By Katie McCrimmon and Kati Blocker
Health experts with the U.S. Centers for Disease Control and Prevention (CDC) have issued an urgent alert, strongly recommending that all pregnant and breastfeeding people should get vaccines to prevent COVID-19 as soon as possible.
That’s because the newest data are showing how dangerous COVID-19 can be during pregnancy, and only about 31% of those who are pregnant have thus far received COVID-19 vaccines.
The August death toll among pregnant women with COVID-19 marked a grim milestone — the highest number of deaths tied to pregnancy and COVID-19 during any month since the pandemic began.
The September death toll could be even worse once health experts tally the data on pregnancy and COVID-19. That’s because the highly transmissible delta variant has sparked a dangerous new wave of COVID-19 infections since June and health experts now know that unvaccinated pregnant people are at high risk for becoming critically ill or dying if they get the coronavirus.
“We know that pregnancy is associated with severe COVID-19 and neonatal outcomes,” Dr. Meaney Delman told vaccine experts during a CDC advisory committee hearing on Sept. 22.
“Some children will grow up without their mothers. Please get vaccinated,” Delman said.
Delman is the CDC’s lead expert on vaccines and pregnancy, including immunizations to protect against COVID-19 during pregnancy.
“Pregnant women with COVID-19 have a higher risk of maternal death, preeclampsia, preterm birth and stillbirth than pregnant women without COVID-19,” Delman said.
CDC experts don’t have the vaccine status of all of the pregnant people who have died of COVID-19 during the pandemic, but data from the COVID-19-Associated Hospitalization Surveillance Network (COVID-NET) indicate that approximately 97% of pregnant people hospitalized (either for illness or for labor and delivery) with confirmed SARS-CoV-2 infection were unvaccinated.
“Pregnant women with COVID-19 have statistically-significant, higher odds of ICU (Intensive Care Unit) admission, ventilation and extracorporeal membrane oxygenation (ECMO, a life-support system that pumps blood outside of the body to a heart-lung machine to keep people alive) compared with non-pregnant women of reproductive age with COVID-19,” she said.
In addition to suffering themselves, the babies born to women with COVID-19 also are at greater risk of suffering health problems and are more likely to need care in Neonatal Intensive Care Units. More newborns also are testing positive for COVID-19 now than during earlier waves of the pandemic.
CDC and UCHealth experts recommend COVID-19 vaccines for everyone who qualifies, and especially to protect against COVID-19 during pregnancy.
“Every pregnant woman should get the COVID-19 vaccine. It’s safe and I recommend getting it,” said Dr. Anna Euser, a UCHealth maternal-fetal medicine specialist who recommends COVID-19 vaccines for all of her pregnant patients and also received her own COVID-19 vaccines as soon as possible to protect herself and her newborn daughter.
Here is the newest information related to the CDC’s urgent alert on pregnancy and COVID-19:
- CDC experts “strongly recommend” COVID-19 vaccination before or during pregnancy.
- Getting a COVID-19 vaccine can prevent severe illness, death, and pregnancy complications related to COVID-19.
- Pregnant women who received their initial COVID-19 vaccines more than six months ago should consider getting booster vaccines. (Read more about COVID-19 vaccine booster doses.)
- Black people and Latinos are more likely to get seriously ill and die from COVID-19; therefore, it’s especially critical for pregnant women of color to get vaccinated as soon as possible.
- As of Oct. 4, more than 127,000 laboratory-confirmed COVID-19 cases have been reported in pregnant people throughout the pandemic, including more than 22,000 people who were hospitalized and 171 deaths.
- While pregnant people were not included in the clinical trials for COVID-19 vaccines, some study participants did get pregnant during the trials, and the vaccines did not have any unusual effects on the women or their babies.
- In addition, ongoing research also is showing that COVID-19 vaccines are both safe and effective during pregnancy.
- For instance, the CDC’s V-SAFE registry includes thousands of people who have volunteered to be studied after receiving COVID-19 vaccines. Among pregnant people who have received vaccines before or during pregnancy, researchers have found no unusual outcomes and no increased risk of negative events like spontaneous abortion (miscarriage), pre-term birth, still birth, birth defects or newborn admission to a neonatal intensive care unit.
- A separate ongoing study group called the Vaccine Safety Datalink is monitoring vaccine safety in real time. Researchers at the CDC and nine health care systems throughout the U.S. (including Kaiser Permanente and Denver Health in Colorado) have studied outcomes related to 105,446 pregnancies and found no increased risk of spontaneous abortion or still birth for women who had received COVID-19 vaccines.
- During past pandemics, stillbirths declined among women who were vaccinated for the flu, and researchers will be studying whether COVID-19 vaccination can also reduce stillbirths.
How to stay safe during the COVID-19 pandemic if you are pregnant or breastfeeding
The most important way that pregnant and breastfeeding women can stay safe is to get COVID-19 vaccines, says Dr. Natalie Rochester, an OB-GYN and medical director of UCHealth Greeley Hospital Birth Center, and an obstetrics expert at UCHealth Women’s Care Peakview Clinic in Greeley.
