In the first 18 months of the COVID-19 pandemic, tens of thousands of pregnant women were wheeled into hospitals, where they fought for their lives and the lives of their unborn babies.
It took until August 2021, eight months after the first vaccination, for the Centers for Disease Control and Prevention to officially recommend COVID-19 vaccination for pregnant and breastfeeding mothers. The CDC found that pregnant women who are infected with COVID-19 have a 70% increased risk of death compared to those who are not infected. They also faced an increased risk of being admitted to intensive care, requiring life support specifically for critically ill patients, and having a stillbirth. In recommending the vaccine, the CDC guaranteed that the shot is safe and does not cause fertility problems.
ProPublica investigated the harm caused by delays in vaccine rollout and approval for pregnant mothers. Federal officials at the time said they wanted to ensure “abundant evidence” before issuing guidance.
But surprising events this summer have upended that guidance.
In May, Robert F. Kennedy Jr., Secretary of Health and Human Services and longtime vaccine critic, announced on X that “COVID-19 vaccines for healthy children and healthy pregnant women have been removed from @CDCgov’s recommended immunization schedule. Bottom line: This is common sense and good science. We are now one step closer to fulfilling the @POTUS promise to make America healthy again.”
The following month, Kennedy fired all 17 current members of the CDC’s Advisory Committee on Immunization Practices and replaced them with handpicked members. The committee has since changed its guidance, encouraging people to make their own decisions about whether to get vaccinated and consider their individual risk factors.
Physicians and medical organizations around the world said the CDC’s new guidance could cause confusion for patients and put pregnant women and their infants at risk of serious illness and hospitalization.
The Society for Maternal-Fetal Medicine released a statement saying, “COVID-19 infection during pregnancy increases the risk of premature birth, preeclampsia, and stillbirth.”
The group and the American College of Obstetricians and Gynecologists, the nation’s leading professional organization of obstetricians and gynecologists, reiterated their recommendation that everyone who is pregnant or breastfeeding receive up-to-date vaccines and boosters, regardless of gestational age.
ProPublica found that COVID-19 vaccines were being usurped by disinformation and suspicion, even though unvaccinated women face devastating risks. Despite federal guidance on how to safely include pregnant and lactating people in biomedical research, pharmaceutical companies and government officials did not ensure that pregnant women would participate in the early development of vaccines.
Andrew G. Nixon, director of communications for HHS, defended the federal government’s action in a statement, saying, “The ACIP recommendations apply to all individuals six months of age and older. They include the emphasis that, according to the CDC’s list of COVID-19 risk factors, the risks versus benefits of vaccination in individuals under age 65 are most favorable for those who are at increased risk for severe COVID-19 disease and least favorable for those who are not at increased risk.”
Pregnancy is listed as a condition that may increase risk.
Amid backlash over the CDC’s guidance, a recent Harvard University study highlights new risks of coronavirus infection during pregnancy. In a rare study of children of women who contracted COVID-19 during pregnancy, the study found that children may be at increased risk of autism and other neurodevelopmental diagnoses by the age of three.
Dr. Andrea Edlow, one of the study’s senior authors and an obstetrician-gynecologist at Harvard Medical School, said the researchers followed the children through medical records from birth to infancy and observed early developmental delays at 12 months of age and again at around 18 months.
“We saw language and motor delays, but we had no idea if it would last or develop into another diagnosis like autism or if the children would catch up,” Edlow said. “But unfortunately, that wasn’t the case.”
Dr. Edlow has treated many pregnant patients during the pandemic, including some who experienced a life-threatening condition known as a cytokine storm. High fever and severe inflammation often persisted for several days. She remembers thinking that this condition could not be good for the placenta or the developing brain of the fetus.
Edrow and his team looked at more than 18,000 live births to mothers who gave birth between March 2020 and May 2021. More than 800 of them had been diagnosed with the new coronavirus. What surprised them was that 16.3% of those babies had a neurodevelopmental diagnosis by age 3, compared with 9.7% of babies who were not exposed to COVID-19 in the womb. It was a statistically significant finding. During the study period, most mothers were not vaccinated because the CDC had not yet issued a formal recommendation for pregnant women to receive COVID-19 vaccinations.
Children and boys of mothers who contracted COVID-19 during the third trimester, a critical period for fetal brain development, were at even higher risk. Researchers say the male placenta and the fetal brain are susceptible to the mother’s immune response to COVID-19 and other infections.
“I know it’s a concerning situation,” Edlow said.
She says the researchers aren’t trying to stir up fear. Although the risk of autism increases, the overall risk remains low, Edrow said. This study highlights the importance of monitoring the neurodevelopmental status of children born to mothers infected with the coronavirus during pregnancy.
Edlow encouraged pregnant women to do everything they can to avoid contracting COVID-19, including wearing masks, avoiding crowded indoor spaces, and getting vaccinated or booster shots.
“COVID-19 is a real issue that poses risks to pregnant mothers and their children,” she said. “And it’s still worth preventing at this point.”
Dr. Naima Joseph is concerned about how the withdrawal of recommendations for COVID-19 vaccines for pregnant patients will affect the country’s health, especially its most vulnerable populations, women and children.
She remembers her husband, who is also a doctor, turning to her as she waited in line to get the coronavirus vaccine during the pandemic.
“Should I really do this?” he asked.
Joseph, a maternal-fetal medicine physician at Boston Medical Center and a member of ACOG’s Immunization, Infectious Disease, and Public Health Preparedness Specialist Working Group, paused. She was pregnant with twins. Like many mothers, her primary concern in this world was protecting her baby, but she was also caring for the many pregnant women infected with COVID-19 who had been fighting for their lives in hospital beds for months. Some have died or lost their babies.
“Yes,” she answered her husband before receiving the injection.
