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A new study from the U.S. Centers for Disease Control and Prevention gives further credence to what obstetricians have been saying for many months – pregnant women should get vaccinated to protect themselves and their babies from COVID-19.
A two-dose mRNA vaccine during pregnancy was 61% effective against hospitalization among infants younger than 6 months, the CDC found by looking at 379 infants, 176 with COVID-19 and 203 without the disease, from July to January in 20 pediatric hospitals in 17 states.
Of those hospitalized with COVID, 84% were born to unvaccinated mothers, according to the study, released Tuesday, Feb. 15. One of the infected babies died, 24% were admitted to intensive care units and 15% were on life support. All the vaccinated mothers involved in the study received both shots while they were pregnant, at least two weeks before delivery.
“This makes perfect sense,” said Dr. David Colombo, division chief of maternal fetal medicine for Spectrum Health, based in Grand Rapids. “Knowing how the placenta works, knowing how the immune system works, knowing how the body goes out of its way to protect the baby, this is exactly what we should have found.”
Because it is “passive immunity,” it lasts about three months in newborn babies, Colombo said.
It is not clear babies whose breastfeeding mothers are inoculated receive the same or as great an impact. The antibodies do not get into the bloodstream after birth in any significant amount. The antibodies in breastmilk do line the mucous membranes, and that might provide some protection, Colombo said.
Though the study found protection was higher among infants whose mothers were vaccinated after 20 weeks gestation and within two weeks of giving birth, Colombo said there is a downside. “If a mother waits to get vaccinated until 20 weeks, she’s putting herself at risk for those first 20 weeks, which can be detrimental to her and the baby.”
He recommends women get vaccinated as “quickly as possible,” regardless of whether they are pregnant, recently postpartum or trying to get pregnant — there has been no evidence of the vaccine affecting fertility or increasing the chances of miscarriage, poor fetal growth or early birth, he said.
The study did not look at booster shots, which health officials now laud as especially important with the highly transmissible omicron variant predominant. “We still need to study that and how much antibody is conferred with a booster vaccination. And that’s certainly something we’re looking into,” Dr. Dana Meaney-Delman, chief of CDC’s Infant Outcome Monitoring, Research and Prevention branch said, according to a transcript of her remarks at a Tuesday press briefing.
Colombo said he would also strongly recommend the additional dose during pregnancy. “I don’t want to be wishy-washy about this at all. COVID in pregnancy is terrible. Pregnant women do not tolerate COVID well at all.”
Their immune systems do not function as a non-pregnant person’s. The baby is pushing on their diaphragms, he said.
Though overall risks are low, there is a greater likelihood pregnant women infected with COVID will experience severe illness, according to the CDC.
Experts now know that the placenta is very good at keeping the virus from the baby, but in doing so, it does not do its primary job as well, Colombo said, so medical professionals are seeing increased risk of adverse pregnancy outcomes, including fetal death.
“I would say, for the average woman, the biggest risk to your pregnancy in 2022 is COVID.”
Spectrum patients, all unvaccinated, have died, he said. “And it’s just painful. I think the worst thing in the world is when you are able to deliver a baby, often preterm, and the mother just doesn’t survive the illness. That is just terrible. It rips your soul out, honestly.”
It is infrequent, but every time he sees this happen, it has him doubling down on efforts to offer the vaccine to those who need it.
In September and August, 75 pregnant women died in the United States. These were the most deadly months of the pandemic for expecting women, according to the CDC. Almost 30,000 of about 140,900 pregnant women with COVID-19 have been hospitalized in country, the CDC reports. (The CDC did not have hospital data for another 32,619 pregnant women with COVID.)
Babies, if they are closer to full-term, usually fare well, Colombo said. When a mother is severely ill at say 23 weeks pregnant, the baby will face more challenges.
Of 40,201 pregnant women with COVID-19, there were 39,820 live births and 381 pregnancy losses, reports the CDC, using data collected from 31 health department jurisdictions across the United States, including Michigan.
In Michigan, the state Department of Health and Human Services identified 1,378 pregnant women with COVID-19 in 2020. Of them, 1,288 gave birth to 1,316 live babies, reported Lynn Sutfin, department public information officer. There were three fetal deaths, including miscarriages, before 20 weeks, and stillbirths, after 20 weeks, and the number was not higher than expected. Two of the women died.
In the United States, about 67% of pregnant women 18 to 49 from Dec. 14, 2020 to Feb. 5 were fully vaccinated, according to information collected through the Vaccine Safety Datalink, a collaborative project between CDC’s Immunization Safety Office and nine health care organizations in seven states, none of them Michigan. Most of these patients, about 57%, were vaccinated before pregnancy.
Rates of vaccination have improved. About 64% of the U.S. population is fully vaccinated. Vaccination among pregnant people previously lagged the general public and other groups.
Over time, there has been an acceptance. People have seen friends become deathly ill with COVID, Colombo said.
The present situation has improved with pregnant patients as it has all with all patients. COVID-19 hospitalizations are way down in Michigan, to fewer than 2,000 adults with confirmed or suspected cases.
During the worst of the omicron surge in the last month, intensive care units were packed. The neonatal intensive care units were full of preterm babies, many of them children to mothers who had COVID. Doctors had to make difficult decisions regarding who received critical care.
Numbers are slowly decreasing. This could be tied to an increase in vaccination rates or the seasonality of the virus. “Which is great, but that shouldn’t discourage somebody from getting the shot thinking they’re out of the woods,” Colombo said.
There are two camps of people, those eager for vaccines and booster shots and those who are adamantly opposed he said.
“It’s almost like, they discount new research being done, or observations that we’ve made,” Colombo said.