Pregnant People May Be at a Much Higher Risk for Breakthrough COVID

Changes in the body during pregnancy make an individual more vulnerable to respiratory viruses like COVID-19. And although vaccination is extremely effective at providing protection against severe illness, it cannot completely prevent infection.

According to a new study published in Epic Research, fully vaccinated pregnant people are 1.91 times as likely to have a breakthrough infection compared to non-pregnant fully vaccinated people. It was the condition with the highest breakthrough infection risk, even higher than solid organ transplant or kidney disease.

The results highlight the need for pregnant individuals to take safety precautions, such as getting boosted and wearing face masks.

How Does Pregnancy Increase Breakthrough Infection Risk?

The study only compared breakthrough infection risk and did not dive into why the difference exists.

It appears to report only the incidence of COVID-19 in vaccinated individuals with different medical conditions without indicating how sick they became, only that they tested positive for the disease, Todd Rosen, MD, director of the Division of Maternal-Fetal Medicine and associate professor of obstetrics, gynecology, and reproductive sciences at the Rutgers Robert Wood Johnson Medical School, told Verywell.

“There are a million reasons not related to the biology of the disease that could explain why certain individuals are more prone to test positive for COVID,” Rosen added. “My very strong suspicion is the reason pregnant women were found to have a two-fold increased risk for infection after vaccination is simply that we were testing them way more often than non-pregnant people.”

It’s also possible that pregnant people’s immune systems make them more vulnerable to infection in the first place, or that something in the environment of the study participants put them at a higher risk for infection, like frequent contact with the healthcare system or having another family member in school, Alexa Mieses Malchuk, MD, MPH, family physician and assistant professor in the department of family medicine at UNC-Chapel Hill, told Verywell.

The review and publishing process of Epic Research is different from traditional scientific journals, and further research is necessary to understand why pregnant individuals have an increased risk for breakthrough infections. The study has not been peer-reviewed, Rosen noted.

Pregnant Individuals Should Get Vaccinated

The American College of Obstetricians and Gynecologists (ACOG) recommends that all pregnant and lactating individuals get vaccinated and boosted to minimize the risk of getting COVID-19, even though they are not 100% effective at preventing infections.

Although the increased risk of breakthrough infections can be alarming, these cases are often not as severe as infections that occur in unvaccinated individuals, therefore it’s still beneficial to be vaccinated against COVID-19, Malchuk said.

“In addition to being vaccinated, pregnant individuals should avoid unnecessary travel, wear a mask indoors if located in an area in which rates of COVID-19 infection are high, and sanitize their hands frequently,” Malchuk added. “Additionally, overall wellness practices such as sufficient rest, hydration, regular physical activity, and stress reduction can boost the immune system.”

Research has shown that pregnant people who are vaccinated are less likely to get COVID-19 than those who are unvaccinated. And that protection also extends to the baby they are carrying.

“The vaccine does not affect fertility, cause birth defects, or cause other problems during pregnancy,” Rosen said. “COVID can be innocuous in pregnancy, but has been shown in multiple studies to increase the risk for adverse events.”

A 2021 study published in the American Journal of Obstetrics & Gynecology MFM found that the majority of pregnant patients who were admitted for delivery and screened positive for COVID-19 are asymptomatic and do not develop symptoms from their infections.

Nonetheless, it’s still important to minimize the risk of infection as much as possible to avoid complications like preterm birth or stillbirth. Pregnant individuals who have a COVID-19 infection should talk to their primary care provider for guidance on how to best manage their condition.

“Some useful standard recommendations include self-isolating until symptoms have resolved, staying hydrated, getting plenty of rest, and calling 911 or going to the emergency department of the nearest hospital if you develop trouble breathing,” Malchuk said. “Your family physician knows you and your family and can offer tailored advice for your unique situation.”

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