Rochester, herself, had preterm complications during one of her pregnancies and said she received great advice from her physician.
“He encouraged me as a patient to practice no-regrets medicine,” she said. “We all must continue to live life and care for our families; however, we must make smart decisions. Keeping ourselves and our family safe is important.”
Am I more susceptible to COVID-19 during pregnancy?
Yes. During pregnancy, women experience changes in their bodies that make them more susceptible to viral respiratory infections including COVID-19, Rochester said.
“Along with getting vaccines, pregnant women should continue to manage their pregnancy using the same preventive actions they always would to stay healthy, such as washing their hands and staying away from people who are sick,” she said.
Are there risks from COVID-19 for unborn children?
Health experts are still learning about all of the dangers that COVID-19 may pose for unborn children. It’s clear that COVID-19 is very dangerous for mothers, who may need to delivery their babies early if they become critically ill.
In addition, there is some evidence that babies might not grow at the rate they should when the mother is infected in the first or second trimester, and that increases with the severity of the mother’s illness.
Mothers with severe COVID-19 also have an increased risk of blood clots in the lungs and legs that can be detrimental to the fetus, Rochester said.
What should I do if I start feeling flu-like symptoms during my pregnancy? Could it be COVID-19?
Seek help and get tested for COVID-19 if you have any concerns.
Symptoms for COVID-19 include the following:
- Shortness of breath or difficulty breathing
- Muscle or body aches
- New loss of taste or smell
- Sore throat
- Congestion or runny nose
- Nausea or vomiting
High fever during the first trimester of pregnancy can increase birth defects. And other respiratory viral infections during pregnancy, such as the flu, have been associated with outcomes such as low birth weight and preterm birth, according to CDC experts.
“If you’re feeling sick, low-sugar hydration (such as water) is very important,” Rochester said. “You know you’re well-hydrated when your urine is a light yellow color.”
Rochester said it is OK for pregnant women to take Tylenol (not aspirin or ibuprofen) if they have a fever of 100.4 degrees or higher.
“If you’re drinking lots of fluids and have taken Tylenol but you’re not able to keep your fever down, or you’re vomiting or have other symptoms such as difficulty breathing, then we’d want you to call your health care provider immediately,” she said.
During the call, your health care provider can help advise you as to where and when you should be evaluated by a health care provider.
What will happen if I show up at the hospital pregnant and I have COVID-19 symptoms?
All pregnant women get tested for COVID-19 before they deliver their babies.
Anyone with mild COVID-19 symptoms should call their provider or clinic before they arrive, Rochester said.
“We will have questions about their symptoms and how far along they are in pregnancy to determine the next best steps,” she said. “Sometimes we may have you stay home, and sometimes we may ask you to come into the hospital. But we will screen patients to reduce the risk of you coming in and being exposed to other things when it’s not necessary.”
UCHealth currently allows a support person for laboring moms. Visit UCHealth’s visitation policy for the latest on visitation requirements.
“UCHealth has done a phenomenal job by never letting laboring moms be without support during this pandemic, which has not been the case around the country,” Rochester said.
How far along a woman is in her pregnancy, as well as severity in symptoms, will determine where she would be sent if she tests positive for COVID-19, Rochester said. When a mother is admitted, she may be placed in a special isolation room on the labor floor or within another unit.
“Providers and staff will wear protective garments when entering and will remove those garments and wash when exiting the room to help limit the spread of the virus,” she said. “And depending on the gestational age of the pregnancy, the patient may also undergo fetal monitoring.”
If I get COVID-19, should I be breastfeeding or giving my child my breast milk?
“Breastfeeding is recommended, as babies receive antibodies,” Rochester said. “Whether a mom pumps her milk or breastfeeds would be based on discussion with the pediatrician and mother prior to birth.’’
Always wash your hands with soap and water for 20 seconds before breastfeeding or expressing breast milk, even if you don’t have COVID-19. If soap and water aren’t available, you can use an alcohol-based hand sanitizer that contains at least 60% alcohol.
If you have COVID-19, practice safe hand hygiene but also wear a mask while breastfeeding and whenever you are within 6 feet of your baby. If there is another support person who can help care for the baby to limit exposure to COVID-19, that is recommended.
What should I do if I get COVID-19 while at home with my newborn?
If you get COVID-19, isolate by following CDC guidelines. You do not need to visit your health care provider if you have mild symptoms or no symptoms at all.
You can use UCHealth’s helpful tool to determine what isolation or quarantine guidelines you should follow. These guidelines include staying home, separating from others who live outside the home, isolating from healthy household members if possible, and always wearing a mask.
It is hard to separate a mother from her newborn, Rochester said, but mothers should wear gloves and masks when caring for their newborn.
Once the isolation period has ended, those caring for the newborn should continue to wash their hands before and after caring for the child but other precautions do not need to be followed.