The CDC is officially recommending the COVID-19 vaccine for people who are pregnant. In September, the CDC reported that only 31% of expecting parents were vaccinated and the percentage has only increased slightly since then. Research now shows that those giving birth who have COVID-19 are five times more likely to end up in an intensive care unit and 15 times more likely to die while hospitalized. Emily West is an Obstetrician and Gynecologist with Kaiser Permanente Northwest and joins us to share how COVID-19 affects expecting parents and how the vaccine can protect both those who are pregnant and their babies.
The following transcript was created by a computer and edited by a volunteer.
Geoff Norcross: This is Think Out Loud on OPB. I’m Geoff Norcross. The CDC is clear in its recommendations. The agency says pregnant people should get vaccinated against COVID-19. Research shows that those who haven’t when they give birth are five times more likely to end up in the ICU or have a preterm birth. Despite that, the CDC says only about a third of pregnant Americans have gotten vaccinated. We’re going to talk pregnancy and vaccines now with Emily West. She’s an Obstetrician and Gynecologist with Kaiser Permanente Northwest. Emily West, welcome to Think Out Loud.
Emily West: Thank you for having me.
Geoff Norcross: So why is it that pregnant people are in such high danger of major illness or death if they have COVID-19?
Emily West: Early in the pandemic, we didn’t know how COVID-19 affected those who were pregnant. And initially we thought maybe they didn’t have more severe illness. But over the course of the pandemic, scientists and doctors around the world have been collecting data to see how COVID-19 affects those who are pregnant. And now we have a lot of data to show that just because someone is pregnant, they are at a higher risk of severe illness. As you mentioned in the intro they have about five times higher chance of needing to be in the ICU and a 14 times higher chance of needing intubation and a 15 times higher chance of mortality. So there are significant risks that are clear now in pregnancy.
Geoff Norcross: Yes but do we know why, what is going on in a pregnant person’s body that has them so susceptible to illness and death?
Emily West: Yeah, we’ve seen this with COVID as well as other things such as influenza where pregnant people tend to get more ill and we think that the reason is because their immune system is actually a little bit less active in pregnancy. It has to naturally adapt because the baby within them actually has a lot of foreign antigens. There’s a lot of DNA and proteins that are not from the mother herself. And so her immune system needs to down regulate to make sure that she doesn’t attack those foreign proteins. And we think that causes them to be more susceptible to a variety of illnesses, including COVID.
Geoff Norcross: What about the baby? If someone with COVID-19 gets pregnant or or they get it while they are pregnant, what does that mean for the baby?
Emily West: The biggest risk to the baby is really the severity of illness in their pregnant mother. When they do have more severe illness, it affects their cardiovascular and respiratory system and that can then pass to the baby and cause them to be getting decreased oxygenation levels. And so when we have patients with COVID-19 admitted to our hospitals, it’s very important that we’re monitoring the well being of their babies and doing everything we can to support the maternal health because really taking care of mom’s health is the best way to support and protect their baby.
Geoff Norcross: And on the other hand, if mom is pregnant and vaccinated, does that mean baby is extra protected too?
Emily West: It does. We know they have a much lower incidence of contracting COVID-19. And if they do have a breakthrough case, a much lower chance of needing hospitalization or higher level of care. And then when their babies are born, we know that 100% of babies born to women who are vaccinated show protective antibodies in their blood at birth. We also know that those antibodies are present in the breast milk. So it really is the best way for people to protect their babies.
Geoff Norcross: As we said, about a third of pregnant people in America have gotten the shot. That seems low to me. How does it compare to other populations?
Emily West: It is low. Our rate across the US is that about, for those who are 18 and over, at least 76% of people have at least had one vaccination. And so we know that this rate is much lower than the broader population. And those also can be stratified by ethnic background. And so we know for our black pregnant people, their vaccination rate is only at about 15%. So just like Amelia was talking about in the last segment, that they are at increased risk. They are also at increased risk because of these low vaccination rates.
