Why flu, COVID-19, and other vaccines are strongly recommended during pregnancy

Amid renewed urgency in the call for COVID-19 vaccination and boosters, Cleo’s Clinical Lead for Birth Outcomes helps distill all of the most current evidence and recommendations for vaccination during pregnancy.

Lost in the larger national discussions around vaccination has been the subject of pregnancy. Pregnant people are among those at increased risk of serious illness and hospitalization from COVID-19. However, their vaccination rates don’t align with this increased risk; they have unfortunately lagged behind.

A recent estimate of the vaccination rate among pregnant women in the U.S. is around 33% with even lower rates among some communities of color, demonstrating continued racial disparities in access to care and outcomes. The COVID-19 vaccine, among others, has not only been proven safe and effective for pregnant people, it is strongly recommended for them. And in light of new Delta and Omicron variants, the need for vaccinating to protect oneself while pregnant or otherwise is even greater.

At Cleo, we believe in providing families the information they need to be empowered advocates in their family’s health journey. Cleo members who are expecting receive personalized push notifications from the Cleo app with information about what vaccines are needed based on the stage in their pregnancy. Cleo’s Clinical Lead for Birth Outcomes, Certified Nurse Midwife Rebekah Wheeler, helps us go even deeper, distilling all of the most current evidence and recommendations for vaccination during pregnancy.

Key takeaways:
  • Vaccines help prevent severe illness from flu and COVID-19 during pregnancy when one’s immune response is naturally weaker.
  • Antibodies created in response to vaccines also cross the placental barrier, offering some protection to newborns whose immune systems are still quite weak.
  • Flu and COVID-19 vaccines and boosters are safe during pregnancy. There is a long history of examining vaccine safety and a framework in place to determine whether safe in pregnancy.

How does pregnancy affect the immune system?

Under most circumstances, the main job of our immune system is to signal “intruder alert” and start making antibodies and other special types of cells to fight off the foreign virus, bacteria, etc. When one is pregnant, it is a bit like having a small intruder growing in the uterus, so an over-alert immune system could mean trouble in the form of too much inflammation and even miscarriage. In an amazing feat of adaptation and evolution, the immune system quiets down during pregnancy, preventing such outcomes. In fact, for many pregnant people with autoimmune conditions—meaning overactive immune systems that cause inflammation and other havoc in the body—their symptoms decrease in pregnancy. A result of this decreased immune functioning, however, is that some viruses and other infections are more severe in pregnancy.

What happens if you get sick while pregnant?

Getting sick is no fun at anytime. But in pregnancy, illness brings with it added risk and related anxiety. Prolonged fever is associated with miscarriage and even birth defects, and infections of many kinds are linked with an increased risk of preterm birth. Because of this, we do a lot to try to keep pregnant people from contracting severe illnesses like the flu and COVID-19.

Flu and COVID-19

We’ve known for decades that getting the flu in pregnancy is linked to more severe and prolonged illness than if a person was not pregnant. High fevers, dehydration, all that inflammation—they’re certainly no fun to experience, and such symptoms can be linked to miscarriage and preterm birth. So for many years, there have been strong recommendations that pregnant people get their annual flu shot.

Now we’re in the COVID-19 era, and there is a parallel recommendation for COVID-19 vaccination and boosters in pregnancy for a very similar reason: severe COVID shows up way more in pregnant people than in their non-pregnant peers. Sadly, COVID-19 infection in pregnancy has been shown to increase rates of miscarriage, preterm birth, need for ventilation, and even death.

Pregnancy is a high-risk condition for COVID-19. And the vaccine has been shown to be incredibly safe in pregnant and lactating people at all points. No association has been found between vaccination early in pregnancy and miscarriage, for example, and the protective effects are clear. There is even evidence that a baby born to a parent who was vaccinated during pregnancy carries antibodies to COVID-19. This is great news.

Other vaccines in pregnancy

Another vaccine commonly offered in pregnancy is the Tetanus, Diphtheria, and Pertussis vaccine, better known as the TDaP. This is offered to help prevent Pertussis (whooping cough) in infants who can get very sick as a result of infection. Infant’s little lungs and immature immune systems are not ready for such an onslaught, and they can’t get vaccinated against it themselves until they are two months old. The best way to protect them is for their parent to get a booster vaccine during pregnancy and let the antibodies cross the placenta to protect the fetus. This is actually an added benefit of most vaccines in pregnancy—babies can be born with some protection from diseases they can’t be vaccinated against yet. Other adults (non-birth parents, grandparents, caregivers) who will be around the infant are also encouraged to get a TDaP booster to decrease the risk of exposure.

How do we know a vaccine is safe in pregnancy?

There is a general division between vaccines that are considered safe in pregnancy and those that are not. This line comes down to whether a vaccine is “live” or not. A “live” vaccine means that a tiny bit of the actual, living virus is given to teach the immune system to fight that virus if it ever sees it again. It’s like getting a little “whiff” of virus to prevent letting the full-blown illness get by if a person is exposed later. Examples include the Chicken Pox vaccine and the Measles, Mumps and Rubella vaccine (MMR). We don’t give these in pregnancy because of the theoretical risk that live virus might pose to the fetus.

Other vaccines are considered safe in pregnancy, as the pregnant person’s immune system can learn about how to fight that virus without any exposure to the illness itself. The flu vaccine given in pregnancy is not a live virus (though other versions are, so always tell the people giving the vaccines if you are pregnant).

With the COVID-19 vaccines, we’ve been inadvertently studying the safety in pregnancy from the beginning, as many of the people in early trials and healthcare workers who received it in the first stages of rollout turned out to be pregnant. Many of those babies are born now, and we’re able to examine whether there are any impacts. Many more vaccinated people are still pregnant, and national and international registries of outcomes are being tracked. Study after study says pregnant people are safe to use the vaccine, and risks of severe illness and miscarriage lead to the strong recommendation to do so.

How is Cleo helping its members have healthier outcomes?

There’s a lot of information out there, and so much of it is either confusing, misleading, or downright wrong. Cleo uses up-to-date evidence-based information to educate our members about the benefits of vaccines and to help everyone make the healthiest decisions for themselves and their children. We offer vaccine education and time-based reminders to pregnant people and parents, enabling them to better understand the benefits of vaccination and to keep on track for their and their children’s vaccine schedules. In a world with a million things to track, Cleo can shoulder the burden on this one.

Request a demo to learn more about Cleo’s holistic support, and how it enables working parents—and their families—to thrive. Our human-centric model of care improves health outcomes, controls costs, and boosts employee engagement, and we look forward to showing you how.

Source: https://www.sciencedirect.com/science/article/pii/S000293782101228X

Note: This content has been reviewed by Rebekah Wheeler, RN, CNM, MPH, and Cleo’s Clinical Lead of Birth Outcomes. Cleo aims to give the most accurate information, but details and recommendations about the pandemic may have changed since this piece was published. For the latest information, please check out resources from the World Health Organization, U.S. Centers for Disease Control, and local public health departments.