Globally, the total confirmed cases of Covid-19 have reached over 361,425,000, with over 5,624,000 deaths reported. On December 8, 2020, the first Covid-19 vaccination was administered in the UK. Since then, 137 million doses of Covid-19 vaccines have been administered across the country. Currently, 48 million UK citizens are fully vaccinated against Covid-19. However, the number of pregnant women who are vaccinated is lagging compared to the general population.
A population-based study in England, published in The American Journal of Obstetrics and Gynecology, compared maternal and perinatal outcomes of women admitted to a hospital between May 2020 and January 2021. The study included 342,080 women, of whom 3,526 had a laboratory-confirmed SARS-CoV-2 infection during pregnancy. Women who had a Covid-19 infection at the time of birth were found to have higher rates of preterm birth and pre-eclampsia, were more likely to require an emergency cesarean delivery and were twice as likely to have a stillbirth. This emphasises how unsafe Covid-19 infection can be for pregnant women, hence why the Center for Disease Control (CDC) and the World Health Organization (WHO) recommend Covid-19 vaccination during pregnancy to prevent maternal morbidity and adverse birth outcomes.
In the UK, one source of Covid-19 vaccine hesitancy during pregnancy may have been the initial advice from the UK Joint Committee on Vaccination and Immunization (JCVI). The JCVI stated that pregnant women should avoid the Covid-19 vaccine unless they were at risk of serious disease. However, this guidance changed in April 2021, as new evidence emerged. Despite this, data from Public Health Scotland shows that only 15% of women who gave birth in August 2021 were vaccinated, this suggests that there is still hesitancy among pregnant women, despite the change in advice and the increasing body of evidence that supports vaccine safety in pregnant women.
In a recently published retrospective cohort study conducted by the CDC, the risk of adverse birth outcomes and Covid vaccination status were evaluated among pregnant women. The study compared 46,079 pregnant women of varying vaccination statuses (unvaccinated, single-dose vaccination and double dose vaccination). All women were expected to deliver between February 21 and July 31, 2021. Lipkind and colleagues found that Covid-19 vaccination during pregnancy was not significantly associated with increased risk of pre-term birth or small gestational age at birth. In fact, the prevalence of pre-term birth was 7 events per 100 live births among unvaccinated pregnant women while it was 4.9 among vaccinated pregnant women. Further, the prevalence of small gestational age at birth was 8.2 per 100 live births, regardless of vaccination status.
There is concern that the benefits of vaccination among pregnant women have not been widely emphasised or understood. It is important that physicians stress the importance of Covid-19 vaccination to pregnant women and eliminate doubts regarding the original guidance to prevent maternal mortality and adverse birth outcomes.