Pregnant People Are More Likely to Get Breakthrough COVID-19—Experts Explain Why

New research had this surprising finding.

  • New research shows that pregnant people are more likely to develop breakthrough COVID-19 infections.
  • Researchers discovered that the pregnant people studied were 90% more likely to be infected than people who weren’t pregnant.
  • Experts recommend getting vaccinated against COVID-19 and wearing masks in indoor areas to mitigate the risk of contracting the coronavirus.

    For months, public health experts have warned that pregnant people are at high risk for developing severe forms of COVID-19. But a new study has found that people who fall into this category also may be more likely to develop breakthrough COVID-19 infections.

    The study, which was conducted by Wisconsin-based company Epic Research, analyzed data from 13.8 million patient records between January 2021 to January 2022 to try to figure out which underlying health conditions increase a person’s risk of contracting COVID-19 when they’re fully vaccinated.

    The researchers discovered that the pregnant people studied were 90% more likely to be infected than those who weren’t pregnant. Pregnant people were even more likely to develop a breakthrough COVID-19 infection than people who are already known to be at severe risk of breakthrough infections, including those with solid organ transplants, people who are immunocompromised, and patients with cancer.

    “These findings support the Centers for Disease Control and Prevention’s recommendation that patients with a high-risk comorbidity may need to use enhanced infection prevention control beyond vaccination to minimize the risk of a COVID-19 breakthrough infection,” the researchers concluded.

    But why might pregnant people be more likely to get infected? And what can they do to protect themselves from the coronavirus throughout their pregnancy? Here’s what you need to know.

    There is a known risk for severe COVID-19 in pregnancy

    The Centers for Disease Control and Prevention (CDC) specifically warns about the risks of developing severe illness from COVID-19 for pregnant people, noting that “if you are pregnant or were recently pregnant, you are more likely to get very sick from COVID-19 compared to people who are not pregnant.” The CDC also says that getting COVID-19 during pregnancy increases the risk of preterm delivery, having pregnancy complications, or delivering a stillborn infant.

    The American College of Obstetricians and Gynecologists (ACOG) and American Society for Maternal-Fetal Medicine (SMFM) recommend that pregnant people and those who are trying to become pregnant get vaccinated against COVID-19 due to risks of contracting the virus.

    “Data have shown that COVID-19 infection puts pregnant people at increased risk of severe complications and even death,” the organizations said in a joint statement in July 2021. They also noted that data show that more than 95% of those who are hospitalized and/or dying from COVID-19 are those who are unvaccinated.

    “Pregnant individuals who have decided to wait until after delivery to be vaccinated may be inadvertently exposing themselves to an increased risk of severe illness or death,” the organizations said in a statement.

    Why might pregnant people be more likely to get a breakthrough COVID-19 infection?

    The study didn’t specifically explore this—it simply found that pregnant people were more likely to develop breakthrough infections than people with other underlying health conditions. It also left some questions open, including how sick the patients became when they developed breakthrough infections. “Not all breakthrough infections are created equal,” points out Thomas Russo, M.D., professor and chief of infectious disease at the University at Buffalo in New York.

    But Dr. Russo notes that people with weakened immune systems and those who have had solid organ transplants are eligible to get a second COVID-19 booster shot, which may lower their risk of breakthrough infection compared to pregnant people.

    Infectious disease expert Amesh A. Adalja, M.D., a senior scholar at the Johns Hopkins Center for Health Security, says that the findings are “not surprising” since pregnancy is a “condition of immunosuppression.” He adds, “other respiratory viruses are more common in this population.”

    If this isn’t a person’s first pregnancy, it’s possible that they could be at a higher risk of COVID-19 exposure from their children, says William Schaffner, M.D., an infectious disease specialist and professor at the Vanderbilt University School of Medicine. “If you already have children in the house, there may be more opportunities for contact with the virus,” he says.

    Overall, though, experts say the exact reasoning for more breakthrough infections in pregnant people needs to be studied more.

    How to protect yourself from COVID-19 if you’re pregnant

    While mask mandates have been lifted in many areas of the country, Dr. Schaffner says it’s crucial for pregnant people to continue to take precautions to limit their potential exposure to COVID-19.

    “Certainly, you’ll want to make sure you’re fully vaccinated as well as everyone around you,” he says. And, when you go into public indoor spaces like the grocery store, Dr. Schaffner recommends that you “get out that mask—and wear it.” He also suggests testing other household members for COVID-19 “frequently, to see whether anyone is bringing COVID into the house.”

    Dr. Russo agrees that extra precautions are needed for pregnant people. “Certainly we know that pregnant women are at greater risk,” he says. “If there is a lot of disease in the community, it would be prudent to wear a mask and take other precautions.”

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