Pregnancy and Severe COVID-19: Separating the Facts from the Fiction

I have been asked about pregnancy and COVID-19 on numerous occasions and I have deferred answering the question because I honestly had not looked much into it. Recently, I was challenged with the task and have stepped up to the occasion of looking into the data of how pregnancy is affected by COVID-19. These are not medical recommendations. All the citations are listed below. These are the statistics collected regarding pregnancy and COVID-19 which I will clearly lay out. It is on you to read the studies further and speak to your own physician/OBGYN prior to making any decisions about your health. Please also check out the information published by the The American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM). Most of these data are pre-Delta. Late update on 10/01/21 as data changes regularly these days. With regards to the vaccination component of this, please read the studies yourself because it’s quite the mess to keep referencing Moderna, Pfizer, and J&J.

Why do pregnant women get sicker with COVID than non-pregnant women?

Per ACOG, “data have shown that COVID-19 infection puts pregnant people at increased risk of severe complications and even death“.

Per Ellington et al. “During pregnancy, women experience immunologic and physiologic changes that could increase their risk for more severe illness from respiratory infections“.

What does this mean for pregnant women who contract COVID-19?

Per Delahoy et al. “pregnant women have disproportionately higher rates of COVID-19–associated hospitalizations compared to non-pregnant women”. Although one must add that “During COVID-19–associated hospitalizations, 448 of 458 (97.8%) completed pregnancies resulted in a live birth and 10 (2.2%) resulted in a pregnancy loss”. I do not know whether this incidence of pregnancy loss is high or normal which is why I ask to defer to an OBGYN.

“Among 596 women with COVID-19 whose pregnancy trimester was known, 14 (2.3%), 61 (10.2%), and 521 (87.4%) were hospitalized during the first, second, and third trimesters” Seems as if the third trimester is the most dangerous based on these data.

More recently, on 08/11/21, Chinn et al, found that there was no increase in needing a caesarean section but there was an increase in preterm births (16.4% vs. 11.5%). The study goes on to say that women with COVID-19, pre-delta, had “higher rates of mortality, intubation, ICU admission, and preterm birth” compared to women who did not have COVID. Any baby born without a mother is tragic, no doubt about that, but of the mothers who had COVID at the time of childbirth 0.1% went on to die. That was 24 of 18715 women. 5.2% of them ended up in the ICU and 1.5% of them ended up on the vent. Thankfully, of those 275 who ended up intubated, only 24 died because mortality is much higher in other populations.

Villar et al. found that “the risk of maternal mortality was 1.6%, ie, 22 times higher in the group of women with COVID-19 diagnosis” compared to those without. I repeat, this is pre-delta. They clarify that they were seeing higher rates of mortality because of the institutions being in “less-developed regions”.

ADDENDUM on 10/1/21: On September 29th, the CDC Emergency Preparedness and Response team put out a newsletter through the Health Alert Network that prompted some eyebrow raising. They stated “symptomatic pregnant people have more than a two-fold increased risk of requiring ICU admission, invasive ventilation, and ECMO, and a 70% increased risk of death“. This has made headlines and appropriately so. 70% increase in risk is a scary number. To be fair, this letter states that “the absolute risk is low” but that won’t make any headlines. So where did this 70% increased risk come from? They actually cited a paper by Zambrano, et al. that was published in the Morbidity and Mortality Weekly Report from the CDC. On page 1642 of that report they explain that there were 1.5 deaths out of 1000 women with COVID and pregnant versus 1.2 death per 1000 women with COVID and not pregnant. The adjusted risk ratio was 1.7 with a confidence interval that could be criticized by some as being too wide at 1.2-2.4. This provides that 70% increase in risk of death.

