Why We Need to Discuss the COVID-19 Vaccine with Women of Childbearing Age

By | June 14, 2021

When we meet with women for perinatal psychiatry consultations, we now ask about vaccinations.  It’s not something we typically do, but after the last year, we are now getting involved in their decisions regarding vaccination against COVID-19.  Just as we counsel women to avoid alcohol and to consistently take their prenatal vitamins, providing information on the COVID-19 vaccine is an important aspect of promoting the health of pregnant and postpartum women.  

Considering a growing body of evidence indicating that pregnant women are more likely to have certain manifestations of severe COVID-19 illness,  including admission to the ICU and mechanical ventilation,  the American College of Obstetricians and Gynecologists (ACOG)  has urged the CDC’s Advisory Committee on Immunization Practices to include pregnant and lactating women in the high-priority populations for COVID-19 vaccine allocation.   ACOG clearly states that all pregnant and lactating people should be allowed to receive the vaccine, and that their decision to do so should be based on a careful discussion of risks and benefits with their healthcare provider.   

From our vantage point, there are other benefits to the COVID-19 vaccine.  During the past year, before the vaccination was available, we watched as pregnant and postpartum patients undertook the most extreme forms of lockdown.  Many of these women were literally housebound: never leaving the house and cutting off contact with friends and family, while at the same time taking on more childcare responsibilities as outside care providers and day care centers were no longer available.  And all the while wondering what would happen if they or a member of their family felt ill?

We are yet to fully appreciate the impact of the COVID-19 pandemic on perinatal women, but preliminary studies indicate that during the lockdown, pregnant and postpartum women reported higher levels of stress, loneliness, depression, and anxiety.   And this is not really a surprise.  So many of the things we typically recommend to reduce stress and social isolation, such as exercising regularly or spending time with friends and family, vanished.

While it might seem like the pandemic is fading into the distance, the resurgence of the pandemic in places like India and Brazil where immunization rates are low, we cannot be so sure about this.  So far the most successful way to avoid becoming seriously ill with COVID-19 is to get vaccinated.  

A recent article in Medscape, however, suggests that mothers appear to be less likely to get vaccinated than others in the general population.  According to a recent poll from Morning Consult, about two-thirds of adults in the US have either already been vaccinated against COVID-19 or plan to do so.  In contrast, mothers are the most likely to be hesitant about the vaccine.  In this study, 51% of the mothers reported that they are unwilling to get vaccinated or are uncertain about getting vaccinated, at 51% (compared to 32% of other women and 29% of fathers).

The article notes that these moms are not typically anti-vaxxers, but their resistance and hesitance comes from their concerns about side effects and the newness of the vaccine.  While there is less information on the vaccine in pregnant women and children under the age of 12, there are high levels of vaccine hesitancy in all mothers.  It seems that, like so many aspects of this pandemic, these decisions may also be tainted by misinformation, with many vaccine-hesitant women expressing concerns that the COVID-19 vaccines may affect their fertility.  

Given the high rates of vaccine hesitancy in this vulnerable population, it is especially important for us to discuss vaccination with mothers and women of childbearing age and to provide accurate information.  On their website, ACOG provides a set of resources for patients and providers to support discussions of the COVID-19 vaccination and decision-making, including informational fliers about the COVID-19 vaccines which can be given to pregnant and breastfeeding patients.  

Ruta Nonacs, MD PhD

What Drives COVID Vaccine Hesitancy Among Moms? (Medpage Today – free with registration)

They’re Not Anti-Vaccine, but These Parents Are Hesitant About the Covid Shot (New York Times)

COVID-19 Vaccines: Tools for Your Practice and Your Patients (ACOG)

MGH Center for Women's Mental Health

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