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Vaccinating During Pregnancy Has Become Even More Urgent As ICU Beds Fill Up

Aug 11, 2021
Originally published on August 11, 2021 7:03 pm

The Centers for Disease Control and Prevention is doubling down on its recommendation that people who are pregnant get the COVID-19 vaccine following new data underscoring its safety and effectiveness throughout pregnancy.

This recommendation is coming at a time when doctors across the country are reporting an uptick in the number of unvaccinated pregnant people getting hospitalized with severe cases of COVID-19.

The low vaccination rate in this group is striking, doctors note. As of July 31, only 23% of those who are pregnant had received at least one dose of vaccine against the coronavirus, according to CDC statistics.

"CDC recommends that pregnant people should be vaccinated against COVID-19, based on new evidence about the safety and effectiveness of the COVID-19 vaccines," the agency said in updated guidance that echoes the urgent recommendation of leading medical societies. "COVID-19 vaccination is recommended for all people 12 years and older, including people who are pregnant, breastfeeding, or trying to get pregnant now or might become pregnant in the future."

According to the agency, concerns among some people that the messenger RNA vaccines might increase the risk of miscarriage when given early in a pregnancy, are not borne out by the data. Officials say miscarriage rates after the vaccine were similar to the expected rate of miscarriage in any group of pregnant people. The vaccine is also safe later in a pregnancy and while breastfeeding, the agency's new analysis indicates.

Pregnant and struggling with COVID-19: risks of forgoing vaccination

It's kind of a perfect storm situation. We have a highly infectious variant of COVID-19 virus in a group of individuals that the majority are not immunized. So yeah, we are seeing a lot of sick people. - Dr. Mark Turrentine, an obstetrics professor at Baylor College of Medicine

Dr. Alison Cahill, a maternal fetal medicine specialist and professor at the Dell Medical School at the University of Texas at Austin, has been telling all within earshot to get vaccinated. She works mostly with pregnant individuals who are sick with COVID-19 and sees the damage the coronavirus can do.

Cahill recalls treating an unvaccinated woman who came into her hospital with shortness of breath. Within 24 hours, she says, things got much worse, and the woman needed a tremendous amount of oxygen to stay alive.

"She was pregnant in her mid-trimester. So if she had needed to be delivered she would have had an extremely preterm baby with a high risk of having lifelong disability or even death."

Cahill says within two days of being admitted to the hospital the woman could no longer breathe on her own. She was intubated and then put on a ventilator.

Eventually, the woman needed ECMO, extracorporeal membrane oxygenation, which is a machine that bypasses her lungs and oxygenates her blood for her. Cahill says she was on ECMO, which is often a bridge to a heart or lung transplant for critically ill people, for several weeks.

"She was eventually able to come off all of those things," Cahill says. "She miraculously did not require a preterm delivery. She remained pregnant and after two and a half months in the hospital was able to go home."

She faces a lifetime of disabilities from COVID-19

Fortunately, the baby was born healthy, but the woman was sent home with likely a lifetime of disabilities. Cahill says it all could have been prevented if the woman had gotten vaccinated.

"I think that it's just an incredible opportunity that we have in the United States, and everybody should avail themselves of this tremendous vaccine to prevent those types of things happening to people," she said. "It's really tragic."

Such cases are why the American College of Obstetricians and Gynecologists, or ACOG, and the Society for Maternal-Fetal Medicine — the two leading organizations representing physicians and scientists who specialize in obstetric care — recommended on July 30 that all who are pregnant get the COVID-19 vaccine.

"It's kind of a perfect storm situation," says Dr. Mark Turrentine, an obstetrics professor at Baylor College of Medicine, who is also the co-chair of a COVID-19 work group for ACOG. "We have a highly infectious variant of COVID-19 virus in a group of individuals that the majority are not immunized. So yeah, we are seeing a lot of sick people."

"ACOG encourages its members to enthusiastically recommend vaccination to their patients," Dr. J. Martin Tucker, president of ACOG, said in a written statement. "This means emphasizing the known safety of the vaccines and the increased risk of severe complications associated with COVID-19 infection, including death, during pregnancy."

How the delta variant is making things worse

Vaccinating those who are pregnant has become especially urgent in states such as Texas, where the highly contagious delta variant currently makes up more than 75% of new cases. The percentage of people in Texas who are fully vaccinated is 44.5%, compared with 50.2% of the entire U.S. population.

As infection rates climb in the state, Dr. Jessica Ehrig, the obstetrics chief at Baylor Scott & White Medical Center in Temple, says she's been seeing a significant increase in the number of pregnant women being hospitalized and intubated; some have died. And those severe cases of COVID-19 are also dangerous for the fetus, she notes.

"Complications include preterm birth and prematurity, increased risk of preeclampsia for these moms — which can require preterm delivery," Ehrig said recently at an Austin press conference on the topic. "And, unfortunately, also increased risk of stillbirth."

Why COVID-19 can be especially dangerous during pregnancy

It's an especially dangerous situation when someone who's pregnant gets a symptomatic case of COVID-19, Turrentine notes, as he breaks down the statistics.

