Meagan Garibay, RN, BSN, CIC, an infection preventionist at Comanche County Memorial Hospital in Lawton, Oklahoma, received the COVID vaccine in December 2020, when she was 35 weeks pregnant. Photo courtesy of WAVE 3 News.

Few aspects of pregnancy and birth have been unaffected by the COVID pandemic. In the past year, pregnant people and their health care providers have had to alter everything from the way they assess risk to the manner in which care is accessed.

Although little information about pregnancy and COVID was available early in the pandemic, emerging evidence is providing a clearer picture. As a result, in the past year recommendations have shifted—sometimes radically so—for both women and their health care providers. Based on the latest available research, this month in AJN Reports we cover what we now know about COVID and maternal health, including guidance about risk and vaccination.

Higher risks for pregnant people with COVID.

As the articles explains, research suggests pregnant people who have COVID are at higher risk of severe illness and death. There’s also been a noted increase in stillbirth, ruptured ectopic pregnancies, and maternal depression.

A multinational cohort study, the results of which were published in JAMA Pediatrics after we went to press, confirms previous research findings. As the researchers note, “COVID-19 in pregnancy was associated with consistent and substantial increases in severe maternal morbidity and mortality and neonatal complications.”

AJN Reports quotes Catherine Spong, MD, professor and vice-chair of the Department of Obstetrics and Gynecology at the University of Texas Southwestern Medical Center in Dallas, who spoke during a JAMA discussion streamed live in early February:

“The literature is a little bit difficult to discern whether or not pregnancy itself increases your risk, but clearly, women with critical illness have much higher risks when they’re pregnant.”

Vaccination safety and pregnancy: no evidence of injury.

Among health experts, there is widespread support for vaccination—using any of the authorized vaccines—in pregnant and breastfeeding people. AJN Reports notes that while the CDC acknowledges there’s been limited vaccination safety data in these populations, there’s also no evidence the vaccines cause problems in pregnancy or with the development of the placenta.

In fact, study results published this month in Obstetrics & Gynecology showed no evidence of injury to the placentas of patients who received the vaccine. Most of the patients received either the Moderna or Pfizer vaccines during their third trimester of pregnancy.

‘We know the risks of being infected.’

By contrast, some of the same researchers reported in a study last May in the American Journal of Clinical Pathology that there was evidence of injury to the placentas of women who tested positive for COVID while pregnant.

Denise Jamieson, MD, MPH, professor and chair of the Department of Gynecology and Obstetrics at Emory University School of Medicine in Atlanta, who also spoke during the JAMA discussion in February, is quoted in AJN Reports discussing vaccination risks, including the “real and meaningful risks” of declining vaccination.

As she says, “we know the risks of being infected.”

For additional information about COVID and maternal health and to learn more about the experiences of pregnant women during the pandemic, read AJN Reports for free through July 1.