How dangerous is COVID for women of childbearing age?
As of writing this blog, there have been 586,659 deaths attributed to COVID in the US. Of those, 2.7% or 15,909 have been in the age group less than 45 years old, which would be the age group including women of childbearing age. (https://www.cdc.gov/nchs/covid19/mortality-overview.htm)
We have demographic data for age on 26 million of the cases of COVID, and of those 26 million, 64.5% of cases occurred in those 49 years old or less. (https://covid.cdc.gov/covid-data-tracker/#demographics) Assuming a similar distribution among the total cases of 33,292,045, that would mean 21,473,369 cases occurred in those 49 or less. So, 15,909 divided by 21,473,369 means that the chance of dying from COVID in this age group if infected is roughly .07% Another study looked specifically at pregnancy (https://www.bmj.com/content/370/bmj.m3320), and it showed 339 deaths from all causes in pregnant women with known COVID of 41,664 total pregnant women with known COVID. This worked out to 0.02% More severe COVID in this study was associated with increased maternal BMI, medical comorbidities, hypertension, diabetes and preeclampsia. Looking at these numbers would suggest a maternal mortality risk of 0.02-0.07% from COVID, although mothers with health conditions listed above would potentially have an increased risk.
How do COVID vaccines work?
There are 3 main types being evaluated:
- mRNA vaccines – this is the newest type of vaccine, and it works by using material (mRNA) from the COVID virus that instructs the body’s cells to make proteins specific to the virus. After exposure to these proteins, the body creates T and B lymphocytes to fight the virus if exposed to COVID in the future. These include the Pfizer and Moderna vaccines. Each requires 2 injections to obtain immunity.
- Protein subunit vaccines – these vaccines introduce a protein from the COVID virus to prompt the body to create T lymphocytes and antibodies to fight the virus if exposed in the future. This is similar to how the Hepatitis B vaccines work and one of the pertussis (whooping cough) vaccines.
- Vector vaccines – these vaccines use another virus modified to contain genetic material from COVID. Once introduced into the cell, the genetic material from COVID instructs the cells to make proteins that will induce B and T lymphocytes. Johnson and Johnson makes a vector vaccine, and it only requires one injection to obtain immunity. Astrazenaca also makes a vector vaccine.
Are COVID vaccines effective?
Johnson and Johnson vaccines are 66% effective at preventing COVID 19 illness in people who haven’t been exposed previously; fortunately, none of those who got COVID more than 4 weeks after vaccination were hospitalized. (https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines/janssen.html)
The Pfizer vaccine is purported to have 95% efficacy at preventing laboratory detected illness in those without evidence of previous infection. (https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines/Pfizer-BioNTech.html) The Moderna vaccine is reported to be similarly effective at 94% (https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines/Moderna.html)
These numbers are a little difficult to track from an independent source as breakthrough cases (infections without hospitalization or death following vaccination) are not reported to VAERS.
Are COVID vaccines safe?
At this time, COVID vaccines have received an emergency use authorization. This means that the FDA makes a product available to the public based on the “best available evidence,” without waiting for all of the evidence necessary for formal FDA approval. For formal FDA approval, adequate evidence must be necessary to determine that a product is safe and effective for its intended use and can be manufactured to meet quality standards. (https://www.fda.gov/consumers/consumer-updates/understanding-regulatory-terminology-potential-preventions-and-treatments-covid-19)
Currently, the big side effects making the news are anaphylaxis (severe allergic reaction in 2-5 per million), thrombosis with thrombocytopenia syndrome (36 of 11 million with the J&J vaccine, highest risk in women under 50), myocarditis (511 cases reported, 323 confirmed mostly with mRNA vaccination, most common in young males), and death associated with vaccination (5,343). Now, to clarify on the last number. These deaths have been reported to VAERS as occurring after vaccination, although at this time there isn’t a way to discern whether the vaccination was the direct cause of death. If a causal link was shown, it would constitute a rate of 0.0017% (https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/adverse-events.html)
Does natural immunity from COVID provide protection?
In Lombardi, Italy 1,579 patients were followed for an average of 280 days after COVID 19 infection, and of those, only 5 (0.31%) were reinfected. Of those 5, only one was hospitalized. (https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2780557)
Over 5 months, 1,359 caregivers at Cleveland Clinic who had previous COVID 19 infection and did not receive vaccination had no recurrent COVID infections detected. (https://www.medrxiv.org/content/10.1101/2021.06.01.21258176v2.full)
What do the experts say?
Formal evaluation of the COVID vaccines in pregnant women with controlled studies have not yet been published, although some trials are in the works. Because of this lack of information, the WHO suggests vaccination with mRNA vaccines only for pregnant women with either high risk of exposure, ie healthcare workers, or those with comorbidities that may increase risk of severe disease. (https://www.who.int/news-room/feature-stories/detail/the-moderna-covid-19-mrna-1273-vaccine-what-you-need-to-know)
ACOG suggests that all women, including pregnant and lactating women, have access to COVID 19 vaccination, as well as the most current safety information, and that they should be supported in whatever decision they make. (https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2020/12/covid-19-vaccination-considerations-for-obstetric-gynecologic-care)
In summary, there are still a lot of unknowns regarding COVID 19 infection, vaccination and particularly how each might affect pregnancy. We don’t yet know how long immunity from vaccination or previous infection lasts, although it looks like both may provide initial protection against COVID 19 infection or reinfection, respectively. We will continue to await information on efficacy of the vaccine and immunity against different COVID variants. Even though we have some idea how COVID 19 may affect a pregnant woman during her pregnancy, we don’t yet know how either infection or vaccination may affect a developing fetus in the long term, and unfortunately, by the time we do, the babies most affected will no longer be babies, and the pregnant women most affected will no longer be pregnant. At TWHC, we will continue to monitor what data is available and provide updates as we can. In the meantime, our goal is to provide the relevant information for each mother-to-be so that she can make the best decision for her.