"There is a threefold increase of intensive care unit admission," he says, "two-and-half-fold increase risk of being put on mechanical ventilation or bypass support, and there's even, you know, a little over a one-and-half-fold increased risk of death."

Medical professionals and scientists don't know exactly why those who are pregnant are at such high risk when they become infected with the virus, but they are concerned this population is especially vulnerable because so many remain unvaccinated.

Since April, the CDC has recommended vaccines for those who are pregnant as the best way to protect them and their babies from the coronavirus. Although people who are pregnant were excluded from the initial clinical trials of the three COVID-19 vaccines authorized for emergency use in the U.S., significant data gathered since then has shown the shots to be safe and effective in this group.

Turrentine says it's important to stress that the benefits of getting vaccinated far outweigh any kind of risk. Especially for someone who is pregnant, he says, the costs of not getting vaccinated are just too high.

"I have seen some pregnant women get really sick. I mean, I have seen some die," he says. "And you know, you go into this business as an obstetrician gynecologist because patients are young and they are healthy. And most of the time you have great outcomes. This is a bad virus."

This story is from NPR's reporting partnership with KUT and Kaiser Health News.

Copyright 2021 NPR. To see more, visit https://www.npr.org.

MARY LOUISE KELLY, HOST:

Just 23% of people who are pregnant in the U.S. have received at least one shot of the COVID-19 vaccine. Today, the CDC is doubling down on the recommendation that those who are pregnant get vaccinated. That's based on new findings that further support the vaccine's safety and effectiveness during pregnancy. This comes as doctors around the U.S. are dealing with an alarming uptick in COVID patients who are pregnant and getting hospitalized. Ashley Lopez of member station KUT in Austin reports.

ASHLEY LOPEZ, BYLINE: Since the pandemic started, Dr. Alison Cahill has been working with mostly pregnant women who are sick with COVID-19. A little while ago, she treated an unvaccinated woman who came into the hospital with shortness of breath. Within 24 hours, things got much worse, and she needed a tremendous amount of oxygen to stay alive.

ALISON CAHILL: She was pregnant, in her mid-trimester. So if she had needed to be delivered, she would have had an extremely preterm baby with a high risk of having lifelong disability or even death.

LOPEZ: Cahill is a maternal fetal medicine specialist at the Dell Medical School at UT Austin. She says within two days, the woman was intubated and then put on a ventilator. Eventually, she needed a machine to completely bypass her lungs and oxygenate her blood for her. Cahill says she was hooked up to all these machines for several weeks.

CAHILL: She was eventually able to come off all of those things. She miraculously did not require a preterm delivery, and after 2.5 months in the hospital, was able to go home.

LOPEZ: Fortunately, the baby was born healthy. But the woman was sent home with likely a lifetime of disabilities. Cahill says this all could have been prevented if the woman had gotten vaccinated.

CAHILL: I think that it's just an incredible opportunity that we have in the United States, and everybody should avail themselves to this tremendous vaccine to prevent those types of things happening to people. It's really tragic.

LOPEZ: This is why two leading medical organizations are urging that all pregnant people get the COVID vaccine. The CDC already recommended the vaccine for pregnant women. And new data show MRNA vaccines early in a pregnancy do not create an increased risk for miscarriage. It's also safe later in a pregnancy. Dr. Jessica Ehrig, the obstetrics chief at Baylor Scott & White Medical Center in Texas, says she's seeing a significant increase in the number of unvaccinated pregnant women hospitalized, intubated and dying. And their babies are at risk, too.

JESSICA EHRIG: Those complications include preterm birth and prematurity, increased risk of preeclampsia for these moms, which can require preterm delivery and unfortunately also increase the risk of stillbirth.

LOPEZ: Dr. Mark Turrentine, an obstetrics professor at Baylor College of Medicine, says it's a dangerous situation when a pregnant woman gets a symptomatic case of COVID.

MARK TURRENTINE: There's a threefold increase of intensive care unit admissions, 2.5-fold increased risk of being put on mechanical ventilation or bypass support. And there's even, you know, a little over a 1.5-increased-fold risk of death.

LOPEZ: This is another reason getting vaccination rates up is critical. And in some ways, pregnant people are catching up to other populations. It wasn't until April that U.S. officials OK'd vaccines for pregnant women.

TURRENTINE: So it's kind of a perfect storm situation. We have a highly infectious variant of COVID-19 virus in a group of individuals that - the majority are not immunized.

LOPEZ: Turrentine says it's important for doctors to stress for pregnant women that the benefits of getting vaccinated far outweigh any kind of risk. He says the costs of them not getting vaccinated are just too high.

TURRENTINE: I mean, I've seen some die. And, you know, you go into this business as an obstetrician, gynecologist, because patients are young, and they're healthy, and most of the time you have great outcomes.

LOPEZ: But Turrentine says he hopes that pregnant people who are on the fence about getting vaccinated roll up their sleeves and finally get their shots.

For NPR News, I'm Ashley Lopez in Austin.

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