Geoff Norcross: If you’re just tuning in, we’re talking right now about pregnancy vaccines and COVID-19. Emily West is an Obstetrician and Gynecologist with Kaiser Permanente Northwest. So what kind of questions are you hearing? What kind of concerns are you getting from your patients on this issue of whether or not to get vaccinated?
Emily West: You know, there’s a few misconceptions out there and so I always talk to my patients about this at every visit. And some of the things that they ask about or are concerned about is whether it might affect their fertility. Early when the vaccine came out, there was a false report on social media that taking the vaccine would cause you to be infertile. And we know that that’s just not true.
Geoff Norcross: I’m sorry to be glib, but if somebody is coming into your office pregnant, that sort of negates that argument, doesn’t it?
Emily West: Sure. Yeah, I hear you there. I do talk to a lot of women who aren’t pregnant or thinking about getting pregnant. So that’s one of the misconceptions. Another one is regarding if it would increase their rate of miscarriage and we know that you know the rate of miscarriage is about 11-16% of all pregnancies. So it’s more common than we think. But there’s been safety vaccine registries since we started giving the vaccine that have been monitoring the rates of adverse events in everyone including pregnant people. We know that the miscarriage rate is about 13% in those who are vaccinated and so we know that it’s the same as what we would expect to see in the background population. And then I would say another one of the concerns that they often bring up is just saying, you know these vaccines, they’re so new. They came out so quickly. How can I know that that’s safe when it seems to have just been developed so fast? And so I like to share with them that actually mRNA technology is not new. This is something that scientists started working with in the lab in the late 1970′s. And by the late 1980′s, they had realized that mRNA could be used for therapeutic approaches. So this is something that has been worked on by many scientists in our country for over 30 to 40 years. And so when the pandemic started, this technology was at their fingertips. And that is part of why it seemed like it happened so quickly is because they had the tools available and they applied it to COVID-19 and it worked. I feel so grateful that we’ve been able to develop and have three safe effective vaccines in our country.
Geoff Norcross: Okay. But what about concerns or objections that might be real? Are there actual medical implications for pregnant people when it comes to getting a vaccine?
Emily West: We talk about vaccination and pregnancy a lot because there are certain vaccines that we recommend for every pregnant person including influenza and Tdap or whooping cough. So there are vaccines that we don’t use in pregnancy because we know that there can be higher risks associated. Those are specifically live vaccines. We wait till after birth to give those. But we have a long track record of using vaccination in pregnancy and knowing that these are tools that can actually really help protect babies too. There’s a technique that we call cocooning to help protect the neonate. Babies have an immature immune system, so they are more at risk of severe illness including from COVID. And so we use cocooning, which is where we vaccinate the pregnant person as well as those who are going to be close caregivers. So their partners or maybe grandparents who are going to be around the baby. And we provide immunity and protection to the baby by vaccinating during pregnancy and making sure those near the baby are vaccinated.
Geoff Norcross: There are three vaccines available in America right now and of those three, is one of them safer than the other two?
Emily West: No, fortunately I mentioned the safety registries have been monitoring all three vaccines and there’s been no red flags that any of them cause a pregnant person to be at increased risk of adverse events. So we think that all three are safe and effective and the patient will receive any one that they choose.
Geoff Norcross: Are you finding that more expecting parents want to get vaccinated now?
Emily West: I would say it’s all across the spectrum. I think there’s been those who are very excited to receive the vaccine even early on including, I knew a lot of pregnant obstetricians when the vaccine first came out and they all chose to receive it. And then I’ve also had patients who are very hesitant and have continued to be. But I would say that over the course of the pandemic in having those conversations with them as they come back to see me every few weeks that I have had patients who went from not being ready to now being ready to go ahead and get vaccinated. Especially because we should be sharing with them this important data that COVID-19 does have significant risk in pregnancy and we have a safe, effective preventive measure in vaccination.
Geoff Norcross: Thank you so much.
Emily West: Thank you for having me.
Geoff Norcross: That’s Emily West, an Obstetrician and Gynecologist with Kaiser Permanente Northwest.
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