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You’re pregnant, healthy and hearing mixed messages: Health and Human Services Secretary Robert F. Kennedy Jr., removed the COVID vaccine from the list of vaccinations you should get.
“I couldn’t be more pleased to announce that as of today the COVID vaccine for healthy children and healthy pregnant women has been removed from the CDC recommended immunization schedule” Kennedy said on Tuesday.
But guidance from the Centers for Disease Control and Prevention and other researchers say being pregnant still puts you in a high-risk group that should receive boosters. The science is on the side of the shots.
COVID in pregnancy
Pregnant women who contracted COVID were more likely to become severely ill and to be hospitalized than women of the same age and demographics who weren’t pregnant, especially early in the COVID pandemic.
An analysis of 435 studies from around the world in 2019-2020 found that pregnant and recently pregnant women who were infected with COVID were more likely to end up in intensive care units, be on invasive ventilation, and die than women who weren’t pregnant but had a similar health profile. This was before vaccines were available.
Dr. Neil Silverman, a professor of clinical obstetrics and gynecology, directs the Infectious Diseases in Pregnancy Program at the David Geffen School of Medicine at UCLA. He said he still sees more bad outcomes in pregnant patients who have COVID. The risk of severe COVID fluctuated as new variants arose and vaccinations became available, Silverman said, but the threat is still meaningful.
“No matter what the politics say, the science is the science, and we know that objectively, pregnant patients are at substantially increased risk of having complications,” Silverman said.
A request for comment regarding the scientific literature that supports COVID vaccination for pregnant women sent to HHS’s Public Affairs office elicited an unsigned email unrelated to the question. The office did not respond when asked for an on-the-record comment.
There’s still a lot unknown about how COVID affects a pregnant person. The physiological relationship between COVID infections, mothers and fetuses at different stages of a pregnancy is complex, said Angela Rasmussen, a virologist at the University of Saskatchewan.
The increased risk to pregnant patients comes in part because pregnancy changes the immune system, Rasmussen said.
“There is natural immune suppression so that the mother’s body doesn’t attack the developing fetus,” Rasmussen said. “While the mother does still have a functioning immune system, it’s not functioning at full capacity,” she added.
Pregnant patients are more likely to get sick and have a harder time fighting off any infection as a consequence.
COVID can harm the placenta
In addition to changing how the immune system works, being pregnant also makes women five times more likely to have blood clots. That risk is increased if they contract COVID said Sallie Permar, Chair of Pediatrics at Weill Cornell Medicine.
The virus that causes COVID can affect the vascular endothelium – specialized cells that line blood vessels and help with blood flow, Rasmussen said. In a healthy person, the endothelium helps prevent blood clots by producing chemicals that keep the vascular system running. In a person infected with COVID, the balance is thrown off and the production of those molecules is disrupted, which research shows can lead to blood clots or other blood disorders.
Permar said that those clots can be especially dangerous to both the pregnant women and baby. Inflammation and blood clots in the placenta could be connected to an increased risk of stillbirth especially from certain COVID variants, according to studies published in major medical journals as well as by the CDC.
When the placenta is inflamed, it’s harder for blood carrying oxygen and nutrients to get to the baby, said Mary Prahl, associate professor of pediatrics at the University of California San Francisco School of Medicine.
“If anything is interrupting those functions – inflammation or clotting or differences in how the blood is flowing – that’s really going to affect how the placenta is working and being able to allow the fetus to grow and develop appropriately,” she said.