“For me, this was the best way to protect my baby”

By Maureen Gilmer, IU Health senior journalist, mgilmer1@iuhealth.org

Three women. Each one pregnant, each one a healthcare worker during an uncontrolled pandemic.

After learning as much as they could and talking to their doctors, each one decided to get the COVID-19 vaccine earlier this year. Now, they are practically begging other pregnant women to do the same, understanding that some are still fearful.

Nationwide, just 23% of pregnant women are vaccinated against COVID-19, according to data released by the Centers for Disease Control last month. Less than one in four.

That is despite growing evidence that moms-to-be are at higher risk for serious disease should they contract the virus and studies that show the vaccine is safe for pregnant women and their unborn babies.

“I WAS CAUTIOUS”

Armisha Desai is a pharmacist at IU Health Methodist Hospital and a new mom. Her son, Ayur, is 8 weeks old. She could have been vaccinated in late December 2020 when the Pfizer vaccine rolled out to healthcare workers, but she elected to wait a couple of weeks until January.

“I was vaccinated at the start of my second trimester,” she said. “I was cautious, I talked to my OB provider. With the side effects of fever and fatigue that you can get with the vaccine, we decided to wait just a little longer. But as soon as I reached 12 weeks, I scheduled my appointment.”

She had no side effects from either dose and carried her son to term. Ayur is getting breast milk from his mom, which she believes is increasing his immunity to the virus. When it’s time for her third shot this fall, she will be ready.

“I want to get my third shot to increase my antibodies in my breast milk and pass those antibodies on to him,” she said. “Any potential benefit out there I want to take.”

Desai, who is on maternity leave until next month, specializes in infectious disease pharmacy, so she has worked (indirectly) with many COVID patients admitted to the hospital in the past year.

“I know firsthand that pregnant patients have more severe complications with COVID than other young people. It’s much safer to get the vaccine than to be pregnant and get COVID.”

She helped IU Health develop treatment algorithms for COVID and discussed with providers which patients met which qualifications for therapies.

“The data show that the vaccine is safe for pregnant women,” Desai said.

Those who get the vaccine are not only protecting themselves, they are protecting their babies, experts say.

“That’s what mothers want – to protect their babies,” she said. “For me, this was the best way to protect my baby. I’m passionate about this as a new mom.”

SEVERE OUTCOMES CAN BE PREVENTED

Dr. Lana Dbeibo, medical director for infection prevention at Methodist Hospital, said her heart breaks for pregnant women who are unvaccinated and struggling in the ICU because of COVID.

“We are seeing pregnant women who are unvaccinated who have concerns over the vaccine causing problems for them or their babies, and they are coming into the hospital sick, especially considering their age,” she said. “They are really getting sick, requiring oxygen and intensive care support at times, and I really feel like this is all preventable.”

The CDC encourages all pregnant women and those who are thinking about becoming pregnant, as well as those who are breastfeeding, to get vaccinated, said CDC Director Dr. Rochelle Walensky in a statement released last month.

“The vaccines are safe and effective, and it has never been more urgent to increase vaccinations as we face the highly transmissible Delta variant and see severe outcomes from COVID-19 among unvaccinated pregnant people.”

Those outcomes can include oxygen support, being put on a ventilator, pre-term birth, even death.

Dr. Christina Scifres, division director for Maternal Fetal Medicine at Riley Hospital for Children at IU Health and associate professor of obstetrics and gynecology, said she and her team have been concerned about COVID in pregnancy since the pandemic began last year, but the Delta variant appears to be making more pregnant women very sick.

Why that’s happening is unclear, but Dr. Scifres said it could be due to changes in the immune system or pulmonary system related to pregnancy.

“We’ve had women admitted to the ICU and needing to be on a ventilator and even needing to be on an ECMO machine (heart-lung bypass),” she said. “There have been some maternal deaths in Indiana and around the country.”

READY FOR HER THIRD SHOT

Dr. Dbeibo, who was breastfeeding her first child when she got the vaccine and is now pregnant with her second child, said she would absolutely get a third shot while pregnant if that is recommended this fall.

“I can’t imagine advising women to do something that I wouldn’t do myself,” she said. “If I didn’t believe in it, I wouldn’t be giving that advice. We know the vaccines work for everyone, including pregnant individuals. We know with more and more data that it’s not going to cause harm to them or their unborn child. It prevents hospitalization, bad outcomes and death.”

The sooner a woman gets the vaccine, the sooner she and her child are protected, the infectious disease specialist said.

“Mom is the closest person to the child, so if she gets infected, the risk of transmission to the child is high. The rates we’re seeing right now with this variant are sky-high.”

While no one should consider themselves at low risk for getting exposed, no matter how careful they are, the vaccine prevents more serious illness, Dr. Dbeibo said.

