By Page Leggett, Novant Health Healthy Headlines
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Pregnant women who don’t get vaccinated for COVID-19 face higher risks of:
– Being admitted to the ICU and intubated.
– Having complicated pregnancies that lead to longer hospital stays.
– Having to deliver early for their health and the baby’s, which in turn can lead to great complications.
That’s the experience of two Novant Health physicians who’ve been caring for pregnant patients in recent weeks as the delta variant fills hospitals with younger patients across the United States.
Dr. Amelia Sutton, maternal-fetal medicine specialist at Novant Health Maternal-Fetal Medicine – Charlotte, and Dr. Navin Bhojwani, an ob/gyn at Novant Health Bradford Clinic OB/GYN and leader of Novant Health’s Women & Children’s Health Institute, recently shared their experiences and advice to women in a briefing with reporters.
“Some patients have said, ‘I didn’t think I could get (the vaccine) during pregnancy,” said Sutton.
The COVID-19 vaccine is safe – and recommended – for expectant and nursing moms and those considering getting pregnant, the doctors said. That message comes from three top health care organizations: the Centers for Disease Control and Prevention (CDC); the Society for Maternal-Fetal Medicine, one of the largest professional organizations guiding women’s health in the United States; and the American College of Obstetricians and Gynecologists.
In fact, the CDC issued a statement Aug. 11 urging pregnant people and nursing moms to get vaccinated for COVID-19. CDC Director Dr. Rochelle Walensky said, “The vaccines are safe and effective, and it has never been more urgent to increase vaccinations as we face the highly transmissible delta variant and see severe outcomes from COVID-19 among unvaccinated pregnant people.”
And, Bhojwani said, “We’ve seen over the past year and a half that COVID poses extraordinary risks to both mother and baby.” Women are at a threefold higher risk of developing severe COVID cases, he said.
Higher rates of severe COVID in women
With the current spread of the delta variant, the U.S. is seeing much higher rates of severe disease in pregnant women, Sutton said. “We now have more data in pregnant women. Over 140,000 pregnant women have been vaccinated in the United States. And we have not seen any increased risk of adverse effects related to the vaccine. There’s no question that the vaccine should be given during pregnancy.”
The concerns about the vaccine among pregnant people have centered around increased risk of miscarriage. “There’s more and more data (indicating) clearly that’s not the case.”
Bhojwani also cited a recent study from San Francisco that looked at 240,000 pregnancies for the past six months in California. Those who had COVID infections during their pregnancies had a 60% chance of having a really early premature birth. And when babies are born prematurely, they can face a host of complications.
If the mother had other chronic conditions like diabetes, high blood pressure, obesity – all the things that tie with increased risk for a COVID infection being severe – the risk was 160% higher, he said. “If pregnant women don’t get vaccinated, they’re really putting themselves at far greater risk for a myriad of consequences, some of which will be impactful to their unborn children,” he said.
When to get the shot
Pregnant patients who have gotten the vaccine within the Novant Health system have not reported any increased adverse effects, no matter what trimester they received the shot, the doctors said.
At any time during pregnancy – from pre-conception all the way to delivery – it’s safe to get the vaccine, they added. Researchers have also studied women who got the vaccine when they were trying to conceive, and it had no discernable effect on fertility.
Complications for the baby when mom has COVID
“The third trimester is a particularly risky time for women with any respiratory viruses,” Sutton explained. It’s risky, she said, because of changes in the way a mom’s lungs work during the third trimester. “If a woman has been hesitant and hasn’t gotten the vaccine, we are encouraging them to be fully vaccinated prior to the third trimester, which begins at 28 weeks.”
The baby receives all of its oxygen from mom, Sutton added. So if she is not getting enough oxygen, the baby will also struggle.
That may lead doctors to induce the birth early to preserve the baby’s well-being as well as help the mother, Bhojwani added. But that early delivery also has significant consequences for babies.
Having COVID also greatly increases the chances of landing a mom “in the ICU and being intubated,” he said. A recently released study in the Journal of the American Medical Association (JAMA) of 870,000 pregnancies showed the risk of being admitted to the ICU is 5 times higher for patients with COVID infection.
And, there is also an increased risk of stillbirth when mom is sick, as well. “We don’t completely know the reasons for that,” Bhojwani said. “We think part of it is due to the way COVID affects how the placenta functions, as well as the decreased oxygenation of the baby due to the respiratory effects of the virus.”
The number of pregnant women on ventilators right now is unprecedented, Sutton said. “Many of my colleagues who’ve been practicing for many decades are shocked and horrified by how the ICUs are filling with pregnant women. And we’re seeing that the vast majority are not vaccinated.” The same JAMA study showed the risk of being on a ventilator is 14 times higher for patients infected with COVID during their pregnancy.
Some pregnant patients have very mild symptoms. But one of the hallmarks of COVID is pneumonia, Bhojwani said, and that “patients can appear and feel quite well and rapidly worsen over the course of the first week or two.” In addition to seeing moms placed on a ventilator, Bhojwani said, “The risk of death is 15 times higher for pregnant patients sick with COVID.”
Breakthrough COVID in pregnancy is rare
So far, Bhojwani said he has not seen a breakthrough case of COVID in a pregnant woman. “The vaccines do a very good job. We know they do a really great job of preventing hospitalization from COVID,” he said. “Even if you were to get a breakthrough infection, hypothetically, your risk of being one of those severely ill pregnant patients who has to have an early delivery and be in the ICU and on a ventilator is eliminated – or at least significantly reduced” when patients are vaccinated.
He also added: “Those who have ended up with preterm deliveries have had their babies affected. We have seen several cases of regret. The mom’s decision (not to vaccinate) affected her well-being and that of her baby. It’s a hard lesson to learn.
“If a pregnant patient gets COVID during her pregnancy, there is a much greater chance she will end up in the ICU, have her baby early and the baby will have to overcome obstacles and will be here longer.”
The vaccine and fertility: No link
When it comes to misinformation on the internet, Sutton and Bhojwani emphasized that the vaccine does not affect fertility. When it comes to the makeup of the vaccine, Bhojwani said, “It’s not even biologically plausible.” Novant Health doctors also remind parents that there is no way the vaccine can affect the future fertility of their children.