I have to mention a couple things about these data. First, it has been out there in the wild since November of 2020. That’s almost a whole year and they didn’t say anything about it. Second, these numbers are pre-delta which have a lower mortality rate than our current waves. In my opinion, the increased risk of death is over 70%, but at the same time, the CDC and others have to be honest about the absolute risk. They should also provide a more-thorough subgroup analyses on what makes these women even more high-risk. They stated that a large risk-increase is found in expectant mothers who are between 35-44. It is not explained further in the paper, but women with severe obesity (BMI≥40) occupied 2.2% of symptomatic pregnant women versus 1.1% of the symptomatic nonpregnant patients. So if a woman has a BMI≥40, they have a relative risk of 1.58 which means they have a 58% increased risk of having symptoms with COVID-19.

One of the things that made me scratch my head was in the subgroup analysis (table 2). Even though severe obesity was one of the key places where the baseline characteristics of the two groups is remarkably different, they did not specify this in the subgroup analysis. I’m unsure why.

What is the incidence of Severe COVID-19 in Pregnancy?

Lokken et al. found that “severe coronavirus disease 2019 developed in approximately 15% of pregnant patients”.

What is the most significant risk factor for developing severe COVID-19 in pregnancy?

Being overweight and obesity prior to getting pregnant appears to be the largest risk factor per Lokken, et al. Diabetes and hypertension are not far behind. This is a major issue as they cited that 39.7% of women in the reproductive age are overweight or obese.

What does COVID-19 do to the placenta?

In a recently published paper, Di Girolamo et al. found that “a significant proportion of placentas where SARS-CoV-2 occurred during pregnancy shows histopathological findings suggesting placental hypoperfusion and inflammation”.  “Only about 17.4% of these pregnancies did not show any placental anomalies.”

Does the baby get sick from COVID-19 as well?

Villar et al. on 8/1/21 published a study where they noted that of the babies who were born to COVID positive mothers, 12.9% of them also tested positive within the first 48 hours. There was an increase in low birth weight. They did not go any further into what happened to those babies moving forward. They did state that breast feeding was not the culprit of passing COVID to the neonates.

Where does the data for vaccination safety in pregnant people come from?

The CDC has created a surveillance system called the “V-safe COVID-19 Vaccine Pregnancy Registry“. I will admit, I am not BFF’s with the CDC these days. From this registry, authors such as Shimabukuro et al. can extract data to analyze for our education.

Are vaccines safe in pregnant patients?

Per ACOG, as of July 30, 2021:

  • “So far, more than 139,000 pregnant people have been vaccinated.”
  • “No unexpected pregnancy or fetal problems have occurred.”
  • “There have been no reports of any increased risk of pregnancy loss, growth problems, or birth defects.”

Shimabukuro et al. published a paper in NEJM on 6/17/21 titled “Preliminary Findings of mRNA Covid-19 Vaccine Safety in Pregnant Persons”. This is perhaps the largest study to date that I have found on the matter. Of the 827 patients who had completed their pregnancy, 86.1% were live births. That number is low but one shouldn’t take it at face value. This is because 12.6% had spontaneous abortions but of those 12.6%, 92.3% occurred within the first 13 weeks. I do not know what the normal incidence of spontaneous abortion is before week 13 to serve as a reference but the paper states it should be between 10-26%. There was only 1 stillbirth out of 827 pregnancies. If you take out the confounders, 98.3% of pregnancies resulted in a live birth.

What immediate reactions could pregnant women have to the COVID-19 Vaccine?

Kachikis et al. in JAMA Open on 8/17/21 found these results in over 17,000 women who were pregnant, lactating, or planning on getting pregnant. The symptoms for the first dose were generally very mild and worse on the second dose (which is to be expected). This included both Moderna and Pfizer vaccines. Here we are talking about the common stuff like pain in the arm, myalgia, fever, headache and chills. We know these things don’t scare you. The article has a really cool graph that I cannot get on here. When it comes to these reactions, Shimabukuro et al. did not find a higher incidence of these compared to non-pregnant women.

