A new study suggests pregnant patients who get COVID-19 face an increased risk of severe illness, ventilation, and even death. There is also the additional risk of having to deliver prematurely due to severe illness.
But, Dr. Jose Prieto, the medical director of the Division of Maternal-Fetal Medicine at Johns Hopkins All Children’s Hospital already knew that–even before the study was published in JAMA-– because he’s seeing the cases for himself among patients here in Tampa Bay.
Like a vast majority of physicians and OB/GYNs, he is strongly recommending his pregnant patients to get the COVID vaccine if they haven’t already. We recently sat down for an interview via Zoom to learn more about what he is experiencing locally and what people need to know about the importance of getting vaccinated–pregnant or not.
How has the COVID-19 impacted pregnant patients–is it true maternal deaths are increasing because of COVID-19 infections?
Dr. Prieto: I’ve been practicing obstetrics in this area for 26 years since 1996—I started here and this really the only job I’ve ever known. We work in a pretty busy labor and delivery units—we also supervise the labor and delivery units Bayfront Health and also at Brandon Regional Hospital in Hillsborough. Combined you’re looking at between 7,000 to 8,000 deliveries depending on the year. Maternal death used to be a rare event. Most pregnant patients are young and the maternal mortality rate in that population is closer to 1 in 5,000 or 1 in 6,000 depending on whether you have a vaginal or caesarian section. Since the pandemic started we have had multiple maternal deaths which we just didn’t see before the pandemic.
What impact have you seen COVID-19 make on unvaccinated pregnant patients?
Dr. Prieto: We’re seeing a clear surge in COVID-19 infection in pregnant patients and it’s become clear—there’s published reports and studies—and our own anecdotal experience suggests that pregnancy alone is a significant risk factor for severe infection. What that means is pregnant patients who are unvaccinated who get COVID-19 are more likely, in our experience, to end up in the hospital, to require supplemental oxygen, to require ICU care, and are at higher risk for death.
The other interesting anecdotal point I would stress is that we are seeing some breakthrough infections in the vaccinated population—typically mild. My experience has been—and I’ve seen many patients in the Tampa Bay area who are pregnant, who have COVID-19 and have gotten hospitalized and are very sick and died—all of them have been unvaccinated. I’ve had a couple patients recently who got the first shot and unfortunately got COVID-19, but I have yet to see the pregnant patient who is fully vaccinated come in and be hospitalized with severe infection.
We are also finding with COVID-19 infection in pregnancy, there are cases where pregnant patients who have delivered and are infected, are sick—there are cases of patients transferring that infection to the baby.
Are pregnant patients infected with a severe case of COVID-19 able to receive treatments like monoclonal antibodies?
Dr. Prieto: One of the other issues with COVID-19 is that the therapeutics are just—they help—there’s a couple of therapeutics we are using with patients and we recommend all of them. If the patient comes in pretty sick then we start them on high doses of steroids for ten days and then we give them an anti-viral called Remdesivir -which the data is a little mixed, but suggests it’s a little helpful.
If you have high risk factors and you’re positive and you start having symptoms, you may benefit from monoclonal antibody infusions that have sort of become a mainstay of therapy as well.
The steroid may actually be helpful — for many years especially with the preterm fetus, administration of steroids to the pregnant mom helps the lungs mature a little faster so those babies spend less time on a ventilator, less likely to end up on a ventilator.
If a pregnant patient is vaccinated, are they passing those antibodies on to their baby?
Dr. Prieto: We are finding, which is very interesting for the vaccine, is that patients who are vaccinated, they are passing those antibodies through the placenta into the newborn’s circulation –so those babies are more likely to be protected. And there was another study published recently in one of our obstetrical journals that suggest high levels of antibody are passed through breastmilk
My opinion is when a pregnant person gets vaccinated, they are not only protecting themselves, they are also protecting their unborn baby.
I think the bottom line for me is that if you’re pregnant, go get the vaccine. You are not only protecting yourself from serious infection, but you are also protecting your unborn child.
What do you tell your pregnant patients about the COVID vaccine?
