During the final month of her pregnancy last March, Amanda Piantedosi faced a dilemma. Her doctor urged her to get vaccinated against COVID-19. Her husband, parents, in-laws, and friends argued strongly against it.
Pregnant women infected with COVID-19 face higher rates of severe illness, preterm birth, and other complications. But her family members, although willing to get vaccinated themselves, worried about whether a new vaccine would be safe for the baby.
The 31-year-old Waltham mother trusted her doctor but succumbed to pressure from others. She declined the shot.
“There was not one supportive person, other than the doctor,” she said.
Piantedosi regrets her decision — but it was far from unusual. At the time, last spring, fewer than 1 in 10 pregnant women in the United States received at least one dose of a COVID-19 vaccine. As of Oct. 30, the rate had climbed to 1 in 4, according to the US Centers for Disease Control and Prevention. Among expectant Black women, the rate is 16 percent, up from 11 percent in August.
In contrast, 58 percent of the US population is fully vaccinated.
Massachusetts health officials do not track vaccinations in pregnancy. With a higher vaccination rate overall in the state — 70 percent — the numbers might be higher. But Boston Medical Center found that only 35 percent of its pregnant patients were fully protected. One practice in Weymouth, the Women’s Center of South Shore Medical Center, counted 43 percent vaccinated, but its head thinks the real number is closer to half.
Many pregnant women embrace other vaccinations — most happily accept the flu and tetanus-diphtheria-pertussis shots offered during pregnancy — but they are hesitant about the COVID shot. A recent survey found that nearly half the women who rejected the vaccine during pregnancy intended to take it after delivery.
Doctors say that the known risks posed by COVID-19 infection are greater — much greater — than any theoretical risk from the vaccine.
Pregnant women who contract COVID-19 have a two-fold risk of admission into intensive care, a 70 percent increased risk of death, and an elevated risk of preterm birth and stillbirth, according to the CDC.
But expectant parents often don’t want to take any chances. Many think they can avoid getting the virus while taking the vaccine is a choice, an action they would be responsible for.
“The fear is that if something goes wrong, even if it’s not a cause and effect, there would still be that doubt,” said Lauren North of Lincoln, R.I., who got her first shot shortly before becoming pregnant in April and then struggled a little before deciding to get the second shot in her first trimester. Now in her 30th week, she’s mulling whether to get a booster.
Information about the safety of the vaccine for pregnant women emerged slowly because initial vaccine studies excluded pregnant people. Last spring, when North and Piantedosi faced their decisions, professional medical organizations were saying there’s no reason to believe the vaccine is unsafe — but there was also not enough evidence to recommend it. North’s doctors told her that she “probably” should get the shot.
Since then, the CDC has tracked more than 170,000 individuals who received COVID vaccines while pregnant and found no increased risk of poor outcomes. Vaccinated pregnant women have been shown to pass their antibodies to the fetus. And the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine now give full-throated support to COVID-19 vaccination, including boosters.
That’s had an effect, said Dr. Khady Diouf, director of the Division of General Obstetrics and Gynecology Specialists at Brigham and Women’s Hospital. “It definitely makes a difference for patients to hear their providers say ‘absolutely’ rather than ‘well, you should,’” she said.
Diouf believes the vaccination rates will increase, but so far, the national data show little change since August, even after the CDC issued an advisory in September calling for “urgent action” to encourage more individuals who are pregnant, nursing, or trying to become pregnant to roll up their sleeves.
“The public health messaging is clearly not getting through,” said Dr. Neel Shah, chief medical officer of Maven, an online women’s health clinic.
Maven commissioned an online survey of a representative sample of 500 US-based pregnant people, which was conducted between Oct. 16 and 22. The survey found that only 39 percent knew of the CDC’s recommendation in favor of vaccination during pregnancy, and only 29 percent knew that pregnant people have a higher risk of severe illness from COVID-19.
Nearly 70 percent said at least one source suggested they avoid getting the vaccine.
In educating patients, Shah said, “You also have to not just reach out to people who are pregnant but reach out to all those around them.”
Disturbingly, 29 percent of respondents said a medical provider advised against getting the vaccine while pregnant.
Dr. Glenn R. Markenson, chair of the Massachusetts section of the American College of Obstetricians and Gynecologists and a Boston Medical Center maternal-fetal medicine specialist, said he tells patients who hesitate to get vaccinated about some of those who got COVID-19 while pregnant.
Just a month ago, he said, a patient of his with COVID-19 needed mechanical ventilation in the ICU. The baby was delivered at 23 weeks and remains in the intensive care nursery, while the mother is also still in the hospital.
“This is something that truly happens on a regular basis. It’s not something theoretical,” he said.
The hesitancy, he said, springs from two factors — a lack of trust in the medical establishment and difficulty assessing risk. Patients need to believe “that the provider really wants the best for you, is not trying to experiment on you, not trying to make money on you,” Markenson said.
Diouf, of the Brigham, notes that each prenatal visit presents a new opportunity to raise the issue and listen to a patient’s concerns. “I’ve been able to convince people that way,” she said.
To patients who worry that the vaccine may somehow affect the child years down the road, she points out that nothing like that has happened in the long history of vaccination.
Dr. Ingrid Kotch, chief of obstetrics and gynecology at South Shore Health, said a patient she saw recently said she’d take the vaccine after delivery and stay isolated until then.
Isolation has risks too, she notes; it can lead to depression and anxiety. “I don’t think it’s a good option for patients,” she said.
But that’s what Piantedosi, the Waltham woman whose family dissuaded her, ended up doing.
Throughout the last month of her pregnancy, she stayed home, going out only for walks and receiving no visitors.
In April, she delivered a healthy baby, Teddy, her fourth child. But now, she said, she knows that if she had gotten vaccinated during pregnancy, the antibodies she produced would have been transferred to Teddy, possibly giving him protection.
“I listened to too many family and friends,” Piantedosi said. “It was 100 percent the wrong decision.”
Felice J. Freyer can be reached at firstname.lastname@example.org. Follow her on Twitter @felicejfreyer.