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Doctors urge pregnant women to get COVID vaccine as severe complications rise

Doctors and health officials are pleading with pregnant women to get vaccinated as more expectant mothers are ending up in the ICU with COVID-19 — and in some cases, they or their infants are dying — mostly in states with low vaccination rates.

On Thursday, the Louisiana Department of Health reported an “alarming increase” in critical illness or death amid the state’s fourth COVID-19 surge. Since mid-July, there have been 14 cases involving mothers who were unvaccinated, resulting in 6 maternal deaths and 10 fetal deaths.

“More COVID-19-related maternal and fetal deaths have been reported during the delta surge than the total number of COVID-19 severe pregnancy outcomes reported during the previous 15 months of the pandemic in Louisiana,” Louisiana Health Officer Dr. Joseph Kanter said in a statement. “It’s a tragic reminder of the vulnerability of pregnant individuals and their children to this highly contagious illness. Babies rely upon us and their parents for protection. We must do everything we can, including getting the COVID vaccine, to ensure safe and healthy birth outcomes.”

This month, Mississippi state health officials also sounded the alarm about fetal deaths doubling among unvaccinated pregnant women who contracted the virus. As of mid-September, 72 fetal deaths had been reported there since the pandemic began.

Alabama and Tennessee have also seen increases in pregnant people contracting the virus and developing complications and even dying.

Between March 2020 and July of this year, 266 pregnancy losses have occurred nationwide. And between January 2020 and this month, 159 pregnant women have died as the result of COVID-19 infections according to the U.S. Centers for Disease Control and Prevention.

Vaccine hesitancy among pregnant individuals remains high, with the most common reason for refusal being concerns over vaccine safety for mother and fetus.

But multiple studies have shown no increased risk of complications in pregnancies for women who got the vaccine, said Dr. Jennifer Thompson, associate professor of obstetrics and gynecology at Vanderbilt University.

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“We also know the vaccine provides the antibodies to baby and can help provide protection after baby's born,” she said. “We know that there's not a vaccine for babies yet, and being able to provide that protection is so important for them.”

And medical experts note pregnant women are more likely to develop complications if infected.

“This is true for most respiratory viruses in pregnant women, things like the influenza — if they get it, they are more likely to have complications,” said Dr. Jeanne Sheffield, director of the Division of Maternal-Fetal Medicine and professor of gynecology and obstetrics at the Johns Hopkins University School of Medicine. “That probably has to do with both the immune function of a pregnant woman but also, as the abdomen is getting bigger with a developing baby, they're less likely to clear secretions and develop complications such as pneumonia and such.”

A study published in the Journal of the American Medical Association in August looked at 869,079 pregnant women, including 18,715 women who contracted COVID-19 between March 2020 and February 2021. It found that women with COVID-19 had increased mortality, need for intubation and ventilation and intensive care unit admission.

Another study published in the Lancet Regional Health - Americas journal in July looked at 240,157 recorded births in California, nearly 9,000 of which indicated a COVID-19 diagnosis in pregnancy. 

Researchers found that, among people infected with COVID-19, there was a 40% increased risk for preterm birth, and there was a  60% increased risk of “very preterm” births, which occur at less than 32 weeks.

“The heightened association for [very preterm birth] is especially concerning, as these births carry the highest risks of infant mortality and adverse outcomes,” researchers noted.

Doctors have also observed an increased risk of stillbirth associated with COVID-19 infection. While experts are still studying why that is happening, “there are a couple of different thoughts on what could be related to that,” Thompson said.

“We know that moms with severe infection become significantly hypoxic, or have low oxygen levels, and when we have low oxygen levels, we're not providing oxygen to baby in a way that is necessary, as well as changes in blood pressure can also affect blood flow to baby, and when mom's critically ill, the body focuses on those aspects which are most important,” she said.

Both Thompson and Sheffield reiterated that the vast majority of people requiring intense medical care are unvaccinated.

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“Unfortunately, pregnant women happen to be one of those populations, even though we strongly, strongly support the COVID vaccine in pregnancy, or in all reproductive-age women,” Sheffield said.

The CDC, the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine all recommend that all eligible people, including pregnant and lactating individuals, be vaccinated against COVID-19.

“Pregnant women, please get vaccinated or if you're even considering pregnancy, please get vaccinated,” Sheffield said. “We know that the antibodies cross the placenta. We know that it provides some protection for the babies after birth, and the earlier they can get vaccinated before pregnancy, first trimester pregnancy, the better off we'll be.”

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Deidre Smith/Naval Hospital Jacksonville

Petty Officer 1st Class Schenita Little receives prenatal counseling from Cecilia Kipnis, an obstetrician at Naval Hospital Jacksonville’s Family Medicine Clinic.