A global public health crisis requires sound, validated and uniform medical information delivered by healthcare providers (HCPs) and decision-makers. The COVID-19 pandemic generated an unprecedented swell of medical information and misinformation, amplified by the news and social media. The World Health Organization describes this phenomenon as an infodemic that leads to "confusion and risk-taking behaviors that can harm health."
Now, nearly three years after the first case was discovered in Wuhan, China, HCPs are confident of the following:
- COVID-19 is an illness caused by the coronavirus that infects the cells of the lungs, causing pneumonia, acute respiratory distress and acute respiratory failure.
- The severity of symptoms can run from asymptomatic to severe — even resulting in death.
- Each case looks different. While some experience a sore throat and cough, others may lose their sense of taste and smell or have gastrointestinal symptoms. Others, still, may have symptoms that last longer than four weeks (called long COVID-19) or that may never resolve completely.
- Vulnerable populations include the elderly, immunocompromised patients, individuals with chronic lung and cardiovascular problems — and pregnant people.
Pregnancy causes many normal changes to the body's immune, respiratory and cardiovascular systems. However, because COVID-19 affects these systems too, an otherwise young, healthy pregnant individual is more likely to develop severe COVID-19 than a nonpregnant person would. An unvaccinated pregnant person who develops COVID-19 faces a greater risk of requiring hospitalization and respiratory support; they also have an increased risk of preterm delivery and severe complications including preeclampsia and eclampsia.
Data published in Obstetrics & Gynecology provide an update on outcomes in pregnancies affected by COVID-19, noting the risk of cesarean delivery and hypertensive disorders of pregnancy was 60 percent higher and the risk of preterm births was 3.5 times higher.
Examining Pregnancy and COVID-19 Vaccines
Communities faced a great deal of confusion and fear surrounding vaccines and pregnancy at the beginning of the pandemic, but we know much more now. Researchers are confident that the best way to prevent negative outcomes is by limiting exposure and getting immunized.
COVID-19 vaccination and pregnancy are not mutually exclusive. Patients can receive the vaccine in any trimester or while breastfeeding, thus providing the parent protection and the fetus or newborn passive immunity. The American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine (SMFM) strongly advocate for vaccination even if a patient has been previously infected, as vaccine immunization results in higher levels of antibodies against COVID-19. Patients can also get the vaccine prior to conception or while undergoing infertility treatment without concern of infertility, according to the American Society for Reproductive Medicine.
Currently, the Federal Drug Administration has approved three types of COVID-19 vaccines available for use in the US:
- The messenger RNA (mRNA) vaccines (Moderna/Pfizer)
- The vector vaccine (Johnson & Johnson's Janssen)
- The protein subunit vaccine (Novavax)
Of the three, the mRNA vaccines and boosters are currently preferentially recommended in pregnancy unless an individual has limited access to or a past history of sensitivity to mRNA vaccines.
Vaccine hesitancy was understandable early on because pregnant people were not included in phase three trials. Theoretically, it was presumed to be as safe and effective in pregnancy. The National Institutes of Health (NIH) began evaluating the response to immunization in pregnancy in 2021. Soon, articles confirmed the positive impact of the vaccine on pregnancy.
Published in JAMA, a retrospective cohort study of 7,530 vaccinated and 7,530 unvaccinated patients was conducted during the second and third trimester of pregnancy. The study definitively confirmed a significantly lower risk of COVID-19 infection in those vaccinated. An observational study published in Nature Medicine demonstrated similar vaccine effectiveness in pregnancy compared with the general population.
Studies soon also demonstrated the transplacental transfer of antibodies. For example, a study published in Nature Communications demonstrated even higher titers of antibodies in both the mother and neonate after receiving a booster compared with those that did not, suggesting excellent immunological response in both the mother and fetus to boosters.
There is no longer any confusion about the recommendation to receive vaccination and boosters in pregnancy.
Testing Positive While Pregnant
If a pregnant patient has mild symptoms and tests positive for COVID-19, outpatient management may be possible. The SMFM notes that while no large-scale studies with pregnant women have been performed, active, ongoing data collection may influence recommended treatment options.
An article in Frontiers emphasizes shared decision-making between patients and clinicians. Follow-up for patients with mild cases can be managed similarly to when a pregnant patient has the flu. Fetal development and well-being evaluations are individualized and based on gestational age and the severity of maternal symptoms; this may include additional office visits, ultrasounds, and fetal heart rate monitoring.
Developing COVID-19 while pregnant is not in and of itself an indication for delivery. However, pregnant patients with moderate to severe symptoms should be hospitalized and require a multidisciplinary team management approach including members of the nursing, infectious disease, pulmonary, OBGYN and pediatric departments.
Empowered and Informed Decision-Making
Infodemics and obstinancy are hard to cure. Clinicians have a responsibility to educate patients on the best and most current prevention and management practices — and evidence shows that for patients who are pregnant, who are breastfeeding or who may become pregnant, the benefits of vaccinations and boosters far outweigh the risks.
Through education, a patient has the opportunity to choose positive strategies for improving their own and their family's health.
