The Covid-19 pandemic has been riddled with question marks, but one thing at least is very, very clear: contracting Covid during pregnancy is BAD NEWS for you and your baby.

Yes, the overall chance of a severe reaction to Covid-19 infection is low, but pregnant people and recently pregnant people (for at least 42 days postpartum) are at significantly increased risk for severe illness from Covid-19 compared to non-pregnant people – especially those who are over 35.
 

What do we mean by “severe illness?” Think: hospitalization, intensive care unit (ICU), ventilator, and possibly even death. Not fun, right?

And as an organization dedicated to stillbirth prevention, what’s most concerning to all of us at PUSH is that there seems to be an alarmingly sharp spike in stillbirth rates during the Covid pandemic, especially since the advent of the Delta variant.

Let’s look at the numbers.

Covid-19 Risks to Your Baby During Pregnancy
Research shows that, compared to pregnancies not affected by Covid, babies whose moms were diagnosed with Covid-19 during pregnancy were:

• 59% to 200% more likely be premature, and 60% more likely to be born before 32 weeks

• Twice as likely to experience respiratory distress

• 2.5 times as likely to have severe complications

• Two to four times (since Delta variant) as likely to die

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Covid-19 Risks to Pregnant (& Recently Pregnant) People
Research shows that, compared to pregnant women who did not contract Covid, those who were diagnosed with Covid-19 during pregnancy were:

• 65% more likely to need a c-section

• Almost twice as likely to have preeclampsia

• More than twice as likely to have severe heart complications and blood clots

• 5 times as likely to be admitted to the ICU

• 13 times as likely to need a ventilator

• 17 to 22 times more likely to die

 

And some of these increased risks held true even for asymptomatic infections (pregnant women who tested positive for Covid, but had no symptoms) – even though these moms felt fine, they were 25% more likely to have complications, and 65% more likely to suffer preeclampsia.

To date, hundreds of thousands of pregnant people have received the Covid-19 vaccine and their reactions and pregnancy outcomes have been closely tracked. From these data, we can see that:

 

The Covid vaccine DOES protect against dangerous Covid symptoms
In a study of more than 10,000 pregnant Covid-19 patients, those who were vaccinated had significantly lower odds of severe/critical Covid symptoms.

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The Covid vaccine does NOT cause pregnancy loss or infertility
The risk of miscarriage/stillbirth is the same in vaccinated vs. unvaccinated pregnant people. This is because the Covid vaccine does not appear to cause any damage to the placenta (but Covid infection definitely does!). Furthermore, there is no evidence to support the unfounded rumor that the Covid-19 vaccine causes infertility or makes it more difficult to get pregnant.
 

The Covid vaccine does NOT have significant side effects for pregnant people
Adverse reactions to the vaccine are no more likely in pregnant individuals than in the general population.
 

The Covid vaccine does NOT cause pregnancy complications for mom or baby
Pregnancy complications and poor outcomes for newborns were no more likely for individuals who received a Covid vaccination compared to those who didn’t. This includes things such as gestational diabetes, preeclampsia or hypertension, fetal growth restriction, preterm birth, congenital anomalies, and neonatal death.
 

The Covid vaccine is NOT untested or unproven
Though developed at record speed, no corners were cut in creating the Covid-19 vaccines. A variety of factors contributed to accelerating the availability of a Covid vaccine, including: decades of previous work studying other viruses such as SARS, MERS, and HIV; widespread urgency and public support which made it easier to find eager test subjects; the astronomical rate of speed at which Covid spread, allowing the vaccine’s effectiveness to be tested more quickly than usual; “jumping the line” on the FDA’s waitlist of approvals; and a massive influx in cash funding that enabled pharmaceutical companies to make big bets on manufacturing large quantities of vaccines before testing was complete (in hopes it would actually be effective and approved!), which enabled distribution efforts to hit the ground running.
 

Worried about other things you’ve heard?
This podcast from our friends at Mommy Labor Nurse features great discussion about common concerns that many expectant families have about the Covid-19 vaccine and pregnancy, as does this Instagram Live interview between Tommy’s PregnancyHub and PUSH Medical Advisor (and leading stillbirth researcher) Dr. Alexander Heazell.

Covid Vaccine Benefits to Baby

With developing immune systems and high vulnerability to illness, newborns are critically dependent on the “herd immunity” of those around them to protect them from disease, and Covid-19 is no exception. The more individuals in their household that are vaccinated, the safer baby will be.

Encouragingly, early evidence is also indicating that antibodies created by the Covid-19 vaccine get passed on to your baby during pregnancy – that means that (similar to the TDAP vaccine), getting vaccinated during pregnancy may provide some level of protection to your newborn as well.

After vaccination, Covid-fighting antibodies have also been found in breastmilk, another form of passive immunity which can help to keep your baby safe.

Covid Vaccine Benefits to Parents
The Covid-19 vaccine is proven to work. It’s just as effective in pregnant people as in anyone else. And it’s far more effective than any natural immunity you may have acquired from contracting Covid-19.

In short, vaccination is by far the best tool we have to protect against severe complications from Covid-19.
 

And the benefits don’t stop at mom! Covid-19 infection has been shown to cause male infertility and erectile dysfunction, so vaccination is also a great way to keep your partner-in-baby-making in tip top form!
 

