Wisconsin DHS Health Alert #36: Increased COVID-19 deaths in unvaccinated pregnant or recently pregnant people in Wisconsin: Providers should intensify vaccine education and promotion efforts
Bureau of Communicable Diseases
Bureau of Community Health Promotion
December 17, 2021
Key Points
- The Wisconsin Maternal Mortality Review Program has identified a recent increase in the number of pregnant or recently pregnant people who have died from COVID-19 in Wisconsin. These deaths occurred in people who were unvaccinated and developed COVID-19 disease during pregnancy, which resulted in either early delivery or miscarriage. In some cases, the infant did not survive.
- CDC has called for urgent action to accelerate primary vaccination and booster doses for people who are pregnant, recently pregnant (including those who are lactating), who are trying to get pregnant now, or who might become pregnant in the future, citing national data that percentage of pregnant people who are fully vaccinated is less than half the vaccination rate of non-pregnant females.1
- Wisconsin providers should intensify COVID-19 vaccine education and promotion efforts among the groups referenced above.
Background
Dear Colleagues,
An increase in COVID-19 related pregnancy-associated deaths was recently identified by the Wisconsin Maternal Mortality Review (MMR) Program. The MMR program is a statewide program housed in the Wisconsin Department of Health Services that facilitates de-identified case review for each pregnancy-associated death (a death during or within one year of the end of pregnancy) that occurs to a Wisconsin resident. 2 To prevent additional deaths among pregnant people and infants, DHS is calling for urgent action to increase COVID-19 vaccination, including booster doses, for people who are currently or recently pregnant or may become pregnant in the future.
Pregnancy, COVID-19, and Vaccination Background
Pregnant and recently pregnant people are at increased risk for severe illness from COVID-19 compared to people who are not pregnant. Severe complications from COVID-19 include hospitalization, the need for intensive care or mechanical ventilation, and death. People who get sick from COVID-19 during pregnancy also have an increased risk of preterm birth, stillbirth, and other pregnancy complications.3,4
As of December 6, 2021, there have been 150,036 total COVID-19 cases among pregnant people, resulting in 25,402 hospitalizations and 248 deaths in the United States.5 Approximately 7,000 pregnant Wisconsinites were diagnosed with COVID-19 between January 2020 and July 2021. Nationally, the largest spike in deaths among pregnant people with COVID-19 occurred during August-October 2021, after vaccines were widely available.5 This is consistent with Wisconsin data.
COVID-19 vaccines are safe and effective for people who are pregnant, breastfeeding, or plan to become pregnant. COVID-19 vaccines are not associated with infertility.3,4 Early data suggest that vaccination during pregnancy may also provide protection against COVID-19 for infants. The Centers for Disease Control and Prevention, American College of Obstetricians and Gynecologists, and Society for Maternal-Fetal Medicine all recommend COVID-19 vaccination at any stage of pregnancy or while breastfeeding. Booster shots are further recommended for pregnant people who have completed their primary vaccination series. COVID-19 vaccination is also strongly recommended for people planning to become pregnant in the future. Research has shown that COVID-19 vaccines are not associated with infertility and do not impact a person’s ability to become pregnant.3,4
Despite the increased risk of adverse effects of COVID-19 during pregnancy and the safety and efficacy of COVID-19 vaccines, vaccination rates among pregnant people remain critically low. Nationally, only 34.8% of pregnant people were fully vaccinated against COVID-19 as of December 4, 2021.5 In Wisconsin, 60.7% of female residents of reproductive age (15-49 years) are fully vaccinated against COVID-19, although that percentage is likely much lower among pregnant Wisconsinites.6
Racial and Ethnic Disparities
There are racial and ethnic disparities in COVID-19 vaccination coverage among pregnant people, with only 22.1% of non-Hispanic Black pregnant people being fully vaccinated nationally.5 Inequities in vaccination coverage can stem from barriers created by structural racism, social issues, and mistrust in the medical system that has a long history of mistreating racial and ethnic minorities, including Non-Hispanic Black people.7 Disparities in vaccination rates and COVID infections have the potential to further exacerbate existing inequities in maternal, pregnancy, and infant outcomes in Wisconsin.
