Pregnant women urged to get COVID-19 shots: Infections, deaths skyrocket among vaccine-hesitant people
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* Kim Krisberg

![Figure1](http://www.thenationshealth.org/http://www.thenationshealth.org/content/nathealth/51/9/1.1/F1.medium.gif)

[Figure1](http://www.thenationshealth.org/content/51/9/1.1/F1)

Michelle Melton receives a dose of COVID-19 vaccine in Schwenksville, Pennsylvania, in February. While vaccination is recommended for pregnant women, uptake has been slow.

Photo by Hannah Beier, courtesy Reuters

Lagging vaccinations and rolled-back public health protections gave COVID-19 an opening to surge across Texas this summer. Amber Samuel, a Houston OB-GYN, said it was the hardest of her career.

“I’ve had a lot more pregnant patients with COVID-19, now more than ever,” Samuel, MD, MBA, a maternal-fetal medicine specialist, told *The Nation’s Health* in September.

While Texas does not collect COVID-19 information specific to pregnancy, front-line providers in Texas and around the U.S. have been reporting significant spikes in pregnant women who are severely ill with COVID-19. As of mid-September, Samuel said she was seeing patients infected with COVID-19 on a daily basis and had seven pregnant patients in the ICU, ranging in age from 19 to 42 — all of whom were unvaccinated.

In general, research shows pregnant women face increased risks for severe COVID-19. Anecdotally, Samuel said the COVID-19’s delta variant seems to be impacting pregnant patients worse than earlier waves.

“I’ve seen too many patients die,” she said. “It’s been as bad as it gets. And to have this confounding factor of not getting vaccinated — it’s just heartbreaking.”

Across the U.S., pregnant women have some of the lowest COVID-19 vaccination rates in the country. Only about 31% of pregnant women ages 18-49 had been vaccinated against the disease as of late September, according to the Centers for Disease Control and Prevention. Black pregnant women had the lowest COVID-19 vaccination rate, at 15.6%, compared to about 35% of white pregnant women, 25% of Hispanic pregnant women and 45.7% of Asian pregnant women.

From January 2020 to late September 2021, CDC reported more than 125,000 cases of COVID-19 among pregnant patients, leading to more than 22,000 COVID-19-related hospitalizations and 161 deaths.

Initial COVID-19 vaccine trials excluded pregnant women, which meant even though the group was eligible for COVID-19 vaccination, evidence-backed guidance lagged.

In August, however, following new data that vaccination does not increase the chance of miscarriage, as well as growing evidence on the dangers of coronavirus infection during pregnancy, CDC officially recommended that all pregnant people, those thinking about becoming pregnant and those breastfeeding get vaccinated against COVID-19. The American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine had already done the same weeks earlier.

The risks of COVID-19 during pregnancy make boosting vaccination particularly urgent. Research shows pregnant women with COVID-19 face higher risks of severe illness, including the need for hospitalization and intensive care. They also have a higher risk of death and are more likely to experience preterm birth and preeclampsia. A study published in April in *JAMA Pediatrics* that was based on 2,100 pregnant women across 18 low-, middle- and high-income nations found pregnant people with COVID-19 were 20 times more likely to die than those not infected.

Another recent study — one of the largest to date — also found higher risks. Published in August in *JAMA Network Open*, the study involved more than 869,000 women who gave birth at a U.S. medical center between March 2020 and February 2021, including more than 18,700 diagnosed with COVID-19. Researchers found that women with COVID-19 were more likely to be admitted to the ICU, need intubation, experience preterm birth and die in childbirth. Among the study’s cohort, women with COVID-19 were more likely to be Black or Hispanic.

“Women with COVID-19 were 10 times more likely to die than women without it,” study co-author Jennifer Jolley, MD, an associate clinical professor at the University of California-Irvine Medical Center, told *The Nation’s Health*. “Anything that makes the rate that much higher is quite distressing.”