The Scientific Consensus
Because of the evidence above, the consensus amongst the most respected scientific institutions in the world has been to recommend that all pregnant people receive a Covid vaccine. See their official statements here:

US Centers for Disease Control and Prevention (CDC)
American College of Obstetricians and Gynecologists (ACOG)
Society for Maternal-Fetal Medicine (SMFM)
Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN)

American Society for Reproductive Medicine (ASRM)

American Academy of Pediatrics (AAP)
American Medical Association (AMA)
World Health Organization (WHO)
United Nations Children's Fund (UNICEF)
Mayo Clinic
March of Dimes
Tommy's
Canadian Health System
UK Royal College of Obstetricians and Gynaecologists (RCOG)
 

With the backing of our medical advisors, PUSH’s official recommendation is the same: the evidence is overwhelmingly positive that Covid-19 vaccination during pregnancy is safe and effective, and is the best way to keep yourself and your vulnerable newborn baby safe. That goes for both initial vaccination and boosters during pregnancy.
 

Only you can weigh your individual risk factors and decide if you agree with these assessments, but we hope the data linked above will help you form a conclusion that you feel confident about.
 

Who Should NOT Receive a Covid Vaccine?
The only people who are currently NOT recommended to receive a Covid vaccination are those who have a known allergy to a component of the Covid-19 vaccine or have had a severe allergic reaction (e.g., anaphylaxis) after a previous dose the Covid-19 vaccine.

If you’ve had a severe reaction to other vaccines, you should speak with your doctor to weigh the risks and benefits of the Covid vaccine, but in most cases can usually still safely receive the Covid vaccine.

If you are immunocompromised or have underlying medical conditions, not only is the Covid vaccine considered safe for you, it is generally considered to be even more important, as the risks of Covid infection are event greater to those who are immunocompromised or have underlying conditions. For those who are immunocompromised, be sure to mention this to your doctor, as you may require additional boosters and extra precautions to protect yourself and your baby.

Vaccinated or not, you know the drill:

• Mask up

• Keep a 6 foot distance from anyone who doesn’t live with you

• Avoid crowds and poorly ventilated indoor spaces

• Wash your hands often with soap and water, and be vigilant with the hand sanitizer

• Stay away from anyone who may have been exposed to Covid, or who is showing potential symptoms

• If anyone in your household is exposed to Covid, follow guidance to isolate/quarantine to the best of your ability

 

Whether you’re talking about Covid-19, other infections, or stillbirth in general, prevention is always your best bet! 

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FYI: Stillbirths Are On the Rise During the Pandemic
Though the final numbers aren’t in, it’s clear that stillbirth rates - especially since emergence of the Delta variant - have been rising during the Covid-19 pandemic, likely due to a combination of both Covid infections and changes to routine prenatal care which have resulted in vulnerable babies and warning signs of at-risk pregnancies being missed.

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Mommy Labor Nurse has an awesome guide to pregnancy and birth during Covid, and particularly how to be an empowered pregnant person (our favorite kind!) during Covid.

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Remember: It’s more important than ever to #KnowYourNormal, #CountTheKicks, #AlwaysAsk, and especially, #UseYourMomVoice. (And never hurts to #SleepOnSide or to ask your provider to #MeasureThePlacenta, either!) 

I’ve Got Covid – Now What?
As stillbirth parents, we know better than anyone that sometimes you can do everything right, and still get stuck with the short end of the stick. So if you’ve contracted Covid despite your best efforts, please know that it’s not your fault – we can attest that far too often, bad things happen to people who don’t deserve it. 

If you suspect or have been diagnosed with Covid, the first thing to do is contact your medical provider (see #AlwaysAsk). Given the risks of severe complications during pregnancy, it’s imperative that you and baby are closely monitored, even if your symptoms are mild or asymptomatic. Don’t hesitate to request extra monitoring now and throughout the rest of your pregnancy (see #UseYourMomVoice).

Especially be on the lookout for worsening symptoms and – like with anything else during pregnancy – DO NOT WAIT to contact your provider at the first sign of any changes. Some warning signs that warrant an immediate call to your doctor:

• Worsening shortness of breath

• Rapid or labored breathing

• Fever (greater than 102 °F or 39 °C) that does not respond to over-the-counter medicines

• Can’t keep down water or needed medications

• Pulse oximeter readings of less than 95% (note: for non-pregnant people, the cutoff is 92% - pregnant people need more oxygen!)

• Chest pain that worsens when you breathe, cough or sneeze

• Confusion or lethargy

• Bluish lips, face, or fingertips

• Worsening muscle/joint aches and pains

• Pregnancy red flags such as preterm contractions, vaginal bleeding, or altered fetal movement (see #KnowYourNormal)

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In terms of treatment, most of the tools available to other Covid patients are considered safe for use during pregnancy as well. Some things to ask your doctor about: 

• What warning signs should I be looking out for? (Be sure to share with your partner/family!)

• How do I get help if I have concerns about my symptoms and it’s outside normal office hours? (Also see Advocating For Yourself)

• I’ve read that monoclonal antibodies such as Bamlanivimab and Casirivimab have been effective for treating mild to moderate cases of Covid. Is that something you would recommend in my case?

• I know blood clots are common in pregnancy and common in Covid patients. At what point would you consider putting me on blood thinners?

• I’ve read that there are no known risks to my baby with the anti-viral medication Remdesivir. Do you recommend the use of that medicine in my case?

• At what point would you recommend the use of steroids such as Dexamethasone? I read it’s only recommended for patients who require supplemental oxygen or ventilation?

• I know that antibiotics don’t treat viruses like Covid, but would you recommend them if I also came down with pneumonia as a result of my Covid infection?

• What factors are you considering to decide when is the best time to deliver my baby? What would prompt you to push for an early delivery?

Being pregnant in a pandemic is no party, but you don’t have to go it alone! Remember to review our #EmpoweredPregnancy tips and don’t hesitate to reach out with any questions.