Thinking about the Delta COVID variant and pregnancy can be scary and intimidating. In August of 2021, the U.S. recorded more than 4 million new COVID cases—many of which are likely the Delta variant. So what does that mean for you if you’re pregnant?
A review of more than 77 studies shows pregnant women and their babies are at a higher risk for severe disease and complications from COVID. We share data and answer common questions about COVID risk during pregnancy, monoclonal antibodies, vaccine safety and considerations, and more.
Why am I at higher risk for COVID complications just because I’m pregnant?
Being pregnant doesn’t necessarily make you any more susceptible to catching a respiratory infection like COVID. But, even long before coronavirus, we’ve known that pregnant women have more serious issues with respiratory illnesses than non-pregnant women. Just look at studies on another respiratory illness: the flu. Compared to the general population, pregnant women are at a much greater risk for serious flu complications involving the heart and lungs, as well as death. Even in the womb, unborn babies also bear complications from respiratory illnesses like influenza. These include pre-term birth, low birth weight, and more. Though rare, catching the flu early in pregnancy can even lead to birth defects.
Why are pregnant women more likely to have complications from respiratory illnesses? Especially in the second and third trimester of pregnancy, your body needs more oxygen. (That’s true even when you’re not sick.) Your lungs work harder. So does your heart—because your blood volume increases to sustain your baby too. Respiratory illnesses stress your body’s ability at a time when your body is already undergoing a lot of complex changes in your hormones and immune system. Some of these changes make pregnant women much more vulnerable should they get a respiratory infection.
What is my risk of having complications from the Delta COVID variant during pregnancy?
Many people who managed to enter the summer of 2021 without having a COVID-19 infection have come down with the Delta variant—even those who feel they’ve been cautious. Many states and local communities dropped mitigation measures. At the same time, the Delta variant has swept across the U.S. and is about two times more transmissible than previous strains.
Assessing your personal risk
Your personal risk of exposure to COVID depends on a variety of factors, from your pregnancy to community spread in your area, your work environment, if you or your family and friends are vaccinated, and whether or not you use mitigation measures.
You may also be at increased risk for complications if you have underlying health issues, like diabetes or high blood pressure, or are significantly overweight. Data has also indicated that certain racial and ethnic groups are at a greater risk for complications due to higher incidences of pre-existing conditions and more barriers to accessing quality care. However, no matter what your health status, there’s just no way for you to predict how your body will respond to COVID or what complications you might have.
The likelihood of serious medical interventions
In November of 2020, the CDC published information on about 400,000 women of child-bearing age—all with confirmed COVID. Overall, the results showed pregnant women were more than two times as likely to be admitted to the ICU and be put on a ventilator than non-pregnant women. They also were at an increased risk of death.
Pregnant women 35–44 years of age had even worse outcomes. They were almost four times as likely to need ventilation and twice as likely to die as non-pregnant women their age with COVID. Even more recent data out of the United Kingdom broke down the effects of different COVID strains on pregnant women. The results showed that the risk of the Delta COVID variant and pregnancy is higher than other strains.
- First wave: 24% of pregnant women admitted to hospitals had moderate or severe disease
- Alpha variant: 36% admitted had moderate to severe disease
- Delta variant: 45% admitted have had moderate to severe disease
I’m pregnant and worried about the Delta COVID variant. Can I get vaccinated?
Historically, non-live immunizations—like the COVID vaccines—have proven overwhelmingly safe during pregnancy. Based on the data regarding vaccine safety, the American Society of Reproductive Medicine, the American College of Obstetrics and Gynecologists, the CDC, and many other health organizations now recommend COVID vaccination for pregnant women.
…since the vaccine is not a live virus, there is no reason to delay pregnancy attempts because of vaccination administration or to defer [fertility] treatment until the second dose has been administered.– American Society for Reproductive Medicine COVID Task Force
Early data on COVID vaccines in pregnant women
Many women already receive the inactivated flu vaccine and the Tdap vaccine during pregnancy. Beyond very temporary side effects, studies haven’t shown any adverse effects to receiving a COVID vaccine while pregnant either. In June of 2021, the New England Journal of Medicine published preliminary findings on COVID mRNA vaccines (Pfizer and Moderna) in pregnant women. The normal occurrence of adverse events during pregnancy was documented. Then, it was compared to adverse events that occurred during the pregnancies of COVID-vaccinated women. The results: women who received a COVID vaccine did not experience any obvious increased risk of issues during pregnancy—to themselves or to their developing fetus.
