy outcomes,” says Kara Polen, MPH, a co-lead for maternal immunization for the CDC’s COVID-19 response. For example, COVID-19 during pregnancy increases the risk of preterm birth and admission of the newborn to an intensive care unit (ICU), Polen says. “Other adverse pregnancy outcomes, such as stillbirth, have also been reported.”
Pregnancy Risks With COVID-19
Even though the total numbers of deaths and serious infections among pregnant women are far smaller than in high-risk groups like the elderly, several studies comparing pregnancy outcomes with and without COVID-19 paint a sobering picture of the risks involved. A study published in January 2021 in JAMA Internal Medicine looked at outcomes for 406,446 women who gave birth in U.S. hospitals from April 1 through November 23, 2020, including 6,380 mothers with COVID-19. In this study, the death rate for pregnant women with COVID-19 was 141 per 100,000 women, compared with 5 fatalities per 100,000 uninfected pregnant women. COVID-19 infections were also associated with higher rates of heart attacks, potentially fatal blood clots in the leg, and dangerously high blood pressure during pregnancy known as preeclampsia. Another study, published in July 2021 in Clinical Infectious Diseases, looked at outcomes from 489,471 deliveries between March and September 2020, including 6,550 cases with a COVID-19 diagnosis. Women with COVID-19 were 34 times more likely to suffer acute respiratory distress, 13 times more likely to require mechanical ventilation, and 17 times more likely to die. COVID-19 infections were also associated with more than twice the risk of cardiac events like heart attacks or strokes, and a 20 percent increased risk of preterm deliveries. And a study published in January 2021 in JAMA Pediatrics examined data on 706 pregnant women with COVID-19 infections and 1,424 uninfected women. COVID-19 infections were associated with a 76 percent higher risk of preeclampsia, a fivefold higher risk of ICU admissions, and 22 times the risk of maternal mortality. Babies were also more than twice as likely to have severe complications or die when mothers had COVID-19. “Getting a COVID-19 vaccine can prevent severe illness, death, and pregnancy complications related to COVID-19,” Polen says.
‘Reluctant to Be Vaccinated’
There are so many things women are advised to avoid during pregnancy — from tuna to cheese to hair dye — that it’s understandable that pregnant women would be extremely cautious about considering the COVID-19 vaccine, says Mariell Jessup, MD, the chief science and medical officer at the American Heart Association and an emeritus professor of medicine at the University of Pennsylvania in Philadelphia. “In the absence of evidence, it is natural that women who are pregnant would be reluctant to be vaccinated,” Dr. Jessup says. “Add this to the general milieu of distrust for the medical system for women of color, and it is understandable for women to be reluctant to be vaccinated.” It’s true that earlier in the pandemic there was limited information about the safety or effectiveness of COVID-19 vaccination during pregnancy, Polen says. That’s because pregnant people weren’t included in the clinical trials for the vaccines. Since then, however, hundreds of thousands of pregnant people have been vaccinated. These real-world cases clearly show the benefits of vaccination and the risks of COVID-19 infections among unvaccinated women, Polen says. The new CDC report highlights stark evidence of the harms associated with infections, and notes that no evidence to date suggests that vaccination poses a risk to pregnant women or their babies. “The accumulating evidence has shown that COVID-19 vaccines are safe in those who are pregnant,” Polen says. “Given the increased risks of severe illness from COVID-19 during pregnancy, CDC strongly recommends that people who are trying to become pregnant receive one of the authorized or approved COVID-19 vaccines as soon as possible.”