Here’s what you are really here for from the Kachikis et al. study:
Pregnant Mothers:
“Obstetrical symptoms” (I don’t know what this means) were reported in 4.4% of women after the first dose and 7.5% after the second dose.
Miscarriages: 49 of 6586 (0.7%) of women experienced miscarriages. I do not know if this is high, low, or normal. Ask your doctor. I’m not your doctor.

Lactating Mothers:
interrupted breastfeeding was reported by 2.3% after the first dose and 2.2% in the second dose.
decreased milk supply for less than 24 hours was reported by 5.0% after the first dose and 7.2% after the second.

Does the COVID Vaccine Lead to an Increase in Spontaneous Abortion in Pregnancy?

Published on September 8th 2021 in JAMA, Kharbanda et al. looked retrospectively at women who received the vaccine at less than 20 weeks of pregnancy. They collected 105446 unique pregnancies from a database. This leads to limitations simply based on what data is collected by the database but it’s the best we have. Having a sample size of this magnitude, however, helps us generalize these results and show that there’s no pattern nor trend towards an increase in spontaneous abortion. When they looked at the full population, of which almost 15% received vaccines in the first trimester, there was no increase in the odds of having a spontaneous abortion due to the vaccine.

The authors then divided the population into subgroups based on the gestational age. There, they also found no increase in the odds of spontaneous abortion after receiving the vaccine 28 days prior. Did receiving the Moderna of Pfizer vaccine make a difference? Nope. They were almost identical. Read the data for yourself here, of course, and don’t trust me. This section was updated on 9/13/21.

Does getting vaccinated in the first trimester lead to an increased in spontaneous abortions? Nope.

ADDENDUM On 10/20/21, data from a Norwegian registry was analyzed to assess whether women who were vaccinated during the first trimester were at increased risk of spontaneous abortion. The fun thing here is that vaccination is NOT recommended in women who are in their first trimester in Norway except in those with risk factors. So these women who they pulled from their registry had risk factors to start and they did a case-control assessment of them (compare to normal miscarriage rate).

What the authors “found no evidence of an increased risk for early pregnancy loss after Covid-19 vaccination”. This article appropriately does not answer the question as to whether there are any adverse effects to the baby. I say appropriately because that’s a completely different type of study.

Does the Pfizer vaccine Protect Pregnant Women from COVID-19?

I wish we had better data at this point (8/28/21). I wish we had long term data but we have to be realistic and make due with what we have. What we’ve learned so far regarding protection afforded by the Pfizer vaccine was published by Goldshtein et al. in JAMA in August 2021. They retrospectively looked at pregnant women who were vaccinated and whether or not they contracted COVID-19 at 28 days or more after the first dose in Israel. This inherently comes with many limitations but again, it’s the best they can do.

When it was all said and done, they found that in over 15,000 pregnant women, getting the vaccine decreased the risk of catching COVID-19. The efficacy of the vaccine was found to be 78%. Is it 100%? No. But those of us in medicine know that nothing is 100% (not even pronouncing someone after a code as those of us who have been in this for a while have seen people develop a pulse after seeing asystole on the monitor for over a minute). And we don’t know what’s going to happen with future variants but for now, 78% protection is what we have. Keep in mind, however, that this includes 28 days after the first dose as a confounder. One gets the best protection weeks after the second dose.

Long-term issues are still a question but they found “no notable differences between the vaccinated and unvaccinated groups regarding preeclampsia, intrauterine growth restriction, infant birthweight, abortions, stillbirth, maternal death, or pulmonary embolism” amongst their exploratory outcomes. 68 of the 7530 women reported possible “vaccine-related adverse effects” which were mild. See page 734 in the paper on the bottom right for these details. Nothing here caught my eye.

Do the COVID Vaccines during pregnancy help the baby after birth?