Data is continuing to be collected on the effects of COVID vaccines during pregnancy. As part of its ongoing efforts, the CDC is enrolling pregnant women in its v-safe COVID-19 Vaccine Pregnancy Registry to monitor for side effects. (For information on how to enroll and details, click here.)
Knowing what recommendations to follow
In any healthcare decision, the guiding organizations that set standards of care are important resources. Another is your medical team—your ob-gyn, primary care physician, and any specialists you see. Go over the risks versus benefits with them, based on your medical history. They also will be able to advise you if you have a severe allergy or history of allergic reactions. However, you do not need documentation from your providers to receive a COVID vaccine while pregnant.
Potential benefits of vaccination
With no increase in adverse events reported, you might wonder next if COVID vaccines are as effective in pregnant women as non-pregnant women. Right now, they do appear to be as effective. A benefit of vaccination is that you’re not just protecting yourself from severe disease. You’re also protecting your unborn baby, as well as other young children and immunocompromised people around you. Plus, studies point out that your vaccination passes a level of immunity on to your unborn baby. After birth, that immunity could help protect your child from severe illness with COVID.
Is there a COVID vaccine that’s better for pregnancy?
All of the COVID vaccines are approved as safe for use in pregnant women. But, because of the widespread availability of vaccines right now, many people report they’re able to decide which type to get. Why is that something to think about if you’re pregnant? During pregnancy and 6–8 weeks postpartum, women are already at an increased risk for blood clots. In fact, they are 5 times more likely to have a blood clot(s) than non-pregnant women. The Janssen (Johnson and Johnson) COVID vaccine carries a rare risk of blood clots. To keep that in perspective, it’s about 7 cases out of 1 million in vaccinated women ages 18–49. However, that compounded risk might make some women feel uncomfortable.
If you’re feeling uncertain, talk with your ob-gyn. The American College of Obstetrics and Gynecologists recommends that providers counsel patients who are under 50 years old and are pregnant, postpartum, or lactating about the small risk of blood clots with the Johnson and Johnson vaccine. Also, know that the mRNA COVID vaccines by Moderna and Pfizer have not been associated with an increased risk of blood clots and are readily available if you feel more comfortable with those options.
I’ve heard that vaccines might cause autism. Is that something that I should be worried about for my unborn baby?
There is no credible data that supports a link between autism and immunization–whether given to a mother during pregnancy or later, in young children.
Here’s the history behind the claim that vaccines cause autism. Concerns about immunization causing autism started in 1998. At the time, a physician named Dr. Andrew Wakefield published a small study that included just 12 kids. The study announced a link between MMR vaccines (measles, mumps, and rubella) and autism. However, an investigation later discovered that an attorney paid Dr. Wakefield about $500,000 USD to fabricate the connection. Dr. Wakefield lost his medical license. Since then, numerous studies exploring a link between vaccination and autism have come up without a connection.
If I do get the Delta COVID variant during pregnancy, can I have monoclonal antibodies? And what are they anyway?
Monoclonal antibodies are lab-created antibodies. (Antibodies are proteins your immune system makes that help you fight infections.) Within 10 days of a COVID infection, monoclonal antibodies are available through an infusion or series of shots. These antibodies work by neutralizing COVID to reduce your risk for hospitalization and death. They’ve been very successful; however, unlike vaccines, the protection they offer is very temporary.
There’s very little data on the safety of monoclonal antibodies during pregnancy—far less than there is for vaccines. If you are infected with the Delta COVID variant during pregnancy, you’ll need to work closely with your healthcare team to determine if the benefit outweighs any potential risk. Some factors physicians use to weigh this risk include: the length of time you’ve been infected, any underlying health conditions you have, and ICU and resource availability and capacity in your area and state.
Why does it feel like information on COVID is always changing?
It’s human nature to want unwavering advice and direction—and that’s especially true as you’re bringing a new life into the world. In a way, the reason it feels like things are always evolving is because they are. COVID’s emergence is still so very recent. As a result, guidance is going to be a fluid situation as data comes in.
To ease your frustration with changing guidelines, rely on your physician rather than checking for updates every day. It’s also good to remember that changes in recommendations equal advancements in our understanding of COVID. This gives us better insight on how to mitigate risk, treat COVID and long-haul COVID, and with what we know about COVID’s effects on pregnancy. Ultimately, that’s a positive for all of us.