Fonda Mitchell, MD, an OB-GYN at Southeast Permanente Medical Group in Duluth, Georgia, also reports seeing more pregnant patients severely ill with COVID-19 during the delta wave. Compared to last year, she said more of her patients with COVID-19 are being admitted to the ICU and more are undergoing unscheduled deliveries, often to relieve respiratory stress on the woman.

“I’ve managed pregnant patients with the flu who progressed to pneumonia, but this is like that on steroids,” Mitchell told *The Nation’s Health*.

Mitchell said she often hears hesitancy about COVID-19 vaccines from her patient population. She leans on personal stories of treating unvaccinated pregnant women who become acutely ill with coronavirus to help persuade patients to get immunized, including stories of women whose babies survive, but who never return home themselves. Because many pregnant patients say they plan to get vaccinated after delivery, Mitchell said local hospitals have started offering COVID-19 vaccines in the days following childbirth.

“Occasionally, I’m able to talk someone into it,” she said. “You just have to lead with the science and hope something sticks.”

Tamika Auguste, MD, an OB-GYN in Washington, D.C., and a fellow-at-large for the American College of Obstetricians and Gynecologists, predicts COVID-19 vaccination rates will pick up among pregnant women, as more data and real-life experiences make the benefits and safety of vaccines during pregnancy clear. The swell of recent vaccine requirements will also likely push the rate up.

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Only about 31% of pregnant women ages 18 to 49 had been vaccinated against COVID-19 as of late September, according to CDC, with wide variations by race and ethnicity.

Photo by Fly View Productions, courtesy iStockphoto

“OB-GYNs are feeling more confident in the data and in guiding patients toward vaccination,” said Auguste, noting that the lag in COVID-19 vaccine data should be a wake-up call to include more pregnant women in all clinical trials. “These can be lifesaving conversations.”

Auguste said she expects future data to show that COVID-19 and its disproportionate impact on communities of color worsened already- stark disparities in maternal health and mortality. Even before COVID-19, Black women in the U.S. were three times more likely to experience a pregnancy-related death than white women.

“Is COVID-19 exacerbating health care disparities among women of color?” she said. “Absolutely — 100%.”

Even with growing safety data and daily headlines about preventable deaths, misinformation remains a major barrier to persuading pregnant women to get immunized, said Chicago-based OB-GYN Maura Quinlan, MD, MPH.

Also an associate professor at Northwestern University Feinberg School of Medicine, Quinlan said she confronts falsehoods about COVID-19 vaccines and pregnancy on a daily basis at the clinic where she practices.

Vaccine hesitancy among pregnant patients is certainly not new, Quinlan told *The Nation’s Health*. However, she said the mainstreaming of vaccine misinformation during the pandemic and its rapid spread on social media have become overwhelming barriers to overcome in the exam room. When trying to persuade patients, Quinlan also leads with the science on COVID-19 vaccine benefits for both woman and fetus. But she said the experience has been “so incredibly frustrating, it’s hard to imagine that those saying ‘no’ (to the vaccine) will budge.”

“I’m at my wit’s end,” Quinlan said about vaccine misinformation. “At this point, it’s killing people.”

Back in Houston, Samuel said she discusses COVID-19 vaccines with pregnant patients “all day, every day” and reported a recent uptick in those seeking out shots. She is not surprised that pregnant women have much lower COVID-19 vaccination rates than the general public, pointing to the lack of early data on pregnancy and COVID-19 vaccines that left a gap where misinformation quickly stepped in.

But with so many news reports of COVID-19 hospitalizing and killing unvaccinated pregnant women, Samuel said she has to believe more women will change their minds.

“I don’t think any of these (vaccine) decisions people are making are coming from a bad place — people are trying to do what’s best for themselves and their families,” Samuel said. “I don’t always agree with it, but I understand it.”

Vaccine hesitancy, misinformation and disparities will be discussed during myriad scientific sessions at APHA’s 2021 Annual Meeting and Expo. To view the meeting program, visit [www.apha.org/annualmeeting](https://www.apha.org/annualmeeting).

For more information on COVID-19 vaccination while pregnant or breastfeeding from CDC, visit [bit.ly/covid19pregnant](https://bit.ly/covid19pregnant)

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