LEWISTON – Dr. Rebecca Brakeley was planning for her third child when COVID-19 vaccinations became available for front-line health care workers in December 2020.
“Obviously, as a (woman of) child-bearing age, you don’t want to put anything in your body that would compromise your fertility or your health,” Brakeley, a pediatric hospitalist at Central Maine Medical Center in Lewiston, said Tuesday.
So, she looked at the facts.
“And luckily, there was a lot of great information, especially as we’ve gone on, that show that these are safe vaccines.” She completed the two-shot series of the Pfizer-BioNTech vaccine.
Ten months later, Brakeley, who is six months pregnant, got her booster shot.
The U.S. Centers for Disease Control & Prevention late last month recommended a booster dose — a third shot of the Pfizer vaccine at least six months after the initial inoculation series — for those at highest risk of exposure or severe illness.
The U.S. CDC added pregnancy to its list of conditions that put individuals at increased risk of severe illness from COVID in May.
“Because you don’t want to attack your own fetus in your body, women’s immune systems are down during pregnancy. And we’re finding that pregnant women are, just like with influenza, we’re at more risk for severe disease as well with COVID-19,” Brakeley said.
Being both a health care worker and pregnant, Brakeley was “double eligible,” in her words.
“To protect myself and my fetus, and promote antibody production for my breast milk, I chose to get my third shot — which is a booster shot — last week, when it was first available to me,” she said.
But the fact that Brakeley got her primary vaccine series in the first place and is now pregnant makes her somewhat of a rarity.
Nationwide, only 33% of people who were pregnant between Dec. 14, 2020, and Oct. 2, 2021, were fully vaccinated before or during their pregnancy, according to the U.S. CDC’s COVID data tracker. Maine-specific data on vaccinations among pregnant women is not available.
In an “urgent” advisory late last month, the U.S. CDC said that it “strongly recommends COVID-19 vaccination either before or during pregnancy because the benefits of vaccination for both pregnant persons and their fetus or infant outweigh known or potential risks,” of the vaccine.
As of Oct. 4, there have been 127,193 cases of COVID among pregnant women in the U.S. since late January 2020, and 171 deaths. About 13% — 22 deaths — occurred in August this year, the single-month record. The CDC has no data on the difference in hospitalization and death rates between vaccinated and unvaccinated pregnant women.
As of Sept. 16, of the 8,249 births registered in Maine this year, 391 indicate suspected or confirmed COVID during pregnancy in the birth records, data provided by the Maine CDC shows. There has been only one maternal death, which is death during or within one year of pregnancy, where COVID was listed as an underlying cause. There have been no COVID-related deaths among fetuses or newborns.
The U.S. CDC said in its advisory that COVID in symptomatic, pregnant women carries twice the risk of admission into intensive care and increases the risk of death by 70% compared to nonpregnant women.
“We’ve seen an increase of severe disease in moms, but also risk for the fetus for premature delivery, sadly, stillbirth or complications post-delivery,” Brakeley said.
“And so, knowing this and knowing that — now that we do have quite a bit of data, an abundance of data, really, to show that the vaccine is safe in pregnant women — we’re urging people to get vaccinated to prevent (those) much higher risks of complications in the mom and the fetus.”
It’s routine that pregnant women are not included in clinical trials, Brakeley said, but there have been a number of completed and ongoing studies conducted in both the U.S. and abroad that show vaccines are safe and effective for pregnant women and the fetus.
“There has been now extensive experience with pregnant women getting the COVID-19 vaccine and not experiencing any side effects,” Maine CDC Director Dr. Nirav Shah said at a media briefing Wednesday.
“Nothing suggests that the vaccine is harmful either to them or to the baby,” he said.
On the other hand, “pregnant women, when they get COVID, have worse outcomes than their nonpregnant counterparts,” Shah said.
The other incentive that pregnant or breastfeeding women have to get vaccinated is that some of that vaccine-induced immunity is passed along to the baby, either in utero or through breast milk.
“So, that’s like the second tier of protection. It reduces risk during pregnancy but also for the baby going forward,” Brakeley said.
The “degree of protection” in newborns can wane, however, which is why Shah said it’s “all the more reason why it’s important for those who are with the baby — mom, parents, grandparents — for everyone around the baby they be vaccinated, to create as much of a protective bubble as possible.”
Though data from the U.S. CDC show that, in 2020, the majority of women with a confirmed case of COVID-19 carried their pregnancies to term and without complications related to COVID, that data is only through December 2020, which means is does not indicate if and how the delta variant affects pregnant women.
Studies have shown the delta variant to be more contagious and lethal than the original strain of the virus. It began spreading rapidly in the U.S. and in Maine over the summer and is now the predominant strain.
It is not clear if the high number of deaths due to COVID among pregnant women in August — the single-month record since the pandemic began — is related to the delta variant.