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Pregnancy Health Alert: COVID-19 Vaccine is Strongly Recommended

Pregnant women gets the COVID-19 vaccine Sandra Murray-Campbell, licensed practical nurse, administers a COVID-19 vaccine to Army Capt. Bryana Fournier , a registered nurse for the Bayne-Jones Army Community Hospital emergency department at the Joint Readiness Training Center and Fort Polk, Louisiana. DOD and CDC advise all pregnant people, those trying to get pregnant, or breastfeeding to get vaccinated against COVID-19 (Photo by: Jean Graves, Regional Health Command Central).

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If you are pregnant, recently pregnant or thinking about getting pregnant in the future, you should get the COVID-19 vaccination, the Centers for Disease Control and Prevention advised in a recent health advisory.

Pregnant and recently pregnant women with COVID-19 are at increased risk of severe illness, death, and pregnancy complications, studies show.

"Pregnant service members should be vaccinated as part of mandatory COVID-19 vaccination of DOD service members directed by the Secretary," according to an Oct. 5 DOD memorandum that aligns with the CDC recommendations. Secretary of Defense Lloyd J. Austin III issued a mandate that all service members be vaccinated against COVID-19 on Aug. 24.

The recommendation that pregnant or recently pregnant women get vaccinated against COVID-19 is not new, but because of the gravity of the concern, CDC issued the recent health alert, which calls for "urgent action," saying the CDC "strongly recommends COVID-19 vaccination either before or during pregnancy because the benefits of vaccination outweigh known or potential risks."

The numbers of Americans who are pregnant and vaccinated fully or previously fully vaccinated against the SARS-CoV-2 virus that causes COVID-19 is only 31%, according to CDC data.

"All women are encouraged to become fully vaccinated against COVID-19 before pregnancy," said Dr. Margaret Ryan, medical director of the Defense Health Agency's Immunization Healthcare Division in San Diego, California. "If not vaccinated before pregnancy, they should become vaccine-protected during pregnancy and enroll in CDC's v-safe tracking system."

About 97% of pregnant women hospitalized (either for illness or for labor and delivery) with confirmed SARS-CoV-2 infection were unvaccinated.

The DOD and CDC recommendations align with other recommendations from professional medical organizations serving people who are pregnant, including the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine.

"A new study shows that patients vaccinated in late pregnancy had no increased risk of delivery problems. Another new study shows that patients vaccinated in early pregnancy appeared to have no increased risk of pregnancy loss," Ryan said.

Death

Symptomatic pregnant women with COVID-19 who are hospitalized have a 70% increased risk of death.

That is the case even though the absolute risk of death is low compared with non-pregnant symptomatic people, according to the CDC.

Pregnancy is independently associated with a three-fold increased risk for ICU admission, a 2.4-fold increased risk for needing extracorporeal membrane oxygenation (ECMO), and a 1.7-fold increased risk of death due to COVID-19 compared to symptomatic non-pregnant patients, according to new data cited by Navy Cmdr. (Dr.) Monica Lutgendorf, chair, Department of Gynecologic Surgery and Obstetrics at the Uniformed Services University of the Health Sciences in Bethesda, Maryland.

Pregnant patients with other health risk factors - like obesity, diabetes, heart disorders, chronic kidney disease, chronic obstructive pulmonary disease, immunocompromised from organ transplantation, sickle cell disease and smoking, and those older than age 35 - also appear to have "an increased risk of adverse maternal outcomes," Lutgendorf said.

As of Sept. 27, more than 125,000 laboratory-confirmed COVID-19 cases have been reported in pregnant women, including more than 22,000 hospitalized cases and 161 deaths.

Pregnant women posing for a picture
Stephanie Faine expecting her first child at Fort Irwin, California, amid the pandemic (Photo by: Janell Ford, Garrison Public Affairs, Fort Irwin, California).

Preterm Birth

Pregnant women with the COVID-19 disease are also at increased risk for preterm birth.

Some preliminary data suggests that COVID-19 increases risk for other adverse pregnancy complications and outcomes, such as preeclampsia (severe high blood pressure), coagulopathy (blood coagulation to clots), and stillbirth, compared with pregnant people without COVID-19.

Risks to Newborn Babies

Furthermore, CDC's alert explained that babies "born to people with COVID-19 are also at increased risk for admission to the neonatal ICU."

"In addition, although rare, pregnant people with COVID-19 can transmit infection to their neonates; among neonates born to women with COVID-19 during pregnancy, 1%-4% of neonates tested were positive" based on polymerase chain technology testing, CDC said.

Breastfeeding

A majority of military doctors agree that women who have been vaccinated against COVID-19 should not have any concerns about breastfeeding.

Getting the vaccine while breastfeeding protects the mother and is safe for both the mother and the baby, Ryan said, adding: "Breastfeeding is healthy for babies, and mom's antibodies may be present in breastmilk. Breastfeeding is not an established way for an infant to attain immunity against COVID-19, but breastfeeding is still clearly healthy for babies."

Other CDC Recommendations

Vaccination coverage for pregnant women differs by race and ethnicity, with vaccination uptake being lowest for non-Hispanic Black pregnant women (15.6%), data collected by the agency show.

