COVID unlocking will create ‘perfect storm’ for pregnant women, say maternity Colleges
The Royal College of Obstetricians and Gynaecologists (RCOG) and The Royal College of Midwives (RCM) are concerned that the combination of restrictions easing from next week, an increasing prevalence of COVID-19 in the community and hesitancy to get vaccinated will lead to a further increase in infections among pregnant women.
Pregnant women are at risk of getting severely ill with COVID-19, particularly in their third trimester with new data from the UK Obstetric Surveillance System (UKOSS) showing that 1 in 10 pregnant women admitted to hospital with symptoms of COVID-19 need intensive care.
In pregnant women with symptoms of COVID-19, it is twice as likely that their baby will be born early, exposing the baby to the risk of prematurity. Recent studies have also found that pregnant women who tested positive for COVID-19 at the time of birth were more likely to develop pre-eclampsia, need an emergency caesarean and had higher rates of stillbirth; however, the actual increases remain low.
With a rise in COVID-19 cases across the UK, national data suggests the numbers of pregnant women being admitted per week are now more than three times greater than they were at the end of May.
Doctors and midwives are urging those who are pregnant or considering pregnancy who haven’t yet been vaccinated to consider getting the vaccine as soon as possible, and to book their second doses as soon as they are eligible.
Unvaccinated or partially vaccinated pregnant women should take steps to avoid COVID-19 infection by continuing to practice social distancing, particularly in their third trimester. Everyone can help pregnant women stay safe by wearing face coverings in indoor spaces, taking tests as appropriate and self-isolating when required. We also encourage pregnant employees to continue following the occupation health guidance from the government to ensure you are safe in your workplace.
Dr Edward Morris, President at the Royal College of Obstetricians and Gynaecologists, said:
“We are concerned that increasing rates of COVID-19 infection will adversely impact pregnant women, due in part to our data showing 58 per cent of women have declined the COVID-19 vaccine especially as we start to return to ‘normal’.
“We know that those who are pregnant with COVID-19 are at an increased risk of becoming severely ill, particularly in their third trimester, and the vaccine is the safest and most effective way of protecting women and their babies. From the numbers of pregnant women admitted into intensive care with COVID-19 over the past few weeks, it is clear that the risk is reduced for those who have received the vaccine particularly if they have had two vaccinations.
“We do understand women’s concerns about having the vaccine in pregnancy, as the messaging for this group has evolved since the COVID-19 vaccines were first licensed. However, we have robust data from the US where more than 130,000 people have had the vaccine in pregnancy and no safety concerns have been raised.
“We recognise there were mixed messages about the vaccine in pregnancy at the beginning but want to reassure women that healthcare professionals are there to support you in making an informed choice about having the COVID-19 vaccine and will be able to discuss the benefits and risks with you. We would encourage healthcare professionals to read our recently released COVID-19 vaccine in pregnancy guidance available on the RCOG website and take the opportunity to have a conversation about COVID-19 and vaccination at every antenatal visit.”
Professor Marian Knight, Professor of Maternal and Child Population Health at the University of Oxford and chief investigator of the UKOSS national study of pregnant women admitted to hospital with COVID-19, said:
“More than 100 pregnant women have been admitted to hospital in each of the last two weeks with COVID-19. Vaccination remains the best way to protect against the known risks of COVID-19 in pregnancy for both mother and baby, including admission to intensive care and premature birth. No pregnant women who have received both doses of vaccine have been admitted to hospital since the vaccination programme began. Most of those admitted recently have been unvaccinated, with only five women admitted who had received a single vaccine dose. I would urge women and health professionals to follow the RCOG/RCM guidance and discuss taking up the offer of a vaccine.”
Gill Walton, Chief Executive of the Royal College of Midwives, said:
“Along with mask wearing, hand washing and social distancing, vaccination is a vital tool in the fight to protect yourself against this virus. If you are unsure or worried about this, do speak to your midwife or doctor to get the facts so that you can make an informed decision. All the evidence is showing that having the COVID-19 jab is safe during pregnancy, and I do urge you to have the vaccine to protect yourself, your baby and your family.
“If you are a midwife or a health professional in maternity services, do look at the guidance on this from the RCM and the RCOG so that you are armed with the information to support women’s decision making. This is especially important now as most restrictions are set to go from next week. Your knowledge, your support and your guidance could be key to increasing vaccination take up rates, which are falling, leaving unvaccinated women at risk of this potentially very serious disease.”
In February and May 2021, the RCOG carried out a survey of pregnant women around vaccine uptake. Around 1,500 women took part in the survey each time. At both points, around 40% of women offered the vaccine had accepted it, and of those not yet offered, around the same percentage plan to have it, 40% plan not to, and 20% remain undecided. Of those not accepting, the main reason cited was they were waiting for more evidence to reassure them that it is safe for their baby.
Robust data from the US has shown more than 130,000 people have had the COVID-19 vaccine in pregnancy and no safety concerns have been raised. Yesterday Public Health Scotland reported that 4,000 pregnant women have received a vaccine with no adverse effects recorded. The RCOG and RCM would welcome the publication of vaccine uptake data from other parts of the UK to support informed decision making.
Notes to editor
The RCOG/RCM decision aid for pregnant women offered a COVID vaccination is available at: https://www.rcog.org.uk/globalassets/documents/guidelines/2021-02-24-combined-info-sheet-and-decision-aid.pdf
The RCOG has developed a range of information on our website for healthcare professionals and pregnant women eligible for COVID-19 vaccination and pregnancy: www.rcog.org.uk/covid-vaccine
Our first survey of 1,627 pregnant women was conducted on social media between 16 February and 26 February. Our second survey of 1,300 pregnant women was conducted on social media between the 17 May and 28 May 2021. Full results are available from the press office.
Government advice for pregnant employees is available from:
The Royal College of Obstetricians and Gynaecologists (RCOG) is a medical charity that champions the provision of high quality women’s healthcare in the UK and beyond. It is dedicated to encouraging the study and advancing the science and practice of obstetrics and gynaecology. It does this through postgraduate medical education and training and the publication of clinical guidelines and reports on aspects of the specialty and service provision.
The Royal College of Midwives (RCM) is the only trade union and professional association dedicated to serving midwifery and the whole midwifery team. We provide workplace advice and support, professional and clinical guidance, and information, and learning opportunities with our broad range of events, conferences, and online resources. For more information visit the RCM website.