Of all the groups still at risk from Covid-19 – including the elderly and the immunocompromised – it is pregnant women who seem the most oblivious to the risks.
Covid can kill pregnant women and can lead to miscarriages, premature births and stillbirths even when women have asymptomatic or mild illness. The infection can also affect the baby’s brain development.
Dozens of studies have shown that the Covid vaccine is safe for pregnant women. Immunization of the mother also transmits protective antibodies to her fetus.
Yet only 70% of women completed the primary Covid vaccination series before or during pregnancy, which means that around 30% of pregnant women did not benefit from this basic protection. Since the beginning of September, only 15% have opted for a booster shot.
Even the flu shot hasn’t proved popular with pregnant women this year: only 37% of pregnant women had been vaccinated against the flu by the end of October, compared to nearly 60% by the end of September 2020.
The United States is now grappling with a mixture of respiratory syncytial virus, influenza and coronavirus, all of which can cause serious illness in pregnant women. Winter promises to be gloomy.
“It worries me, especially given the low vaccination rates,” said Dr. Denise Jamieson, an obstetrician at Emory University in Atlanta and a member of the American College of Obstetrics and Gynecologists’ Covid Expert Panel. .
Even at the start of the pandemic, it was obvious that Covid was dangerous during pregnancy. Data from a June 2020 study showed that of pregnant women infected with Covid, around one in three ended up in hospital, compared to around 6% of women who were not pregnant.
Infected pregnant women were 50% more likely to be admitted to intensive care units and 70% more likely to need a ventilator.
“It’s very clear now that if you’re pregnant, planning to get pregnant, or breastfeeding, for you and for your baby, it’s very important to get vaccinated,” said Dr. Neel Shah, an assistant professor at Harvard and physician- head of Maven Clinic, a digital healthcare provider for women and families.
Pregnant women, their families and even their doctors may not realize the importance of vaccination due to “slow and confusing” communication from public health agencies, Dr Shah said.
The Centers for Disease Control and Prevention did not approve the vaccination of pregnant women without reservation until September 2021, about three months before the Omicron variant swept the country and months after the American College of Obstetricians and Gynecologists Society for Maternal-Fetal Medicine strongly recommended injections for pregnant women.
By then mistrust and misinformation had already been sown and only about a third of pregnant women were vaccinated. “It was a big part of the failure, honestly,” Dr Shah said.
Scientists used to believe that pregnant women were, in essence, immunocompromised – that the body tolerates the fetus by responding to it as if it were a foreign invader and suppressing its own immune responses. “We now know that’s not true, that’s an oversimplification,” Dr Jamieson said.
Pregnancy comes with some immune changes, she said, but they don’t compromise the ability to fend off infections, like an organ transplant or some medical conditions might.
Yet pregnant women are vulnerable for other reasons. The growing uterus compresses the lungs, preventing the ability to take in air, for example. Pregnancy can also cause conditions like diabetes and high blood pressure, which themselves put a person at risk for severe Covid.
Studies have shown that the placenta of pregnant women infected with the coronavirus resembles that of women with pre-eclampsia, a dangerous form of high blood pressure during pregnancy.
The placenta is a sponge of blood vessels that allows the exchange of oxygen and nutrients between mother and fetus. It functions as the lungs, liver and kidneys for the fetus, but Covid can ravage it, said Dr. Anne V. Herdman Royal, a pathologist at Tulsa Medical Laboratory who studies placental tissue.
“The placenta is basically the lungs of the fetus, and it’s damaged the same way the lungs are damaged by Covid,” she said. Most babies are fine, as long as they’ve completed at least 30 weeks’ gestation, she added.
So why have so many pregnant women avoided vaccination? Many have focused on risk claims for which there is little or no evidence while ignoring the very real dangers of Covid, Dr Royal said.
This is true not only for pregnant women, but also for friends, family, and even their health care providers.
In October 2021, Maven Clinic surveyed 500 women in the United States. Almost 70% said at least one person had suggested avoiding the vaccine during pregnancy. In about a third of these cases, the source was a health care provider.
Doctors were already worried about taking any risks with pregnant women, and any ambiguity in the evidence around Covid vaccination could have reinforced their fears, said Dr Anne Lyerly, a bioethicist at the University of North Carolina at Chapel Hill. .
Dr. Lyerly pointed to a scientific paper in the journal JAMA titled “Association of Covid-19 Vaccination in Pregnancy With Adverse Peripartum Outcomes.”
The researchers concluded that there was no significant association. But leaving that information out of the title surely didn’t reassure doctors, she said.
“Neutral messages, like those in the JAMA article, are not fear-neutral,” Dr. Lyerly said.
“The more cautious than sorry stance that so many in the public, so many doctors — even so many public health officials — tend to take toward pregnancy is ultimately no safer,” said she added. “In fact, it puts pregnant women at risk.”
She also said that public health messages had not sufficiently emphasized the risks of Covid for pregnant women and the benefits of vaccination for the fetus, she said.
Many women voluntarily receive the DTaP vaccine – which protects against diphtheria, tetanus and whooping cough – during the third trimester, because they understand that it is necessary to protect the baby.
But the message didn’t get through that flu and Covid shots are also needed during pregnancy, Dr Jamieson said. In the Maven survey, for example, one in three women said they planned to get a Covid shot only after giving birth.
Dr Jamieson said she was able to convince some women to get vaccinated by first asking them what they thought of the vaccine and then coming back to the subject at a later appointment.
The key “is not to push so hard on the first visit,” she said, “and sometimes they will change their minds.”
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