Despite increased risks of severe outcomes of Covid-19 for both pregnant women and their babies, many pregnant women remain hesitant about getting vaccinated—a concern that may stem in part from shifting guidance over the course of the pandemic.

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Covid-19 vaccination rates remain low among pregnant women

In September, CDC issued a health advisory urging pregnant individuals to get vaccinated against Covid-19 since the disease increases the risk of poor pregnancy outcomes, including preterm birth, stillbirth, and admission of an infected newborn into the ICU.

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However, vaccination rates remain low among pregnant individuals. According to data CDC released in the last two weeks, only around 35% of pregnant women ages 18 to 49 are fully vaccinated against Covid-19. So far, CDC has reported more than 140,000 cases of Covid-19 in pregnant women, which has resulted in 24,000 hospitalizations and more than 200 deaths.

Rebecca Wineland, the director of labor and delivery at the Medical University of South Carolina, said she has seen firsthand the detrimental effects of Covid-19 on pregnant individuals. According to CDC, pregnant Covid-19 patients are twice as likely to be admitted to the ICU and 70% more likely to die from the disease.

"The risk of putting your life at risk, your unborn child's life at risk, is not worth it," Wineland said. "[Vaccination] will absolutely save your life and decrease your risk of hospitalization if you were to get Covid."

What has contributed to vaccine hesitancy among those who are pregnant?

According to Politico, one key reason for hesitancy is that pregnant women were not included in early clinical trials of the Covid-19 vaccines—which meant data on the vaccines' safety and efficacy was not initially available for this group.

"Pregnant women being excluded from the initial vaccine clinical trials left us with basically zero evidence of their safety and efficacy," said Dana Meaney-Delman, an obstetrician-gynecologist who leads CDC's maternal immunization efforts.

Without concrete data to support the vaccines' use in pregnant women, CDC and the American College of Obstetricians and Gynecologists (ACOG) initially advised patients to consult with their doctors about getting vaccinated against Covid-19 instead of outright recommending vaccination.

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Over time, analyses of real-world data found Covid-19 vaccines to be safe and effective for people who were pregnant or trying to become pregnant, Politico reports. But by then, misinformation about the vaccines' effects on fertility and birth outcomes had already spread, making it more difficult for health officials to reach some women with updated guidance recommending the vaccines.

It was a detriment "to not strongly come out of the gate and recommend these vaccines, instead of saying pregnant women may choose to be vaccinated," said Linda Eckert, ACOG's liaison to the CDC's independent advisory panel on immunization.

Maternal health experts recommend including pregnant individuals in future research

According to Politico, physicians and public health leaders have urged the medical establishment to include pregnant and breastfeeding people in future studies of vaccines and treatments.

"[W]e need to protect pregnant women through research instead of from research," said Diana Bianchi, director of NIH's National Institute of Child Health and Human Development.

NIH is currently funding research on the effects of Covid-19 and vaccination on women. For example, the agency awarded grants to five institutions to determine a potential connection between reported menstrual cycle changes and Covid-19 vaccination. The agency has also announced a four-year study on the potential long-term effects of Covid-19 on women who contract the coronavirus during pregnancy.

"The pandemic has crystallized—if there was any doubt over what the cost is of failing to change this presumption of exclusion—it's been very bad for pregnant women globally and for their babies and for the people who love them," said Ruth Faden, founder of the Johns Hopkins Berman Institute of Bioethics. "I believe that there is a really good chance that this time, pregnant people will not be left behind but will get a place at the table." (Hansen, NPR, 10/23; Whelan, Wall Street Journal, 11/4; Gardner, Politico, 11/1; American Hospital Association, 11/3; Castronuovo, The Hill, 9/2)