Early in COVID-19 vaccine rollout, the shots were considered safe during pregnancy. But then came the delta variant, and the Centers for Disease Control and Prevention sounded a new alarm.
It determined that pregnancy raises the risk of complications from COVID-19.
Last month, the CDC urgently called for those who are pregnant — or thinking of becoming pregnant — to get the vaccine.
We spoke with Sarasota's Dr. Washington Hill, an OB-GYN who specializes in high-risk pregnancies, about why the CDC recommendations changed over time.
HILL: Early in the pandemic, early being maybe 18 months ago, the Society for Maternal Fetal Medicine, American College of Obstetrician-Gynecologists (ACOG) and practicing physicians did not feel that COVID — at least the initial variant — was serious to the pregnant woman. We knew that certainly they could get the infection, they would show up in the emergency room, they will be counseled, and for the most part, most of them are asymptomatic, and would go home. And that's the way it started. But then it evolved.
And there were a couple of things that played a role in that. One, we had to deal with the delta variant. And then there were some reports, one, particularly from Mexico and another one from Israel published in our literature, that showed that with the new delta variant, particularly with that variant, that pregnant women were at significant risk for serious disease.
More numbers were showing up at the emergency room in our OB ECC — (obstetrics) emergency care centers. Those who were showing up were sicker, frequently, and had to be admitted to the hospital. And then once admitted to the hospital, regardless of the therapy or monitoring, etc., more ended up in the intensive care unit. And then when they ended up in the ICU, more ended up on the ventilator, and the results of being on a ventilator for a long period of time, more died. So over time, we found out, particularly with the publications, that we need to really stress to pregnant women and their providers that they needed to get the vaccine.
Was this a situation where the CDC guidance changed over time?
I think that's exactly what happened. And this is something that the public has had some difficulty understanding, and that is that science evolves. We don't do today what we will be doing in six months.
And then the CDC came out late in September with an urgent message. How serious was that warning and why did that come about?
I think that warning was serious. And it was based on data from other studies. It was recommended, and then it became urgent. With the delta variant, when I talked to my colleagues around the country who do what I do — high-risk pregnancy — they were all saying, "Boy, we're getting our butts kicked here because of the delta variant." And we need to be out and about counseling patients, and more importantly, counseling their providers that this is a different disease, women are getting sicker and dying. And we need to urgently get them vaccinated.
I know you follow the data closely, but there are some constraints to what we know about what’s happening to people who are pregnant. I would like to ask you how many pregnant women have died or how many have lost their fetuses as a result. But do we know that in Florida?
Unfortunately, we do not. Those questions are important to know; we don't have the data. We don't know. As of right now, how many pregnant women have died as a result COVID in the state of Florida, we know that some have, and we will we have a very robust maternal mortality review committee, and we'll be looking at those deaths in a year or so. But right now ongoing current data, we don't have it. We don't know how many women have died. We don't know how many have ended up in the ICU. We don't know how many fetuses have died, we don't know how much preterm labor, etc. And this type of data is very important, and when managed properly, can help us as physicians and as providers, and the public, and get learning more about this disease. It can also encourage the pregnant woman to get vaccinated.
Certainly, there is a lot of misinformation out there. Current data shows that nationwide about a third of pregnant women are vaccinated. With your patients, what do you do to convince them to get vaccinated?
I ask them, "Have you been vaccinated?" Fortunately, about half of our patients have been, and that's good. So a lot of them will tell me, "Yes, I've been vaccinated, I got my first dose," and they have a big smile, "I'm due to get the second one on such and such a day." So that's a good thing. I tell them, "Thank you." I also tell them that "you're one of our disciples, and we want you to go out and tell your friends and neighbors that you got vaccinated, and things went well."
And then others are hesitant. Some are hesitant and will never get vaccinated. And I think providers feel it is our job to give them the accurate information, the correct information. That's what I'm here for. And if I have done that, and they say, "Thank you very much, I choose not to get vaccinated," I say, "Well, please wear your mask."
And then the other half of those are waiting to deliver and they'll get it postpartum. We have a program at Sarasota Memorial Hospital where they are offered the vaccination up on the postpartum floor, and they can get it before they go home. And then there are others who say, "OK, I'll be in Thursday," still pregnant and get it. So it's a matter of meeting them where they are, talking to them, explaining it to them. You mentioned something earlier, there's a lot of misinformation. And we need to be about the business of trying to correct that misinformation.
People may have heard or read that it interferes with fertility or changes your menstrual period. These things are not true?
Right. They are not true. In terms of fertility, there is no evidence that this vaccine or any vaccine hurts a woman's fertility. If she's had difficulty getting pregnant, this is not going to hurt that more. There's no evidence her getting the vaccination will affect her fertility workup at all. And I've talked with a number of our ACOG infertility specialists.
The issue with menstrual irregularities is actually currently being looked at by National Institutes of Health. But there is no information at this time that receiving this vaccine makes woman's menstrual cycles more irregular.
What about timing? When is the right time to get it?
That's a great question. Should a woman get it before she's pregnant? First trimester, second trimester, third trimester, postpartum? There's no evidence that timing makes a difference. It's not going to be harmful during any of those periods of time. And we would encourage her to get it when she can.
The other question that always comes up is which one? And as has been mentioned by other authorities, the answer is whichever one is available. We do feel that the Johnson & Johnson vaccine, the “one-and-done” probably should not be given to the pregnant patient, because of that rare incidence of thrombosis and clotting. And many of us in obstetrics say we don't need to do anything in pregnancy to help women clot. They seem to be able to do that on their own very well.
So that we would encourage not the J&J one. And then the other point that comes up is, "Well, I received one vaccine and then I found out I was pregnant. Do I have anything to worry about?" Not at all. You need to just go ahead and get the next dose or when it's due.
And what are the main benefits of the vaccine in this population? I've read that there's some protection given to the child once the child is born. But if you're talking to someone who's pregnant, and they say, 'I don't know, should I really do it?' What do you say?
I try to divide it up into the baby and the mother. I think I've pointed out already the benefits to the mother. It can save her life. Clearly, a woman who's pregnant is at high risk. All over the country, they have ended up in the ICU. Unfortunately, all over the country, some are still in the ICU, and some die. So clearly, it is a benefit for a woman pregnant, or otherwise to receive the vaccine.
Now, the other part of the question is,"Well, what's it going to do to my baby?" And yes, we, we've taught women over the years. And that's why it's sometimes a hard sell, to be careful what you do during pregnancy, because of your baby and your fetus. But here's a situation where it's a benefit to the fetus, there is no evidence that either currently or in the trials that the fetus is harmed, or the pregnancy is harmed by receiving the vaccine.
Now, as you mentioned, the patient receives the vaccine, and then she develops antibodies, those antibodies have been found in the umbilical cord, which means that they have gone to the fetus. So they have then protected the fetus and will protect the newborn, we still have cases of COVID in newborn, and certainly in those that are two and three or four months old, some of that could have been prevented by the mother receiving the vaccine.
So all in all, it's a benefit to the fetus. It is a benefit to the newborn. And clearly it's a benefit to the mother. And I think it's that emphasis that the CDC said — to urgently to save our mothers, which have made us all say, let's get people vaccinated.
Editor's note: Health News Florida has reached out to the Florida Department of Health to ask for the state's data on maternal mortality due to COVID-19. As of publication time, we have not yet received a response.
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