Dr. Prieto: I make it a point to talk to every patient about the importance of the importance of the COVID-19 vaccine in pregnancy –I make it a point to discuss the fact that pregnancy alone, regardless of other risk factors—if you are pregnant and otherwise healthy, you are still at risk if you get COVID-19 for severe infection, hospitalization, ICU care and regrettably dying from COVID-19.
We see a lot of patients in our office who are fit, they’re young, they exercise, they eat right, they do everything right—if you are pregnant and get COVID-19, you are more likely to get much sicker than if you weren’t pregnant.
The other point I bring up with patients– there’s now pretty good data that because these patients are getting so sick, and they’re typically in the pre-term period, we are seeing higher rates of premature delivery in pregnant patients who get COVID-19—just because they get so sick, at some point you just have to deliver the baby and many times you have to deliver a very premature baby unfortunately.
The golden rule in obstetrics is the mother’s life always comes first. That unfortunately means many times we have to deliver a baby that may not be ready to be delivered.
I think the vaccine– in every patient, but especially in pregnant patients–it protects their lungs, The key to the vaccine is that it prevents severe infection, it prevents hospitalization, and it prevents death.
Does it matter which trimester you are in when you get the COVID-19 vaccine?
Dr. Prieto: We are recommending the vaccine—the American College of OBGYN and the Society of Maternal Fetal Medicine has recommended that all pregnant patients, regardless of trimester, to get the vaccine as soon as possible.
The data is clear that the vaccine seems to be safe and it’s a very effective in preventing severe disease.
Does it matter which COVID vaccine a pregnant patient receives?
Dr. Prieto: It seems that all three vaccines that are currently available are safe and are effective.
Do you think the CDC will eventually recommend pregnant patients to get a booster shot if already vaccinated?
Dr. Prieto: I suspect that it will. The data suggests now that after about 7 or 8 months, the immunity sort of starts fading—I imagine at some point because pregnancy is a high-risk condition in of itself, that booster shots will be recommended.
What if a pregnant patient already had COVID-do they still need to get the vaccine?
Dr. Prieto: What I tell those patients—the data also suggests that COVID-19 is one of those viral infections where you can get infected many times over. The vaccine reduces your risk of getting COVID-19 again, getting recurrent covid infection. That’s what I typically tell patients, I say “Yes, you do have some immunity but if you get the vaccine you are reducing your risk significantly of getting covid infection again.”
Can pregnant patients receive all normal vaccines recommended during pregnancy like the flu shot and the pertussis (whooping cough) vaccine along with the COVID vaccine?
Dr. Prieto: The date also suggests you can give all of these vaccines along with the covid vaccine
Has the FDA approval of the Pfizer/BioTech COVID vaccine helped increase vaccination rates among pregnant patients?
Dr. Prieto: I still see some hesitancy—I think regrettably this topic has been politicized and there—is still a lot of hesitancy out there but you work hard to try and get as many of your patients as possible—that’s the bottom line. It’s still their choice, but we just strongly recommend the vaccine.
What if the patient already delivered their baby?
Dr. Prieto: The recommendation is if you’ve delivered and you are breastfeeding, you should get the covid vaccine and you should not delay or alter your breast-feeding schedule after getting the first and the second shots.
What else can pregnant patients do to protect themselves and their baby during the pandemic along with getting the COVID vaccine?
Dr. Prieto: The other thing I recommend is everyone to wear a mask when indoors-I think it’s important. Masks have been shown to reduce transmission and what we’re finding is that a lot of patients the kids are back in school, they are spreading the virus and then they come home and infect the rest of the family. Try to encourage your kids to wear a mask. If your kids are older than 12, I reconned they get vaccinated I have four kids and they are all vaccinated.
I feel like the vaccine and then mitigation factors like wearing masks, trying to stay socially distant and just avoiding large crowds in general where you have people who are just unwilling to wear a mask.
So, are in-person baby showers okay right now?
Dr. Prieto: I think if you are with a group of friends and everyone is vaccinated –how do you tell a pregnant patient she can’t have a baby shower, so but these are some of the issues that come up—you just have to use your judgment and decide how many people are too many and go from there.
Just make sure everyone is wearing a mask and try to socially distance.
Photo credit: istock by Getty Images, Marina Demidiuk