COVID-19 and Pregnancy: What to Know

By Published On: March 9th, 2021

Q: Should pregnant women get a COVID-19 vaccine?

The initial COVID-19 infection seems to be decreasing, but there are new variants, the east coast and the west coast mutations, both moving toward the central part of the United States.

In attempts to vaccinate enough people to establish herd immunity, pregnant women are now being offered vaccination by obstetricians and health care providers. The Vaccine Adverse Reaction Reporting System (VAERS) collects reports of vaccination reactions. In pregnancy, the complication reported involved preterm delivery at 5 to 36 weeks and usually occurred a few days after getting the vaccination. A total of 34 preterm births have been reported. It is important to remember that this reporting system is voluntary, so there is no way of knowing whether there have been unreported incidents of preterm birth from a number of people after vaccination.

Many women do not realize that their immune systems are repressed when they are pregnant in order to protect the baby from the mother’s own immune system. I would advise pregnant women to wait until the third trimester at 35 weeks of pregnancy before receiving a COVID-19 vaccination. The baby is then old enough to survive preterm birth.

The Centers for Disease Control and Prevention (CDC) encourages pregnant women and breastfeeding moms to talk with their OB-GYN if they have questions about the vaccine. Pregnant women are at an increased risk for severe illness from the novel coronavirus, including intensive care (ICU) admission, mechanical ventilation and death. However, the CDC acknowledges there is limited data on the safety of the vaccine for people who are pregnant. Until findings are available from clinical trials and additional studies, it is maintained that getting vaccinated while pregnant (if in the recommended group for vaccination, such as healthcare workers) is a personal decision.

Q: What happens if I get COVID-19 while pregnant?

Most women who test positive for the coronavirus disease during pregnancy will not give COVID-19 to their unborn baby and will not make their baby sick. Researchers have cultured placenta membranes and amniotic fluid of pregnant patients who have COVID-19 during pregnancy and they have found no evidence of the virus in any infected person.

There has been some testing of the COVID-19 vaccine with pregnant women, but much testing is still going on. Pfizer will be testing the safety, tolerability, and immunogenicity in 4,000 pregnant women.

And finally, I’ve said it many times before: Take an extra precaution and get a pulse oximeter. Hypoxemia (a below-normal level of oxygen in your blood) is one of the signs of serious illness with COVID-19. Low blood oxygen levels show up long before shortness of breath or other symptoms of COVID-19. Get a baseline so that you know if something looks off. A baseline for healthy people is 90 or higher. When we see below 90, we start getting concerned.

If you choose to travel, choose safely. For example, you might choose to visit a family member or loved one in a remote rural town with few to no COVID-19 cases, but don’t travel somewhere that you’ll be in close contact with a lot of people and have trouble social distancing.

Masks and cloth face coverings are a subject of much discussion, but for some extra protection when you are going to be around other people, wear a face mask. It’s an additional safety measure that can only help you and your baby.

Q: What should I cover at my next prenatal care appointment concerning COVID-19?

Here are some specific questions to ask your doctor if you are pregnant NOW, during the coronavirus outbreak:

  • Have you already been exposed? You have the right to know whether or not your doctor has already been exposed to COVID-19 or not, and what the implications are either way. Have they been tested recently? When was the last negative test? Don’t hesitate to gather information to put yourself more at ease.

  • What will happen if I’m positive for COVID-19 when I deliver? Make a plan with your doctor so that you have one less thing to stress about if this occurs. As much as you don’t want your baby whisked away after birth, the plan to protect and test your new baby for the illness will include isolating you from her/him initially after birth.

  • Will my baby be immune if I have/had COVID-19? One Chinese case study found that a mother who had COVID-19 and delivered her baby via C-section passed immunity onto her baby but not the illness. Other studies, however, have shown cases of mothers passing the virus on to their babies.

  • Will you be the one delivering my baby? Often, the O.B. you’re working with may not actually be the one to deliver your baby. Asking this question now gives you an opportunity to understand who will be there during delivery, and who else you need to talk to about their COVID-19 exposure and testing.

  • Will I be allowed to have my support team in the birthing room with me? If you want your partner and/or a doula in the birthing room with you, this is a very important question to ask your doctor. The rules as we navigate the pandemic are constantly changing and under evaluation, so ask now, and ask again as birth gets closer.

Alan Lindemann, M.D., obstetrician and maternal mortality expert in Elgin, North Dakota