The interaction of COVID-19, pregnancy, and maternal and fetal health is complex and rapidly changing. As the virus progresses through new variants and vaccinations are deployed, experts are turning their attention more and more to how these variants intersect. Angela Rasmussen, one of the field’s foremost researchers and advocates, is teeing up an important reality check. The physiological interactions between COVID infections and pregnancy may vary considerably by gestational age. This complexity has damning real-world implications for maternal and infant health.
New evidence shows that for infants who are too young to be vaccinated, their risk from COVID-19 is unacceptably high. They now have higher hospitalization rates than any other age group, with only the 75+ group higher. Alarmingly, almost one out of five babies admitted to the hospital for COVID required intensive care. Moreover, almost one in 20 needed a ventilator. These numbers highlight the urgent need to vaccinate expectant mothers.
The probability of experiencing severe COVID-19 infection varies as new variants remain constant in shifting the epidemiology. In fact, an analysis of 435 studies found a troubling pattern. Pregnant individuals who contract COVID-19 are at increased risk for needing intensive care, invasive ventilation, and death compared to non-pregnant individuals with similar characteristics. In addition to neuronal damage, the virus attacks vascular endothelial cells, specialized cells that are key to maintaining proper blood flow.
Risks Associated with Pregnancy and COVID-19
With an intersection of pregnancy and COVID-19, there are various unique experiences expectant mothers face. Rasmussen explains that pregnancy itself creates the risk for complications such as blood clots. This preexisting condition puts women at 5 times greater risk. It is understood that pregnancy suppresses women’s immune systems to protect the developing fetus. This natural immune suppression doesn’t help matters, greatly increasing the risk even further.
Neil Silverman directs the Infectious Diseases in Pregnancy Program, David Geffen School of Medicine, UCLA. I think he rightly calls for more of an aggressive lookout mentality in this area. He states, “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.” This recognition of risk is fundamental as health care professionals support pregnant people in making an informed choice about vaccination.
Pregnant women remain at greater risk for complications such as preeclampsia, preterm birth, and miscarriage, despite immunity conferred from prior infections or vaccinations. Sallie Permar shines a bright light on this alarming trend. The effects of these risks underscore the importance of vaccination during pregnancy.
The Impact of Vaccination on Maternal and Infant Health
Experts are unified in their message that getting a COVID vaccine while pregnant is the best way to reduce those risks. Angela Rasmussen, an infectious diseases expert, confirms that vaccination can help prevent severe disease in the event that a pregnant woman does get COVID-19. “It will protect the pregnant person from more severe disease,” she explains.
A study published in Nature Medicine illustrated that receiving a booster during pregnancy can significantly reduce newborn hospitalizations in the first four months of life. Despite these findings, challenges remain. The Trump administration has just now decided to no longer recommend the COVID vaccine for pregnant people. This decision has serious implications for insurance coverage for those vaccinations. As Neil Silverman puts it, “I don’t want to be that doctor who just says… you have to pay for it out of pocket,” highlighting the financial burden many may face.
Future Directions in Research and Recommendations
Experts expect that new data continuously as it relates to COVID-19 vaccines will offer further information to mothers and infants. These important findings will be influential in shaping recommendations going forward. Mary Prahl looks forward to further proof in the near future. We hope that this evidence will reinforce the benefits of receiving a COVID booster while pregnant. This time-intensive research is needed to establish best clinical practice and shape policy to support maternal health.
The research uncertainties and complexities related to COVID-19’s effect on pregnancy require a nuanced and delicate approach to public health messaging. As Angela Rasmussen points out, “While the mother does still have a functioning immune system, it’s not functioning at full capacity.” This nuanced understanding is key for healthcare providers counseling pregnant people on vaccination to address their available options.
Even when political climate threatens independence of vaccine recommendations, maternal vaccination will always be worth fighting for on scientific merits, experts pledge. “There is natural immune suppression so that the mother’s body doesn’t attack the developing fetus,” Rasmussen explains, reinforcing the need for vaccinations to ensure both maternal and fetal well-being.
