FEATURE
PREGNANCY AND THE COVID-19 VACCINES AUTHOR Stanley Gall , MD
The COVID-19 pandemic has been present for at least one year . It has affected millions of people , especially older individuals , and it has affected women during pregnancy and postpartum . Importantly , vaccines have been developed for the general population , but not specifically for pregnant women . In an attempt to evaluate whether vaccines would be indicated during pregnancy , the following two questions should be answered : ( 1 ) What is the impact of COVID-19 infection on the pregnancy , on the woman and on her fetus ? and ( 2 ) What is the impact of COVID-19 vaccines on the pregnant woman and her fetus ?
There is increasingly strong data that pregnant women are more vulnerable to COVID-19 infection and other highly pathogenic respiratory infections . This is illustrated in a report on hospitalization rates which shows the rate for pregnant women with COVID-19 virus infection was 10 % compared to 2.8 % in non-pregnant adults aged 20-39 years . The study included 240 patients with 56.3 % of COVID-19 infections diagnosed in the third trimester , 27.9 % diagnosed in the second trimester and 15.8 % diagnosed in the first trimester . It was determined that 90.8 % had mild disease , 7.5 % had severe disease and 1.7 % had critical disease . The hospitalization rate for COVID-19 infected women was 3.5 fold higher among pregnant women ( 10 %) compared with non-pregnant adults aged 20-39 years ( 2.8 %) RR = 3.5 ; 95 % CI ( 2.3-5.3 ). Three pregnant women with COVID-19 infection died , giving a maternal mortality rate of 1,250 / 100,000 pregnancies . This mortality rate was 13.6 fold greater than the rate in similarly aged adults in the state of Washington which was 91.7 per 100,000 pregnancies . The deaths among pregnant women accounted for 9.4 % of COVID-19 related deaths for the age group .
An updated report from the CDC in October 2020 stated that pregnant women with symptomatic COVID-19 disease were at increased risk for intensive care unit admission , invasive ventilation and death . 1 Other reports have shown that pregnant women infected with COVID-19 virus are at increased risk for cesarean section , premature delivery and postpartum complications of fever , hypoxia and hospital re-admissions . 2 , 3 In these studies of maternal COVID-19 disease , there has not been evidence of primary fetal disease or abnormality .
A study on IgG antibody response in COVID-19 infected patients showed the IgG response was significantly higher in symptomatically pregnant women than in asymptomatically pregnant patients . IgM and IgG levels peaked at 15 days and 30 days after onset of symptoms . IgG was demonstrated in 78 % of neonatal blood and the serological levels in mothers correlated with the serological levels in the matched neonates . 4
It has become clear that pregnant women infected with the COVID-19 virus face greater risk for both hospitalization and adverse medical and obstetrical outcomes . No specific fetal or neonatal adverse outcome due to the COVID-19 virus has been described .
The risk for preterm delivery has ranged between 10 % and 25 % with rates as high as 60 % among women with critical illness . The primary risk to a pregnancy is from maternal illnesses . In a study of 409,462 women with symptomatic illness , the adjusted risk ratios in pregnancy versus those of similar age and not pregnant were 3.0 for intensive care admission , 2.9 for mechanical ventilation and 1.7 for death . 2
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