ACOG states that “There is accumulating data demonstrating that antibodies are passed to the fetus when a pregnant person is vaccinated” and that “IgG antibodies after maternal vaccination in the third trimester have been shown in observational studies. However, no data is available to demonstrate if this prevents COVID-19 disease in neonates.” I am trying to find these observational studies as they are not cited on their webpage.

That being said, Shimabukuro et al. states “we do not have data on antibody transfer and level of protection relative to the timing of vaccination”. My intuition states that third trimester may be the best time to get it in order to provide protection to the baby. I am aware that we don’t hear anything at all about COVID making newborns sick (because I’m certain this would be front-page news) but we also don’t know what’s going to happen with the variants down the line.

What effect does the COVID vaccine have on the newborn baby?

If one is worried about the effect of the vaccine on the neonate, Shimabukuro et al. published that vaccinated mothers produced neonates who were within the expected incidences of preterm birth, congenital abnormalities, small for gestational age, and zero neonatal deaths. Since their study came from a database, they cannot dig deeper into these issues to tease out more information. That being said, Pfizer does have a prospective clinical trial in the works which you can check out HERE.

What about lactation in vaccinated patients?

Gray et al. went through a short study where the finds suggested that vaccination of pregnant and lactating women can confer robust maternal and neonatal immunity. In this study, they collected the blood and breastmilk from lactating women as well as umbilical cord blood. They looked at those who received either the Pfizer or Moderna vaccines. They found that “vaccine-generated antibodies were present in all umbilical cord blood and breastmilk samples”.

ADDENDUM on 10/06/21: More recently, Fox, et al. in a not-yet-peer reviewed paper looked at the passing of antibodies being passed from mother to baby to protect the baby against the SARS-CoV-2 virus. It all gets quite immunologic and pretty dense, but overall Moderna produces the most antibodies. Behind that is the Pfizer vaccine. The laggard appears to be the J&J vaccine. Heck, even the manuscript states that the “J&J vaccine should be considered a last resort.” They do not discuss how long this passing of antibodies continues, nor the temporality of the vaccination. In the methods they states that the women could be enrolled in the study if they were “scheduled to be or had recently been vaccinated with the Pfizer, Moderna, or J&J COVID- 19 vaccine.”

In March, the same team looked at the effects of antibodies being passed from the mother to the newborn in patients who had recovered from the SARS-CoV-2 virus. The title of the article says it all “Spike-specific IgA in milk commonly-elicited after SARS-Cov-2 infection is concurrent with a robust secretory antibody response, exhibits neutralization potency strongly correlated with IgA binding, and is highly durable over time“. Here, they found that up to 10 months after being infected, mothers still were passing antibodies to the baby. It could potentially last more than 10 months, by the way. The reason why 10 months is specified here is because of the temporality. Think about it, if this paper was completed and posted in March (again, it is not yet peer reviewed) and you subtract 10 months, you’re looking at people who were infected in April/May of 2019. I hope the team is following up with these mothers as long as they are breastfeeding to analyze the concentrations.

Both of these papers were posted by the same team out of Mount Sinai. Hat tip to them for their fantastic work. I am honestly curious as to why the paper that looks at how much more robust the immunity provided by the natural infection rather than the vaccine has not been peer-reviewed nor published. It has been 7 months (it is currently October of 2021 at the time of this writing). The other paper was posted online in late July. The vaccine-mediated antibody transmission appears offer protection as well, just not as good per these data that you should read for yourself and not trust me. This leads to your personal decision of how you calculate risk. The data is clear that there’s worse outcomes with catching COVID while pregnant, so there’s an increased risk there. One could reasonably argue that it’s better for the baby’s protection with natural-immunity from the mother, but is worth the risk? Should one risk catching COVID while pregnant to pass this immunity to their babies, especially with the variants showing increased virulence? We also don’t know how long this all lasts in both groups. Time will tell, though. There is no data that I have found that looks at “hybrid immunity”, those women who have had COVID and also were vaccinated. If you find some, let me know!

