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Over the past couple of decades we've seen a steady parade of studies showing how damaging many infections can be to an expectant mother and their developing fetus.
While often most apparent during an epidemic or a pandemic, studies have also shown that even milder, seasonal respiratory infections can have a major impact on mother and child.
In 2019's JAMA Psych: Long-term Risk of Neuropsychiatric Disease After Exposure to Infection In Utero we looked at an impressively large, multi-decade study published in JAMA Psychiatry on the risks of developing neuropsychiatric disease later in life that found (emphasis mine).
`. . . those people whose mothers had been hospitalized for any infection during pregnancy had a 79 percent higher risk of being diagnosed with autism and a 24 percent increased risk of being diagnosed with depression.'
In a Perspective, written by 3 CDC physicians (Sonja A. Rasmussen, Denise J. Jamieson, Joseph S. Bresee) and published in a 2008 CDC EID Journal article - Pandemic Influenza and Pregnant Women - we saw this assessment of the historic impact of influenza on pregnant women.
Although appropriate nonpregnant control groups were generally not available, mortality rates among pregnant women in the pandemics of 1918 and 1957 appeared to be abnormally high (5,7). Among 1,350 reported cases of influenza among pregnant women during the pandemic of 1918, the proportion of deaths was reported to be 27% (5).Three years later - after the end of the 2009 H1N1 pandemic - we looked at BMJ: Perinatal Outcomes After Maternal 2009/H1N1 Infection, which found pregnant women who were admitted to the hospital with an H1N1 infection experienced a 3 to 4 times higher rate of preterm birth, 4 to 5 times greater risk of stillbirth, and a 4 to 6 times higher rate of neonatal death.
Similarly, among a small case series of 86 pregnant women hospitalized in Chicago for influenza in 1918, 45% died (6). Among pregnancy-associated deaths in Minnesota during the 1957 pandemic, influenza was the leading cause of death, accounting for nearly 20% of deaths associated with pregnancy during the pandemic period; half of women of reproductive age who died were pregnant
Although the data is still under review, and outcomes can vary depending upon the variant, we've seen similar studies linking maternal COVID infections to increased rates of maternal complications, premature births, and other adverse outcomes.
- Although the overall risks are low, if you are pregnant or were recently pregnant, you are more likely to get very sick from COVID-19 compared to people who are not pregnant. Additionally, if you have COVID-19 during pregnancy, you are at increased risk of complications that can affect your pregnancy and developing baby.
A smattering of studies on the risks of COVID in pregnancy include:
Nature: Deleterious Effects of Nervous System in the Offspring Following Maternal SARS-CoV-2 Infection
Preprint: Impact of SARS-CoV-2 Variant on the Severity of Maternal Infection and Perinatal Outcomes
AJOG: Disease Severity, Pregnancy Outcomes and Maternal Deaths With Patients With SARS-CoV-2 - Washington State
MMWR: Two New Reports On Pregnancy & COVID-19
While not every infection is vaccine preventable, there are safe and (moderately to highly) effective vaccines against Pertussis (Tdap), influenza, COVID, and (now) RSV, which can reduce the risks for both the mother and child.
Vaccine hesitancy among expecting parents is fairly common, and is increasing likely due to `pandemic fatigue' and the amount of anti-vaccine rhetoric online, putting mothers and their offspring at greater risk.
While no vaccine is 100% safe or 100% effective, they have an excellent safety profile, and have saved countless lives. Next week the CDC will hold a COCA call for clinicians on how best to approach and discuss vaccines with hesitant expectant parents.
Clinical Vaccination Guidance for Pregnant People
= Free Continuing Education
Overview
The Centers for Disease Control and Prevention (CDC) and the American College of Obstetrics and Gynecology (ACOG) continue to emphasize the importance of vaccinations for pregnant people. CDC and ACOG recommend pregnant people get vaccinated against pertussis, influenza, and COVID-19 during each pregnancy to protect themselves and to protect their baby from these infections during the first few months of life. There have been concerning declines in vaccination coverage for Tdap (tetanus, diphtheria, and pertussis) and influenza vaccines, and low uptake of COVID-19 vaccines among pregnant people. In addition, racial and ethnic disparities persist in vaccination coverage among pregnant people.
During this COCA Call, presenters will give a comprehensive overview of timing and promotion of vaccines people should receive during pregnancy to protect themselves, their pregnancies, and their babies, focusing on Tdap, influenza, and COVID-19 vaccines, and providing an update on respiratory syncytial virus (RSV) vaccine for pregnant people.
Presenters
Tara C. Jatlaoui, MD, MPH, FACOG
CDR, U.S. Public Health Service
Chief, Applied Research, Implementation Science and Evaluation (ARISE) Branch
Immunization Services Division
National Center for Immunization and Respiratory Diseases
Centers for Disease Control and Prevention
Naima T. Joseph MD, MPH
Division of Maternal Fetal Medicine
Department of Obstetrics and Gynecology
Beth Israel Deaconess Medical Center
Assistant Professor, Harvard Medical School
Call Materials
Not available at this time. Please check back.
Call DetailsThese presentations are often technical, and are of greatest interest to clinicians and healthcare providers, but also may be of interest to the general public.
When:
Thursday, August 10, 2023,
2:00 PM – 3:00 PM ET
Webinar Link:
https://www.zoomgov.com/j/1604412918
Webinar ID: 160 441 2918
Passcode: 650748
Telephone:
Dial (for higher quality, dial a number based on your current location):
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+1 551 285 1373 US
+1 669 216 1590 US (San Jose)
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As always, If you are unable to attend the live presentation, these (and past) webinars are archived and available for later viewing at this LINK.