In addition, "pregnant people should continue to follow all recommended prevention measures" such as mask wearing, hand washing and physical distancing, "and should seek care immediately for any symptoms of COVID-19."

Healthcare providers should have "a low threshold for increased monitoring during pregnancy due to the risk of severe illness."

Pregnant women "should be counseled by health care personnel in alignment with the CDC, ACOG, SMFM, and the American Society for Reproductive Medicine and the recommendations for vaccination," Lutgendorf said.

"Counseling to support the recommendation for vaccination should include data on vaccine efficacy and vaccine safety during pregnancy and lactation," she added.

"Provider counseling has been shown to have a significant positive impact on patient vaccination," she said. The CDC added a strong recommendation from a health care provider is a critical factor in COVID-19 vaccine acceptance.

The CDC also recommends that health care workers remind patients that COVID-19 vaccination is recommended even for those with prior COVID-19 infections.

Eligible pregnant women should also consider a booster dose.

There is currently no evidence that any vaccines, including COVID-19 vaccines, cause fertility problems in women or men, CDC data show.

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Pregnancies and live births among female service members

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12/21/2017
Women have been able to serve officially in the U.S. military since 1901. Both the number of women serving in the active component and their occupational roles have steadily increased and expanded. Currently, almost one in seven active component service members are female and more than 95% of military occupational specialties are open to women. This infographic summarizes data on the demographic and military characteristics of women including women of childbearing potential (WOCBP) in the active component of the U.S. Armed Forces during 2012 – 2016. Data on pregnancy-related care and birth rates are also presented. FINDINGS •	In 2016, WOCBP comprised the vast majority of active component service women. •	202,849 women served in the active component of the Army, Navy, Air Force, or Marine Corps. 197,947 (97.6%) were WOCBP. Pie chart displays depicting this information. •	In 2016, 13.1% of all WOCBP had at least one pregnancy-related event. Pie chat displays depicting this information. Female stick figures display to show visual of the largest proportions of WOCBP. Breakdown of WOCBP by service: •	Army (32.9%) •	Air Force (30.0%) •	Navy (29.7%) •	Marine Corps (7.5%) Pie chart displays to visually depict breakdown of WOCBP by service. The largest proportions of WOCBP were: •	In a communications / intelligence occupation (32.3%) •	Junior enlisted rank (46.5%) •	Non-Hispanic white (43.4%) •	20 – 24 years old (34.3%) Live births: •	There were 63,879 live births during the surveillance period. •	Overall live birth rate was 64.9 live births per 1,000 person-years (p-yrs). This rate of live births decreased steadily from 69.8 per 1,000 p-yrs in 2012 to 59.7 per 1,000 p-yrs in 2016. Line graph displays this information. Rates of live births were highest among: •	Women who were 30 – 34 years old •	Enlisted or junior officer rank •	Army •	In healthcare / intelligence occupations •	Married Access the full report in the November 2017 MSMR (Vol. 24, No. 11). Go to: www.Health.mil/MSMR

This infographic summarizes data on the demographic and military characteristics of women including women of childbearing potential (WOCBP) in the active component of the U.S. Armed Forces during 2012 – 2016. Data on pregnancy-related care and birth rates are also presented.

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Pregnancies among female service members, Active component, U.S. Armed Forces, 2012 – 2016

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With the increasing numbers of service women and the expansion of roles available to women within the military, understanding the epidemiology of pregnancy is important for both the health of U.S. service women and the readiness of the U.S. fighting force, two closely related issues. Between 2012 – 2016, 344,536 unique women of childbearing potential (WOCBP) served at least 1 day in the military, and of those, 132,466 spend at least 1 day as a recruit trainee. Of the 224,718 WOCBP who served at any time in 2016, 13.1% had at least one pregnancy-related event during that year. A “pregnancy-related event,” refers to a health care encounter (visit) for which the record contains a diagnosis code for either pregnancy or a positive pregnancy test. In 2016, the highest prevalence of pregnancy-related events was among service women 30-34 years of age (16.8%) and among senior enlisted women (13.7%). Pie chart displays depicting the information. The annual prevalence of pregnancy-related events decreased slightly, from 14.2% in 2012 to 13.1% in 2016. Line plot graph displays this information. FINDINGS •	Prevalence of pregnancy-related events was approximately evenly distributed among the race/ethnicity categories and military occupation groups. •	A slightly higher percentage of WOCBP in the Army (14.5%) had pregnancy-related events compared to WOCBP in the other services. •	A higher percentage of women who were married (21.4%) had a pregnancy-related event, compared with those in the single (5.7%) or “other” (8.8) categories. •	Only 0.2% of women who served during a recruit training period in any given year had a pregnancy-related event. Access the full report in the November 2017 MSMR (Vol. 24, No. 11). Go to www.Health.mil/MSMR.  Graphic on infographic shows a pregnant service member.

With the increasing numbers of service women and the expansion of roles available to women within the military, understanding the epidemiology of pregnancy is important for both the health of U.S. service women and the readiness of the U.S. fighting force, two closely related issues. This infographic documents pregnancies among female service members, active component, U.S. Armed Forces from 2012 – 2016.

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Tdap vaccination coverage during pregnancy, active component service women, 2006 – 2014

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Interim Guidance for Prevention of Sexual Transmission of Zika Virus

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Zika Virus and Pregnancy

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