As the winter respiratory illness season fast approaches, this is the first year that four vaccines are being recommended during pregnancy. Yet, there are already signs that fewer pregnant women are getting vaccinated — putting themselves and their newborns at increased risk of severe illness or death.
“We are meeting more resistance than I ever remember,” said Dr. Neil Silverman, a maternal-fetal medicine specialist at UCLA Health. “We didn’t get this kind of pushback on this scale before the pandemic.”
“Now all vaccines are lumped together as ‘bad,'” he said.
In September, the Centers for Disease Control and Prevention recommended for the first time that pregnant people get the RSV vaccine to protect against an infection that is usually mild in healthy adults but can be dangerous for children younger than 5. The new guidance means pregnant women will be encouraged to get four vaccines to protect against the flu, Covid and pertussis (also called whooping cough), as well as respiratory syncytial virus, or RSV.
However, a recent CDC report found growing doubts about vaccination during pregnancy.
Among almost 2,000 women who were pregnant during the height of last year’s cold and flu season or when the survey was conducted in March and April, almost a quarter said they were “very hesitant” about getting a flu shot.
That is a significant increase over the 17.2% who said they had the same level of reservations during the 2021-2022 respiratory illness season.
That reluctance has translated to fewer pregnant women protected against influenza and other illnesses.
“Even prior to the pandemic, it was a struggle to get pregnant women vaccinated,” said Dr. Denise Jamieson, vice president for medical affairs at the University of Iowa Health Care, as well as a spokesperson for the American College of Obstetricians and Gynecologists. Since then, skepticism about vaccines has ballooned and spread to common flu shots that have been given to millions of pregnant women over several decades without any evidence of problematic side effects.
Last year, the CDC study found, 47.2% of expectant mothers got their flu shots, down from 57.5% who got their flu shots during the pre-Covid 2019-20 season.
Just more than half, or 55.4%, got their Tdap vaccines and only 27.3% of women got the Covid booster before or during pregnancy last season, when omicron infections were filling hospitals. The Tdap vaccine protects newborns against tetanus, diphtheria and pertussis and has been recommended during pregnancy since 2011.
“Tdap is just barely recovering from pre-pandemic levels,” Jamieson said. “The number of women vaccinated for Covid is disappointing.”
According to Dr. Linda Eckert, an OB-GYN and global health and immunization expert at the University of Washington, “there’s a bias that some patients have, more than they used to, about how they feel about a vaccine.” When Eckert recommends a vaccine to her pregnant patients, more now react with, “I’m not going to talk about it,” she said.
What pregnant women need to know about vaccines
Pregnant women are primed to question everything they put in their body, and that’s not necessarily a bad thing, experts say.
“That instinct is a good one. It’s protective mothering,” said Dr. Jodie Dionne, associate director of Global Health in the University of Alabama at Birmingham’s Center for Women’s Reproductive Health. “We actually want women to question what they’re putting in their body.”
“There are a lot of myths out there, what I would call blatant disinformation that is intended to be more politically charged, not based in science,” said Dr. Melissa Simon, an OB-GYN at Northwestern Medicine in Chicago.
The only way doctors can address those concerns effectively, Dionne said, is to “create an open atmosphere where they feel comfortable telling you what they’re worried about.”
A key finding in the CDC report is that when obstetricians or providers talked to women about the need for vaccination, they were less hesitant.
“A lot more people are vaccine hesitant than anti-vaccine,” Eckert said. “Vaccine hesitant individuals tend to be curious.”
Doctors perfected their skills addressing patients’ vaccine concerns when Covid shots became “crucial,” said Dr. Sarah Pachtman, a maternal/fetal physician at Northwell Health’s Katz Women’s Hospital of Long Island Jewish Medical Center in New Hyde Park, New York.
“We’ve had so much practice,” she said, adding that she’s encountered less vaccine hesitancy this year compared to before the pandemic.
“I noticed myself spending more time counseling patients,” she said. “That helps decrease their hesitancy.”
Flu and Covid are dangerous during pregnancy
During pregnancy, the belly enlarges, pushing up against the diaphragm, decreasing lung capacity. That makes pregnant women — especially those late in their pregnancies — more vulnerable to breathing difficulties, Simon said.
“When an infection like RSV or Covid or influenza gets into that lung space, it’s even harder for people who are pregnant to breathe,” she said.
Pregnant women are one of the most at-risk groups for flu complications. Covid can also be harmful during pregnancy, and can increase the risk of preterm births and other complications.
The virus almost killed Haeli Graham of Swansboro, North Carolina, and caused her son to be born three months early.
On July 4, 2021, Graham, then 27 years old and six months pregnant, went to the emergency room, “gasping for air,” she said.
“I couldn’t breathe and I couldn’t feel my baby moving anymore,” she said.
A Covid test came back positive.
Within days, her lungs collapsed and she developed two pulmonary embolisms. She was intubated and put into a medically induced coma to give her lungs time to heal.
Graham had no idea that doctors had to deliver her baby early until she woke up more than a month later.
“I was speechless,” she said. “It was just shocking that me — a very healthy, active 27-year-old female — could have died.”
Her son, Colton, was born at just 3 pounds, 9 ounces. Despite some delays, he is now a healthy 2 year old.
Though Covid vaccines were available by summer 2021, Graham’s doctor at the time advised her against getting the shot, citing a lack of evidence about their safety.
“It was a very scary time,” Graham said. “We had no idea what to do.”
It was not until August 2021, a month after she had been hospitalized with Covid, that the CDC said it had gathered enough evidence to recommend the shots for pregnant people.
Vaccinated moms protect their newborns
Now is the time for flu, as well as Covid shots — just ahead of the typical winter respiratory virus season, experts say. Those shots can be given at any stage of pregnancy, according to the CDC.
Timing for the two other recommended shots is more specific and should be given during the third trimester.
The Tdap vaccine is given between the 27th and 36th weeks of gestation, ideally during the earlier part of that timeline.
That timing “helps pass the greatest amount of protective antibodies to your baby before birth,” the CDC says on its website. That is especially important when it comes to protecting against whooping cough.
Babies are not eligible for the shots themselves until they’re several months old.
“Babies who catch whooping cough, especially those younger than 3 months old, are most likely to have serious problems, have to be cared for in a hospital, and possibly even die,” Tami Skoff, a CDC epidemiologist, wrote in an email. “Vaccinating women during every pregnancy is critical for providing the best protection to the youngest of babies.”
A CDC study published in February found that the number of babies 2 months and younger who developed whooping cough was significantly lower after the vaccines were recommended. The vaccine is given during each subsequent pregnancy because those antibodies decrease in the mother’s body over time.
The single-dose RSV shot from Pfizer is recommended between 32 and 36 weeks’ gestation. It was found to lower the risk of severe RSV among infants by 91% within the first three months after birth, a time when babies are especially vulnerable.
Last winter, a surge of RSV among young children overwhelmed hospitals.
Doctors insist there is no danger in vaccinations during pregnancy.
“We’ve been vaccinating pregnant people for decades,” Silverman said. “While any vaccine for any person, pregnant or not, can have a rare side effect, those serious side effects are exceedingly low. And none of these vaccines have ever been shown to have any negative impact on the fetus or newborn.”
“Vaccines are a very efficient way to protect mothers and to protect their babies in one fell swoop,” he said.