Yale study finds unvaccinated pregnant women may be at risk for additional COVID-19 complications
During a Jan. 12 press conference, Marna Borgstrom, CEO of Yale New Haven Health – among other health professionals – urged pregnant women to get vaccinated to avoid potential health complications during pregnancy and delivery.
Yale Daily News
Nearly half of all pregnant women arriving at hospitals at the Yale New Haven Health system tested positive for COVID-19 as of Jan. 12, Chief Executive Officer Marna Borgstrom announced earlier this month. The news has sparked conversations surrounding the potential health risks that unvaccinated pregnant women face.
At a virtual Yale New Haven Health press conference, Borgstrom cited a research project spearheaded by Heather Lipkind, associate professor of obstetrics at the School of Medicine, that analyzed 46,000 births — 10,000 of them by vaccinated women. Published on Jan. 4 in a report from the Centers for Disease Control and Prevention, the study found that the vaccine does not cause premature births or low birth weight in babies. Rather, the opposite is true — Lipkind said that there is evidence suggesting that unvaccinated pregnant women may face additional health complications if they contract the virus, including preterm deliveries.
“Any pregnancy has the possibility of several potential adverse outcomes,” said Sonya Abdel-Razeq, Yale New Haven Health maternal fetal medicine specialist. “Coupled with conditions such as COVID, which is a highly inflammatory condition … it also has the potential to affect multiple organ systems and [the pregnancy].”
The Yale New Haven Health system currently considers pregnant women who have contracted COVID-19 to be a distinct group within the general protocols put in place for COVID-19 patients, Abdel-Razeq said.
Criteria used when implementing treatment protocols include infection severity, oxygen levels and risk level of the pregnancy, she noted. She especially emphasized the efforts of multidisciplinary experts who have come together to share their knowledge on obstetrics and COVID-19.
Katherine Campbell, the medical director of labor and birth and the Maternal Special Care Unit at Yale New Haven Hospital, noted that over time the hospital’s procedures for taking care of patients have changed as new information and developments become available. According to Campbell, initially there were around “eleven publications on COVID and pregnancy … from the whole world,” but now, there are “thousands.” She said that therapies such as monoclonal antibodies and antivirals, along with vaccines, have helped make caring for patients with COVID-19 “a little bit more manageable.”
Campbell said that previously, newborns were separated from their birth mothers who tested positive for COVID-19. However, that is no longer the recommendation. Instead, the hospital prefers for the baby to room with the mother, with some in-room separation and typical precautions such as mask-wearing and hand washing. There also used to be a unit solely for COVID-19 positive patients, but after YNHH adapted patient care, the separate unit no longer exists. Because of new air management systems, Campbell noted that the hospital “can be very adaptable” when caring for patients now.
“With our principle in medicine of ‘do no harm,’ we were very conservative about the precautions we took to protect our patients, our health care workers and our newborn babies,” Campbell said. “We weren’t sure what type of risks the newborn babies were going to have. As we got more and more data… We’ve been able to relax a little bit so that the whole process of delivering your baby and growing your family can be a little bit more physiological and supportive of our families.”
Throughout the pandemic, the percentage of pregnant patients who entered the Yale New Haven Health system and tested positive for COVID-19 reflected “what was going on regionally across the state” at that time, Campbell said.
With the recent surge in cases driven by the Omicron variant, all medical professionals interviewed by the News emphasized their recommendation for people to get vaccinated. Hugh Taylor, chief of obstetrics and gynecology at Yale New Haven Hospital, noted that “COVID risks are higher in pregnancy,” so anyone looking to become pregnant or are pregnant should get vaccinated.
“The vaccine is not harmful to pregnancy or fertility,” Taylor wrote in an email to the News. “The disease is harmful in pregnancy; pregnant women have a higher risk of becoming very sick, needing ICU admission and even dying from COVID. They also have a higher risk of pregnancy complications. Omicron seems to be milder but we don’t have good data on the pregnancy effects yet. Some people, particularly those who are unvaccinated, are still becoming quite sick.”
According to Campbell, from this wave of Omicron, patients in the hospital with severe COVID-19 infections “most likely are unvaccinated.” Campbell noted that at this point in the pandemic, unvaccinated individuals put themselves at risk for contracting severe cases of COVID-19. Pregnant patients with severe COVID-19 cases that require hospitalization are at risk for preterm delivery and, consequently, increase potential health complications in premature infants, she said.
Abdel-Razeq said that the presence of symptoms is a factor to consider when determining whether COVID-positive, pregnant women may experience “adverse outcomes.” Those who express symptoms experience several-fold increases in other complications, such as premature rupturing of the water bag and potential vascular development and growth issues in infants.
“We strongly recommend our pregnant patients get vaccinated, and they can get vaccinated at any point in their pregnancy,” said Campbell. “It’s not reserved to certain trimesters of pregnancy. That, in addition to your pretty standard public health measures like mask wearing, minimizing your social interactions in large crowded spaces, are probably the … best way our pregnant patients can protect themselves.”
Graduate student Zainab Chemssy Khan SPH ’23, who previously served as a public health specialist at the New York State Department of Health, argued that there are a number of factors hindering national vaccination rates, including “government mistrust” and a lack of “health sciences” education. The result is widespread adoption of a “wait and see” approach, she said.
Of the vaccinated women who participated in Lipkind’s study, approximately 95.8 percent received at least one dose of the two-dose Moderna or Pfizer-BioNTech vaccines, while the remaining 4.2 percent of women received one dose of the single-dose Johnson & Johnson vaccine. Most of the women were vaccinated during the second or third trimester of their pregnancy, regardless of the company they received their vaccination from.