Amid the buzz of excitement and relief with the COVID-19 vaccine rollout in December 2020, there was uncertainty. I was 31 weeks pregnant and found myself immediately eligible for vaccination as a high-risk obstetrician. At the time, those of us who were pregnant didn’t have any data on vaccine efficacy or safety to inform our decision. But we had experienced the devastation firsthand, and were desperate to finally have some internal PPE — for ourselves and for our babies. We also got vaccinated knowing that our actions would provide others with the data and peace of mind we didn’t have.
The decision to get vaccinated during pregnancy has been validated by study after study. As data on the myriad maternal and perinatal complications of COVID-19 have accumulated, so have data reassuring us the vaccines are safe and effective. The primary reason for vaccination is to prevent severe maternal disease, which in turn protects the baby. But maternal vaccination results in tangible benefits for babies too because maternal antibodies pass to the baby through the placenta. Importantly, vaccination results in higher antibody titers and longer lasting immune protection for the baby than natural infection. This passive immunity translates into a reduction in infant hospitalization. At the same time, disturbing increases in stillbirth (fetal death) and maternal morbidity and mortality occurred following the arrival of the Delta variant. A recent international case series of COVID-related stillbirths and neonatal deaths showed that SARS-CoV-2 can infect and effectively destroy the placenta — a nightmare scenario.
With two lives on the line and the ongoing threat of new variants, getting pregnant people vaccinated ASAP is a public health priority. Clearly, efforts to address low vaccination rates and vaccine hesitancy in pregnancy are urgently needed.
Confusion and Fear Among Pregnant Individuals
Pregnancy leads many to question decisions they wouldn’t normally think twice about (e.g. coffee consumption). Inconsistent advice from clinicians is common (see medication use and bedrest). Many pregnant individuals, understandably, become risk-averse, as they weigh the potential risks for the baby. A big part of my job is helping patients understand that maternal health and well-being are paramount and inextricably linked to fetal health. With COVID-19, this message has never been more critical. As some like to point out, the fetus tolerates maternal death poorly.
From the outset, messaging on COVID-19 vaccination during pregnancy has been confusing, uncoordinated, and muddied by misinformation. The data void that resulted from default “protection by exclusion” policies and underfunding of pregnancy and women’s health research was quickly filled with misinformation and fearmongering directed at women and people of reproductive age. Harmful and false narratives linking the vaccines to infertility, miscarriage, and fetal harm have been amplified in social media echo chambers. It’s no wonder patients question our confidence in the vaccines. As one patient put it plainly, “I can’t take over-the-counter medications during pregnancy but you’re telling me it’s safe to put a new vaccine into my body?”
Pregnant people are also judged — all the time. Questions from loved ones or strangers can easily insert doubt: “You’re not getting the vaccine while you’re pregnant, are you? Aren’t you worried about the baby?” Pregnant people desiring vaccination have been turned away from vaccine clinics and dissuaded by people administering the shots. Even prenatal care providers offered inconsistent advice before clear recommendations for vaccination in pregnancy were issued by professional medical organizations and the CDC in July and August 2021. Mom shaming has gotten worse during the pandemic, and the COVID-19 vaccines are yet another target.
Remember there are many reasons people are unvaccinated other than deeply held anti-vaccine beliefs. Many personal circumstances contribute to vaccine hesitancy. People who have experienced infertility, loss, or trauma in a previous pregnancy may be especially worried about doing something that “might hurt the baby.” Many pregnant people, especially women of color, experience mistreatment and discrimination when they interact with the healthcare system, which has likely contributed to racial-ethnic disparities in vaccination. A person may belong to a family or community that stigmatizes vaccination. Logistics (childcare or transportation issues) and lack of up-to-date information (e.g. current consensus guidelines recommending vaccination in any trimester) are also common reasons.
Getting More Pregnant Patients Vaccinated
We have a collective responsibility to amplify evidence-based messages and combat misinformation about the COVID-19 vaccine in pregnancy. The onus is on each of us. Do not underestimate your potential impact. You might be the first person to take the time to listen and clearly communicate the proven benefits and safety of the vaccines. I know clinicians have grown weary of vaccine conversations. But the key is to operate from the baseline assumption that all people want a healthy pregnancy and healthy baby. Use patience, empathy, and credibility as a healthcare professional to get your message across.
Here is my approach:
Example responses to common concerns:
Remember, don’t underestimate the impact you can have and don’t give up. Let’s get our pregnant patients vaccinated.
Jacqueline Parchem, MD, is a maternal-fetal medicine subspecialist and researcher at McGovern Medical School at The University of Texas Health Science Center at Houston. She is an advocate for COVID-19 vaccination during pregnancy and protecting pregnant people through research.