How to Boost COVID Vaccination Rates in Pregnant Women

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Camille Clare, MD, MPH, calls the moment a pregnant patient decides to get the COVID-19 vaccine “a win.” 

“A personal win, a win for our field, a win for medicine and science,” said Clare, chair of the department of Obstetrics and Gynecology at SUNY Downstate Health Sciences University in New York City. 

As clinicians like Clare brace for the winter trifecta of influenza, RSV, and COVID-19, they must also contend with another concerning trend: the low rates of pregnant women who are getting the updated COVID-19 vaccine.  

Pregnant patients face an increased risk of severe illness or complications if they contract the virus. Yet, despite ample evidence supporting the safety and efficacy of the latest COVID-19 vaccine, expectant parents remain undervaccinated.

The American College of Obstetricians and Gynecologists recommends a single dose of the latest COVID-19 vaccine for all adults, including pregnant and lactating patients, at least 2 months after their last COVID-19 vaccine dose. The updated COVID-19 vaccine protects against the circulating Omicron variant and restores immunity against the virus that may have decreased over time.

Despite a majority of pregnant women reportedly receiving the initial two-dose series of the COVID-19 mRNA vaccine, only 27.3% have received the booster, according to the US Centers for Disease Control and Prevention. Less than half of pregnant women reported receiving the flu vaccine, the report found. 

Despite misinformation that questions the vaccine’s safety, women who received the COVID-19 vaccine have no increased risk for miscarriage, placental abruption, pulmonary embolism, postpartum hemorrhaging, or lower birth weight in their babies. 

Some studies suggest a link between the vaccine and a reduced chance of stillbirth. Infants whose mothers received the COVID-19 vaccine while pregnant are also at a reduced risk for hospitalization from the disease. 

Still, misinformation surrounding the safety of the vaccine has contributed to its uncertainty or refusal.

Dr Aaron Glatt

“There’s a big concern that a lot of pregnant women have about taking any products into their body,” said Aaron Glatt, MD, chief of infectious diseases at Mount Sinai South Nassau in Oceanside, New York. 

Pregnant patients may be more likely to receive the flu shot because of its longer time on the market. COVID-19 vaccines may still feel novel, Glatt said. 

“We haven’t had years and years of experience with it,” making it much easier for patients to believe misinformation about the vaccine, Glatt said.  “I think departments of public health, infectious disease doctors, individual doctors — we [all] have to make sure that we do a better job of getting out correct information.”

Janet Perkins, MD, medical director of Obstetric Simulation and Perinatal Optimization at Wentworth-Douglass Hospital in Dover, New Hampshire, said more of her patients bring her concerns about what turns out to be misinformation regarding the COVID-19 vaccine than for the flu or any other vaccine.

Perkins said a fear of miscarriage is the most prominent safety concern. 

Dr Janet Perkins

But many larger-scale studies have found no increased risk of miscarriage among women who received the COVID-19 vaccine; instead, research suggests that protection from severe disease passes from a mother to their child. 

In some instances, patients have consulted artificial intelligence platforms to ask whether the COVID-19 vaccine is safe, she said. Despite frustration, Perkins said clinicians should not allow patients’ differences of opinion interfere with having an empathetic relationship. 

“People are just trying to do what they think is best for themselves and their baby,” she said. 

Approaching each patient with compassion can help ease concerns, even if patients initially decline to get vaccinated, Clare said. 

Obstetricians and gynecologists can incorporate discussions about COVID-19 booster shots into routine prenatal care appointments. This direct interaction with healthcare professionals can help dispel doubts and encourage vaccination.   

“If you’re not willing to decide today, we’re going to keep talking about it at every single time that we meet,” Clare said. “We’re still going to be there for you, we’re still going to take care of you.” 

Leading by example may also help pave the way for more pregnant patients to consider getting vaccinated. Perkins discusses with patients her own decision to get vaccinated as well as caring for sick patients who may have benefited from getting the vaccine.  

“The whole concept of shared decision-making and true informed consent is important,” Perkins said. “The last thing we want to do is shame people, if [instead] we can empower people to make decisions on data that is so strongly in favor of getting vaccinated for their health and for the health of their baby.”

While hesitancy may be among the reasons for not getting vaccinated, lack of convenient access to the shots may be another barrier. Even if these patients do decide to get the COVID-19 vaccine while in their clinician’s office, many are not keeping it in stock; the patient will need to book a separate appointment at a pharmacy.

“We’re just making it that much more difficult,” Perkins said. “We need to strike while the iron’s hot, as it were, and accommodate people’s busy schedules, if we’re to say that this is very important.” 

Indeed, people who have historically faced barriers to easy access to healthcare are more likely to report COVID-19 vaccine hesitancy, some studies suggest.  

Partnering with maternity hospitals to offer on-site vaccinations for patients after childbirth may also simplify the process, experts said. 

Perkins said she envisions that COVID-19 vaccinations will reach a level of normalization much like the flu vaccine, where it will become more routinely available in places like clinicians’ offices. Until then, public health messaging that prioritizes this population the same way the vaccine is messaged to older adults and other vulnerable populations may help to increase uptake, she said. 

Although hospital admissions from COVID-19 infections have decreased, deaths from the virus have slightly increased. Perkins said keeping severe cases down this season will take all adults, including pregnant patients, to remain vigilant in their care.  

“The truth is that the vaccine is wildly helpful with mitigating risk of morbidity and mortality,” she said. 

Lara Salahi is a journalist living in Boston.

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