“Even though these women are younger, we are seeing younger people in the hospital, and the fact that they are pregnant actually does put them at risk for having bad forms of COVID,” she said. “Pregnant women have a higher chance of admission to the ICU compared to others, and they are at higher risk of adverse pregnancy outcomes.”

AN URGENT PLEA

Each of the women interviewed for this story is desperate to communicate the urgency of pregnant women getting vaccinated against the deadly virus. Conflicting messaging over the past 18 months has left some skeptical of the seriousness of the disease, despite a death toll now of more than 650,000 in the U.S. alone.

The vaccine rollout was supposed to put COVID-19 in the rearview mirror, but nearly half of the U.S. population is yet to be vaccinated, including children (for which there is no approved vaccine yet for ages 0-11).

“We’re talking about getting protected at a time when the pandemic is at its worst,” Dr. Dbeibo said. “Not only are infection rates high, but hospitals are almost full. We have something that is lifesaving for us and we have a pandemic that is raging, completely uncontrolled, and we’re still in the summer,” she said.

“We haven’t seen the worst of it yet and we’re already at capacity. The health system is overburdened. I worry about pregnant women having access to good care because hospitals are full, and they could have averted that outcome by just getting a shot.”

Now six months pregnant, Dr. Dbeibo understands the hesitancy some women feel about the vaccine, but she urges them to consider the consequences of doing nothing.

“I totally understand that they don’t want to do something excessive that might have a risk. But I would emphasize that COVID will hurt their baby much, much more. I can’t imagine a mom who is delivering her baby while she’s intubated and can’t have those first moments with her baby. Or the baby getting an infection from the mom while their immune system is basically nonexistent when they are born. That will hurt the baby. Losing their mom will hurt the baby,” she said.

“So, no, you won’t be hurting your baby with the vaccine. COVID will hurt your baby. I think the fear is misdirected – it should be fear of the virus, not the vaccine. We don’t know what the virus is going to do to us. It’s not a benign thing. We can’t say we’ll get it and get over it. There is a significant risk, and it is certainly higher than the vaccine.”

CONVINCED BY THE DATA

Dr. Geeta Karnik Mantravadi, medical director of IU Health LifeCare and an infectious disease specialist at Methodist, delivered her baby boy in May. He is her first child, the result of many years of trying to conceive and carry a child to term.

“It took us a while to get him,” she said, “and you always worry. He was my precious baby and this (the vaccine) was new. So I definitely understood other women’s concerns, and I did want to wait a bit to have more data come out.”

But she also understood the risks better than most. She worked on COVID units at Methodist in 2020 and had seen firsthand as an infectious disease specialist how pregnant women were coming in with more serious forms of the virus.

She was fortunate that when she became pregnant she was able to step away from her work in the units, which gave her a little time to think and not risk exposing herself before she was vaccinated.

“It was always a matter of weighing risks and benefits, and ultimately the data has shown that the vaccines are safe and effective,” she said. “When I made my decision to get it, I felt really confident because there had been such good CDC analysis and other data demonstrating that there were really no safety concerns.”

Dr. Mantravadi said anytime she felt herself hesitating about getting vaccinated, she had flashes of real-life unvaccinated patients who suffered severe illness, pre-term labor, miscarriage.

“Those images and stories flashed in my mind, and I realized it’s way better to get the vaccine. And now women have the benefit of nine months of data. It’s a no-brainer.”

She received the vaccine during her second trimester, and although her son was born six weeks early after she developed pre-eclampsia, he was perfectly healthy, she said.

She has done her best to correct misconceptions about COVID and the vaccine with patients, friends and acquaintances, but she worries about the higher transmission rates of the Delta variant and what it could mean down the road.

The vaccine isn’t bullet-proof, she said, but not getting it carries a much greater risk.

“The vast majority of people being admitted to the hospital are unvaccinated individuals,” she said. “It’s just so clear how risky it is at this point. For me, it was a personal decision, but everyone wants to be a good mom and that means making hard decisions. The first step these days is getting the vaccine.”

A GLIMMER OF HOPE

As the healthcare system around the country continues to be upended by the virus, Dr. Scifres and her Maternal Fetal Medicine team continue to stress the safety of the vaccine during pregnancy with their patients.

“We’ve certainly never seen anyone hospitalized from taking the vaccine, but we’ve seen plenty of women hospitalized from COVID,” she said. “And the patients we’re seeing who are getting very sick have not been vaccinated.”

In talking with patients, she knows that some women are concerned because of something they might have seen on social media or heard from a friend, so she does her best to reassure them.

Maybe the message is getting through.

“I do feel like we’re seeing more pregnant women get vaccinated, and I think that brings us all hope,” said Dr. Scifres, a mother of two. Her older child is vaccinated, and she is holding her breath until the younger one can be, she said.

“I want to let patients know that we make this recommendation out of an abundance of care for them and their babies. We want to do everything we can to protect them.”