Why only one-third of pregnant women are vaccinated

Pregnant women are among the most health-conscious Americans — taking vitamins, limiting coffee, avoiding alcohol, exercising and eating well.

But only 31% are vaccinated against the dangerous COVID-19 virus, less than half the 69.7% vaccination rate of other U.S. adults and even lower than traditionally resistant groups, such as young men, low-income rural residents and conservative Republicans.

This startling vaccination gap is alarming experts because pregnant women with COVID are at elevated risk of severe illness. Compared to nonpregnant women, they’re more likely to end up on a ventilator. And their infants face higher odds of premature birth.

“Because of COVID-19, some children will grow up without their mothers,” said obstetrician-gynecologist Dr. Dana Meaney-Delman, the U.S. Centers for Disease Control and Prevention’s lead scientist for maternal COVID-19 immunization.

“If you are pregnant, breastfeeding, trying to get pregnant now, or might become pregnant in the future, please get vaccinated,” she urged, at a recent CDC meeting on vaccines.

Pregnant women are vulnerable to severe COVID-19 because of physiological changes during pregnancy, said experts. Their immune systems adjust to prevent the body from rejecting the fetus, so they may be less successful in fending off pathogens. In addition, the virus targets the woman’s lungs and heart, which are already stressed during pregnancy.

San Jose’s Sheila Collins, now in her second trimester of pregnancy, doesn’t have to be sold. She sought a booster shot not only for her own safety but for the health of her unborn baby, who is protected by maternal antibodies.

“I trust the science and the evidence,” said Collins, an attorney, who experienced no side effects from the booster, other than one day of extra fatigue. “I know that vaccines for infants are likely more than a year away from approval, and by getting a booster shot while pregnant, I can provide some immunity to my unborn child.”

So why are other women hesitant?

It’s not political, doctors say. “The majority of pregnant women are not ‘antivaxxers,’ ” said Dr. Stephanie Gaw, a UC San Francisco obstetrician who specializes in high-risk pregnancies. They willingly get vaccines to prevent flu, diphtheria, tetanus, whooping cough and other diseases, she said.

Their concerns are deeply personal, she said. “They’re worried because it’s new.”

In general, pregnant women tend to be cautious about doing anything that seems novel, doctors agree.

But resistance to COVID-19 vaccines has deeper roots.

One reason: All of the initial COVID-19 vaccine trials excluded pregnant women. This research approach stems from the thalidomide scare of the early 1960s when children exposed to the drug in utero were born with severe birth defects.

“Because there was essentially no data at the beginning” of the COVID-19 vaccine trials, “that fomented a lot of insecurities about how safe things are,” said Gaw. “Even just a kernel of insecurity will cause someone to wait for a little bit more for information.”

A second reason: Messaging from medical and public health groups was initially tepid, due to the lack of data. Even as it urged others to be vaccinated, the CDC called vaccination for pregnant women “a personal choice.”

Then purveyors of anti-vaccine disinformation jumped into the vacuum, warning of infertility and other unproven dangers on Instagram, Facebook and YouTube.

“On social media, there’s all sorts of bogus information that may be scaring off some pregnant women,” said Dr. Ronald Gibbs, clinical professor of obstetrics & gynecology at Stanford University School of Medicine.

“The recommendation to vaccinate pregnant women was a little late coming out,” he said. “So there’s a ‘catch up’ phenomenon going here.”

Since then, he added, major studies have proven vaccines very safe and effective in pregnant women. Every professional medical body — including the CDC, the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics — endorses the shots.

But the myth that vaccines are dangerous remains widespread. Here are the facts from studies and medical experts.

Q: Do vaccines increase the risk of miscarriage or birth defects?

A: No. A large CDC study of 2,456 pregnant women who received an mRNA vaccine found that vaccination is not associated with an increased risk of spontaneous abortion, the New England Journal of Medicine reported this month. Last June, a CDC analysis of spontaneous abortion, stillbirth, preterm birth and birth defects did not find any safety concerns for pregnant people who were vaccinated or for their offspring.

Q: Do vaccines cause menstrual cycle problems?

A: No. The CDC’s Vaccine Adverse Event Reporting System has recorded only a small number of minor and transient menstrual‐related adverse events among the more than 72 million women who have been vaccinated, according to this month’s Journal of Obstetrics and Gynecology.

“There’s no scientific evidence that it’s cause and effect,” said Gibbs.

Q: Do vaccines cause infertility?

A: No. Reports on social media blamed the similarity of proteins used in vaccines and egg implantation but that’s erroneous; the two proteins share a sequence of only four amino acids.  Another inaccurate theory, citing a rat study, alleged that the mRNA from the Pfizer and Moderna vaccines accumulates in the ovaries. This has since been disproven.

Q: Are vaccine side effects, such as fever, dangerous to the newborn?

A: No.  A large prospective study published in the Journal of the American Medical Association (JAMA) found that vaccination reactions after the Pfizer or Moderna vaccines consisted only of mild fever, similar among individuals who were pregnant, lactating, or planning pregnancy compared with nonpregnant individuals.

“That does not represent a risk to the pregnancy,” said Gibbs.

Q: Which vaccine is better for pregnant women?

A: While the Pfizer and Moderna vaccines have a slight edge over the Johnson & Johnson vaccines, they’re all safe and effective. “Get whatever you can, whenever you can,” said Gibbs.

Q: Are newborns protected by their mother’s vaccine?

A: Yes. An August study in the journal Obstetrics Gynecology found antibodies in the fetus after a mother’s vaccination as soon as five days after the first vaccination dose.

“This represents the only effective strategy that we have to immunize the newborn,” said Gibbs.

Q: Which trimester is best for vaccination?

A:  “It doesn’t matter,” said Gaw, although vaccination during the second and third trimester is most likely to transmit antibodies to the baby. “Get it as soon as possible.”

Q: Is it safe to breastfeed after vaccination?

A: Yes. A JAMA study, confirmed by a second study in this month’s issue of the journal Pediatrics, reported that antibodies were detected in the breast milk of vaccinated mothers, suggesting an additional protective effect for the infant. Another study found no serious side effects in 180 breastfeeding mothers or babies receiving either the Pfizer or Moderna vaccine.

“Immunity from breastfeeding and its possible impact on infant protection from (COVID-19) infection is a hope for breastfeeding girls and boys,” the Pediatrics researchers said, “for whom the prospect of vaccination in this pandemic is still a long way off.”

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