A: The medical community has considered this question repeatedly over the past 3 years. And with the ongoing appearance of new strains combined with a steady case positivity rate, pregnancy with
remains a very relevant issue.
The published data on the effects of covid on mothers and babies shows that the delta strain seemed to cause more severe illness than the omicron strain. We now know that the omicron variant has at least six different lineages, which have slightly differently characteristics than previous variants. There are additional variants identified by the CDC as “other,” since they currently affect less than 1% of the U.S. population.
The two populations most affected by covid during pregnancy are pregnant mothers, and babies born to mothers who had active covid infection during their pregnancy.
The impact of covid on these two separate populations is different. Mothers are at risk for more severe respiratory illness, while babies are at higher risk for preterm birth or even stillbirth. It is better for both mother and baby if the mother does not get sick with covid during her pregnancy.
We know that pregnant women who had active delta variant covid-19 had a higher likelihood of needing ICU admission, and of needing a ventilator to support their breathing. Covid-19 vaccination has been shown to decrease severity of illness, and this holds true for pregnant women as well.
Vaccination during pregnancy has been shown to be safe for mothers, and for their babies. The Centers for Disease Control (CDC) recommends covid-19 vaccination for women who are pregnant or who are thinking about becoming pregnant, and women who are breastfeeding.
Pregnancy can alter a mother’s immune response to vaccines and to infections, and it does seem like the vaccine might be more effective in pregnant mothers after the 20th week of pregnancy.
However, there is not strong enough data on this point to recommend specific timing for getting the covid-19 vaccine during pregnancy. The CDC does not recommend specific timing for covid-19 vaccination during pregnancy. It does recommend that all women who are pregnant, planning to become pregnant or are breastfeeding get vaccinated.
Fetuses can be affected by maternal covid-19 infection during pregnancy.
The most commonly reported effect on the fetus is preterm delivery. Preterm delivery is when a baby is born prior to his/her 37th week of gestation. Preterm newborns are at an increased risk for trouble breathing after birth, low blood sugar (which can be dangerous), feeding difficulties, difficulty maintaining normal body temperature, hyperbilirubinemia and seizures.
Older infants who were born preterm have higher rates of lung problems such as asthma and frequent pneumonias in childhood and adolescence. They are more likely to have a higher incidence of learning difficulties compared to infants born at term.
There is evidence that adults who were born as preterm infants have higher blood pressure and more diabetes than adults who were born at term.
Fortunately, fetuses do not appear to contract acute covid from their mother. In fact, if a mother is infected or vaccinated, some of the antibodies generated can cross the placenta and potentially protect the fetus and later the newborn from acute covid infection.
There is an extremely low incidence reported of newborns testing positive when their mother has acute covid – as long as regular contact precautions are maintained between mother and newborn baby. Maternal holding and breastfeeding is encouraged. But the mother should wash her hands and wear a mask when handling her newborn, until she is 21 days out from the start of her acute covid infection.
Vaccination reduces the risk of a mother developing covid-19, and reduces the severity of disease if a breakthrough infection occurs. All available evidence supports the safety of administering SARS-CoV-2 vaccines before, during and after pregnancy.
Covid-19 vaccination during pregnancy is safe for mothers and their babies. The CDC recommends vaccination for women who are pregnant, may become pregnant or who are breastfeeding. A history of SARS-CoV-2 infection is not a factor; these individuals should still receive COVID-19 vaccination. Breastfeeding should not influence timing of vaccination. Maternal SARS-CoV-2 antibodies induced by vaccination can pass into breast milk and may offer passive protection to the infant.
To summarize, covid is here and seems like it is not leaving anytime soon. Life must go on. The best thing an expectant mother can do is take steps to prevent herself from getting an acute covid infection during pregnancy. That translates to getting the covid-19 vaccine and booster when eligible.
Anjali Subbaswamy is a Pediatric Intensive Care Physician at UNM. Please send your questions to firstname.lastname@example.org.