Getting a covid vaccine during pregnancy even more urgent as ICU beds fill up

Reviewed by Emily Henderson, B.Sc.Aug 12 2021

The Centers for Disease Control and Prevention is doubling down on its recommendation that people who are pregnant get the covid-19 vaccine, in light of new data underscoring its safety and effectiveness throughout pregnancy.

This recommendation comes at a time when doctors across the country are reporting an uptick in the number of unvaccinated pregnant people getting hospitalized with severe cases of covid.

The low vaccination rate in this group is striking, doctors note. As of July 31, only 23% of those who are pregnant had received at least one dose of vaccine against the coronavirus, according to CDC statistics.

“CDC recommends that pregnant people should be vaccinated against COVID-19, based on new evidence about the safety and effectiveness of the COVID-19 vaccines,” the agency said in updated guidance that echoes the urgent recommendation of leading medical societies. “COVID-19 vaccination is recommended for all people 12 years and older, including people who are pregnant, breastfeeding, or trying to get pregnant now or might become pregnant in the future.”

According to the agency, concerns among some people that the messenger RNA vaccines might increase the risk of miscarriage when given early in pregnancy are not borne out by the data.

Officials said miscarriage rates after getting vaccinated were similar to the expected rate of miscarriage in any group of pregnant people. Getting a covid vaccine is also safe later in pregnancy and while breastfeeding, the agency’s new analysis indicates.

Dr. Alison Cahill, a maternal-fetal medicine specialist and professor at the Dell Medical School at the University of Texas-Austin, said she has been telling all within earshot to get vaccinated. She works mostly with pregnant individuals who are sick with covid and sees the damage the coronavirus can do.

Cahill recalled treating an unvaccinated woman who came into her hospital with shortness of breath. Within 24 hours, she said, things got much worse, and the woman needed a tremendous amount of oxygen to stay alive.

“She was pregnant in her mid-trimester. So, if she had needed to be delivered, she would have had an extremely preterm baby with a high risk of having lifelong disability or even death,” Cahill said.

She said that within two days of being admitted to the hospital the woman could no longer breathe on her own. She was intubated and then put on a ventilator.

Eventually, the woman needed ECMO, extracorporeal membrane oxygenation, which is a machine that bypasses her lungs and oxygenates her blood for her. Cahill said she was on ECMO, which is often a bridge to a heart or lung transplant for critically ill people, for several weeks.

“She was eventually able to come off all of those things,” Cahill said. “She miraculously did not require a preterm delivery. She remained pregnant and after 2½ months in the hospital was able to go home.”

The baby was born healthy, but the woman was sent home and may face a lifetime of disabilities from covid. Cahill said it all could have been prevented if the woman had gotten vaccinated.

“I think that it’s just an incredible opportunity that we have in the United States, and everybody should avail themselves of this tremendous vaccine to prevent those types of things happening to people,” she said. “It’s really tragic.”

Such cases are why the American College of Obstetricians and Gynecologists, or ACOG, and the Society for Maternal-Fetal Medicine — the two leading organizations representing physicians and scientists who specialize in obstetric care — recommended on July 30 that all who are pregnant get a covid vaccine.

“It’s kind of a perfect storm situation,” said Dr. Mark Turrentine, an obstetrics professor at Baylor College of Medicine, who is also the co-chair of a covid workgroup for ACOG. “We have a highly infectious variant of covid-19 virus in a group of individuals that the majority are not immunized. So yeah, we are seeing a lot of sick people.”

“ACOG encourages its members to enthusiastically recommend vaccination to their patients,” Dr. J. Martin Tucker, president of ACOG, said in a written statement. “This means emphasizing the known safety of the vaccines and the increased risk of severe complications associated with COVID-19 infection, including death, during pregnancy.”

Vaccinating those who are pregnant has become especially urgent in states such as Texas, where the highly contagious delta variant currently makes up more than 75% of new cases. The percentage of people in Texas who are fully vaccinated is 44.6%, compared with 50.3% of the entire U.S. population. As infection rates climb in the state, Dr. Jessica Ehrig, obstetrics chief at Baylor Scott & White Medical Center in Temple, Texas, said she's seen a significant increase in the number of pregnant women being hospitalized and intubated; some have died. And those severe cases of covid are also dangerous for the fetus, she noted.

“Complications include preterm birth and prematurity, increased risk of preeclampsia for these moms — which can require preterm delivery,” Ehrig said recently at an Austin press conference on the topic. “And, unfortunately, also increased risk of stillbirth.”

It’s an especially dangerous situation when someone who’s pregnant gets a symptomatic case of covid, Turrentine noted.

“There is a threefold increase of intensive care unit admission,” he said, “two-and-a-half-fold increased risk of being put on mechanical ventilation or bypass support, and there’s even, you know, a little over a one-and-a-half-fold increased risk of death.”

Medical professionals and scientists don’t know exactly why those who are pregnant are at such high risk when they become infected with the virus, but they are concerned this population is especially vulnerable because so many of them remain unvaccinated.

Since April, the CDC has recommended vaccines for those who are pregnant as the best way to protect them and their babies from the coronavirus. Although people who are pregnant were excluded from the initial clinical trials of the three covid vaccines authorized for emergency use in the U.S., significant data gathered since then has shown the shots to be safe and effective in this group.

Turrentine said it’s important to stress that the benefits of getting vaccinated far outweigh any kind of risk. Especially for someone who is pregnant, he said, the costs of not getting vaccinated are just too high.

“I have seen some pregnant women get really sick. I mean, I have seen some die,” he said. “And, you know, you go into this business as an obstetrician-gynecologist because patients are young and they are healthy. And most of the time you have great outcomes. This is a bad virus.”

This story is from a reporting partnership with KUT, NPR and KHN.