Editor's Note: The information published in this story is accurate at the time of publication. Always refer to uab.edu/uabunited for UAB's current guidelines and recommendations relating to COVID-19.
The Delta variant brought a drastic increase in COVID-19 cases and hospitalizations, including an alarming number of pregnant women. The highly transmissible variant is an added threat to pregnant women and their babies. However, vaccine misinformation has led to high levels of vaccine hesitancy in the population.
Audra Williams, M.D., assistant professor in the University of Alabama at Birmingham Department of Obstetrics and Gynecology, and Jodie Dionne, M.D., associate director of UAB Global Health in the Center for Women’s Reproductive Health and associate professor in the Division of Infectious Diseases, clarify misinformation and discuss the effect of the Delta variant and vaccines on pregnancy.
Why should pregnant women receive the vaccine?
The COVID-19 vaccine is the best prevention for people, including pregnant women, from developing severe symptoms from the virus and reduces the risk of hospitalization and death.
In August, UAB Hospital saw a striking increase in the number of hospitalized pregnant patients with COVID-19. Physicians in UAB Medicine’s Division of Maternal-Fetal Medicine reported that 51 unvaccinated pregnant women were admitted. Of those, 12 were in the intensive care unit, almost six times more than in a typical month. The positivity rate in the UAB Maternity Evaluation Unit was also around 50 percent — showing high community spread in the region and a higher risk of pregnant women becoming infected.
“We see how those with comorbidities are at a higher risk of severe COVID, hospitalizations and death; pregnancy is a comorbidity,” Dionne said. “However, the Centers for Disease Control and Prevention reported as of August 2021 that only about 23 percent of pregnant women had received at least one dose of the COVID-19 vaccine.”
ICU physicians also saw the Delta variant putting more strain on their pregnant patients’ bodies, often causing the need for emergency cesareans or preterm births.
“If a mom is not oxygenating her body well, she is not oxygenating the baby well either,” Williams said. “That’s what may lead us to deliver the baby early. And there are lots of risks associated with prematurity — long-term neurological or gastrointestinal complications, among others. It’s not just the acute risk of the COVID infection these babies are facing, but long-term, lifetime risk.”
Williams also references a California study that showed an almost 40 percent increased risk for preterm birth in women who become infected with COVID-19.
When should pregnant women get the COVID-19 vaccine?
According to Williams and Dionne, the sooner the better.
Pregnant women have been eligible to receive the COVID-19 vaccine since it became available to the public. The vaccine was encouraged, but pregnant women were initially advised to talk to their provider about their best course of action. Since then, new data reinforces that COVID-19 vaccines are not only safe, but beneficial for mom and baby.
“The CDC, along with every major women’s health organization including the American College of Obstetricians and Gynecologists as well as the Society for Maternal-Fetal Medicine, now strongly recommends pregnant women receive the vaccine,” Williams said.
Additionally, researchers from Massachusetts General Hospital’s Edlow Lab found neutralizing antibodies — antibodies that clear the virus from the body — clearly crossed placentas and were passed to the baby. The lab also found mothers could pass protective antibodies to their newborns through breast milk.
However, it takes four to six weeks to receive both doses of the mRNA vaccines and for the antibodies to reach full protective potential. The earlier in a pregnancy, or even before a pregnancy, someone receives the COVID-19 vaccine, the more likely the antibodies will be passed to the baby.
“The best trimester to get vaccinated is whichever one you are in now,” Williams said. “Do not continue kicking the can down the road.
How do we know the vaccine does not have long-term side effects?
The history of vaccines and side effects provides a reference point for the COVID-19 vaccines, Dionne says. Vaccine side effects are linked to when one receives the vaccine. The majority of side effects develop in the first 24-48 hours, some occasionally occur three to five days later, and a small percent may not become apparent until 14 days following the injection. It is extremely rare to see vaccine side effects after eight weeks, and she notes seeing a side effect from the COVID-19 vaccine after this period “does not fit with everything we know about vaccines.”
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Dionne notes that, while pregnant women were not included in the original clinical trials, there were trial participants who became pregnant during the process and have since delivered healthy babies.
Unlike the COVID-19 virus, which has proved to have lasting negative effects on people and has caused maternal and fetal deaths, there is no evidence of long-term side effects of COVID-19 vaccines in pregnant women. Dionne reiterates that the benefits of the vaccine outweigh the high risk of contracting the virus with high case counts seen with the Delta variant across Alabama.
A pregnant physician’s story
Jessica Grayson, M.D., assistant professor in the UAB Department of Otolaryngology, received her vaccine while she was pregnant with her second child in December 2020. Besides a sore arm and some fatigue in the few hours after her shots, Grayson says the rest of her pregnancy was normal.
When asked why she decided to receive the vaccine, her decision boiled down to using the evidence-based data presented to decide the course of action that would protect not only her, but her family as well.
“Do not put yourself at risk, do not put your baby at risk, and if you have other children at home, do not take the risk that you are either too sick to care for them or that they have to grow up without you,” Grayson said. “It is not fair.”