Influenza and Pregnancy
Pregnant people are also at increased risk of severe illness from influenza, due to changes in the immune system, heart, and lungs. Vaccination can help protect against severe illness for the pregnant person as well as help protect the baby after birth, due to antibodies passed to the baby during pregnancy.8 The influenza vaccine is safe for pregnant people and can be administered at the same time as the COVID-19 vaccine.9
Recommendations for people who are currently or recently pregnant, or who are trying to get pregnant
- All people who are pregnant, recently pregnant (including those who are lactating), who are trying to get pregnant now, or who might become pregnant in the future should:
- Be fully vaccinated against COVID-19.1,10
- Receive a COVID-19 booster shot six months after their second dose of a two-dose vaccine or two months after their one-dose vaccine.1,10
- Continue to follow recommended prevention strategies such as wearing a mask in indoor public places, washing hands frequently, staying 6 feet away from others when possible, avoiding crowds and poorly ventilated areas, and testing for COVID-19 when indicated.1,10
Recommendations for Providers
- Ensure all clinical staff are aware of the recommendation for vaccination of people before and during pregnancy and the serious risks of COVID-19 to pregnant and recently pregnant people and their fetuses/infants.1
- For healthcare providers who see patients who are pregnant, recently pregnant (including those who are lactating), who are trying to get pregnant now, or who might become pregnant in the future:
- Review patients’ COVID-19 vaccination status at each pre- and post-natal visit and discuss COVID-19 vaccination with those who are unvaccinated.1
- Reach out to your patients with messages encouraging and recommending the critical need for vaccination.1
- Remind patients that vaccination is recommended even for those with prior COVID-19 infections. Studies have shown that vaccination provides increased protection in people who have recovered from COVID-19.1
- Support efforts to ensure people receiving the first dose of an mRNA COVID-19 vaccine (i.e., Pfizer-BioNTech, Moderna) return for their second dose to complete the series as close as possible to the recommended interval.1
- Communicate accurate information about COVID-19 vaccines and confront misinformation with evidence-based messaging from credible sources. For example, there is currently no evidence that any vaccines, including COVID-19 vaccines, cause fertility problems in women or men.1
- Encourage vaccination against influenza at each pre- and post-natal visit and discuss influenza vaccination with unvaccinated pregnant patients during flu season. The influenza vaccine can be administered at the same time as the COVID-19 vaccine.8,9
- Work with community partners and employers to make vaccination easily accessible for unvaccinated populations, including those who are pregnant, recently pregnant (including those who are lactating), who are trying to get pregnant now, or who might become pregnant in the future.1
- When discussing COVID-19 vaccines with an individual who expresses concerns, it is critical to:
- Be aware of historical and current injustices perpetuated on communities of color.10
- Actively listen to and validate expressed fears and concerns while also addressing misinformation about the vaccine.10
- Be knowledgeable of the existing avenues for vaccine access in traditionally underserved communities.10
Thank you for your collaboration on this important public health issue.
Sincerely,
Jasmine Zapata, MD, MPH, FAAP Chief Medical Officer and State Epidemiologist for Community Health
Wisconsin Department of Health Services
Co-Chair Wisconsin Maternal Mortality Review Program
Ryan Westergaard, MD, PhD, MPH Chief Medical Officer and State Epidemiologist for Communicable Diseases
Wisconsin Department of Health Services
Where to find vaccines
References
- Centers for Disease Control and Prevention. COVID-19 Vaccination for Pregnant People to Prevent Serious Illness, Deaths, and Adverse Pregnancy Outcomes from COVID-19 (accessed December 14, 2021)
- Wisconsin Department of Health Services. Maternal Mortality and Morbidity (accessed December 14, 2021)
- Centers for Disease Control and Prevention. COVID-19 Vaccines While Pregnant or Breastfeeding (accessed December 14, 2021)
- Wisconsin Department of Health Services. COVID-19: Vaccine, Fertility, and Pregnancy (accessed December 14, 2021)
- Centers for Disease Control and Prevention. COVID Data Tracker (accessed December 14, 2021)
- Razzaghi H, Meghani M, Pingali C, et al. COVID-19 Vaccination Coverage Among Pregnant Women During Pregnancy — Eight Integrated Health Care Organizations, United States, December 14, 2020–May 8, 2021. MMWR Morb Mortal Wkly Rep 2021;70:895–899. DOI: http://dx.doi.org/10.15585/mmwr.mm7024e2external icon.Wisconsin Department of Health Services.
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COVID-19: Racial and Ethnic Disparities (accessed December 14, 2021)
- Centers for Disease Control and Prevention. Flu & Pregnancy (accessed December 14, 2021)
- Centers for Disease Control and Prevention. Frequently Asked Influenza (Flu) Questions: 2021-2022 Season (accessed December 14, 2021)
- The American College of Obstetrics and Gynecology. COVID-19 Vaccination Considerations for Obstetric-Gynecologic Care (accessed December 14, 2021)
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