Encourage Pregnant Women to Get COVID-19 Vaccine

Health care professionals need to redouble efforts to motivate pregnant women in the United States to get the COVID-19 vaccine, according to an urgent health advisory issued by the Centers for Disease Control and Prevention (CDC).

According to Our World in Data, an information gathering organization out of the University of Oxford, 55.9% of Americans are fully vaccinated, while 64% of Americans have received at least 1 dose of a vaccine. Meanwhile, according to the CDC, only 31% of pregnant individuals have been fully vaccinated.

The advisory, which was issued Wednesday, alludes to the possible misinformation that may be causing vaccine hesitancy among pregnant individuals, saying that “there is currently no evidence” that the COVID-19 vaccines cause infertility. The advisory includes steps that health care providers should take when treating or interacting with women who are pregnant or plan to become pregnant. Health care providers should:

• Review a patient’s vaccination status at each pre- and post-natal visit.
• Encourage unvaccinated patients to get vaccinated.
• Inform individuals that COVID-19 vaccination offers a layer of protection for her and her baby even if the woman had already had COVID-19.
• Make sure that pregnant women who’ve gotten 1 dose of a vaccine get the second dose.
• Determine whether the pregnant woman is eligible for a booster shot.

“A strong recommendation from a health care provider is a critical factor in COVID-19 vaccine acceptance and can make a meaningful difference to protect the health of pregnant and recently pregnant people and their fetuses/infants from COVID-19,” the CDC advisory states.

Significant disparities in COVID-19 vaccine uptake exist among different ethnic and racial groups: Asian-Americans (45.7%), Latinos (25%), Blacks (15.6%).

“Efforts should specifically address populations with lower vaccination coverage and use approaches to reduce racial and ethnic disparities,” the CDC advisory states. “CDC recommends ensuring tailored, culturally responsive, and linguistically appropriate communication of vaccination benefits.”

As of Monday, there have been more than 125,000 confirmed COVID-19 cases in pregnant individuals that resulted in about 22,000 hospitalizations and 161 deaths, according to the CDC.

“Pregnant and recently pregnant people with COVID-19 are at increased risk for severe illness when compared with non-pregnant people,” the CDC advisory states. “Severe illness includes illness that requires hospitalization, intensive care unit (ICU) admission, mechanical ventilation, or extracorporeal membrane oxygenation (ECMO), or illness that results in death. Although the absolute risk is low, compared with non-pregnant symptomatic people, symptomatic pregnant people have more than a two-fold increased risk of requiring ICU admission, invasive ventilation, and ECMO, and a 70% increased risk of death.”

Public health departments also need to get more involved. The CDC recommends that they:

• Increase efforts to partner with community organizations to increase vaccination rates for racial and ethnic minorities.
• Encourage health care providers in their jurisdictions to offer COVID-19 vaccines.
• Work with businesses and community organizations to make it easy for pregnant individuals to get vaccinated.
• Monitor infection and vaccination rates to better target education campaigns to the groups with low vaccination rates.

An article on September 14 in Infection Control Today^®’s sister publication, Contagion^®, puts the danger COVID-19 poses to unvaccinated pregnant individuals in context. That article looks at a study in BMC Public Health that found that in Mexico, COVID-19 was the leading cause of maternal death, with 22.93% confirmed, and 4.5% unconfirmed. Data show that 1056 maternal deaths occurred during the study period. But, as Contagion^® notes, the study period took place before the availability of COVID-19 vaccines in Mexico, and that the coming availability of vaccines should ameliorate maternal mortality rates in that country.

That’s if pregnant individuals get the vaccine, and as the CDC advisory notes about what's going on in the US, that’s a big if at the moment.