What about future Fertility with the COVID-19 Vaccine?

Based on the CDC website, the major societies (ASRM, ACOG, SMFM, AAP) state that there are no issues with fertility. Gonzalez et al. looked at sperm parameters and noted that everything was cool a median 75 days after vaccination. Glad I don’t have that job.

Morris published an often cited paper titled “SARS-CoV-2 spike protein seropositivity from vaccination or infection does not cause sterility”. To be honest, they did some extremely nerdy (even for me) stuff that I cannot understand. Their concern was regarding the subsequent production of antibodies against the virus spike protein after vaccination and their cross-reaction with syncytin-1. I wouldn’t blame you for not knowing that syncytin-1 is a protein that is critical to the formation of the syncytiotrophoblast in a developing embryo because I had never even heard of that prior to writing this post. They used in-vitro fertilization frozen embryo transfer (FET) to analyze all this.

One of the ways to reject the notion of infertility through this mechanism of cross-reaction with syncytin-1 is that anyone with COVID or vaccination would have issues with infertility for the rest of their lives. I can’t say we are seeing that. If you want to dig deeper, check the citation.

Menstrual Irregularities with the COVID-19 Vaccine (and COVID-19)

This is a topic I honestly hadn’t thought about but it was asked so many time that for the sake of completeness, it is being added on here. Word on the street is that there are many women who are noting menstrual irregularities due to the vaccine. On their report put online on 7/31/21, ACOG stated ” There have been anecdotal reports of temporary changes in menstruation patterns (eg, heavier menses, early or late onset, and dysmenorrhea) in individuals who have recently been vaccinated for COVID-19. While environmental stresses can temporarily impact menses, vaccines have not been previously associated with menstrual disturbances.” They also called on the NIH to research this more thoroughly.

Li et al. published in January of 2021 a paper looking at “ovarian reserve, sex hormones and menstruation of women of child-bearing age” in NON-VACCINATED women. As I keep on repeating, please read these data yourself. Here’s what she and her team found:

  • 20% patients had a significant decrease in menstrual volume
  • 5% patients had an increased volume 
  • Severely ill patients had longer menstrual cycles
  • 18% had prolonged cycles 
  • 3% had shortened cycles 
  • 7% showed cycle disorders 

My take on all this is simple. If you, like me, believe that on a long enough time line we are all either going to have natural or vaccine-mediated immunity from COVID-19, then the menstrual abnormalities are going to happen at one point or another to 20% of people. In both cases we can’t admit that we know with 100% certainty what is going to happen 30 years from now. Currently trying to find data on menstrual irregularities in those who ARE vaccinated. It’s proving to be challenging.

To conclude….

This is obviously a work in progress and I plan to contribute more to it as time permits. As you all can likely correctly assume, I do not have a ton of free time these days. Last updated on 8/28/21. Check out links to my other COVID-19 content HERE. If someone who is pregnant with COVID ends up on mechanical ventilation, I created a post on what the family could expect.

Update: this post has been peer-reviewed by Jyoti Desai, MD, FACOG on 8/27/21 who is an assistant professor in the Kirk Kerkorian School of Medicine at UNLV Department of Obstetrics/Gynecology. I thank her for looking over this content to double check my work. Commentary updated after this date has not yet been peer-reviewed.

Citations for this post on COVID-19 and Pregnancy for you to read and not trust me.

American College of Gynecology Resources:
ACOG and SMFM Recommend COVID-19 Vaccination for Pregnant Individuals
Practice Advisory: COVID-19 Vaccination Considerations for Obstetric-Gynecologic Care
Vaccinating Pregnant Individuals: Eight Key Recommendations for COVID-19 Vaccination Sites
COVID-19 Vaccines and Pregnancy: Conversation Guide for Clinicians

Society for Maternal Fetal Medicine
Provider Considerations for Engaging in COVID-19 Vaccine Counseling With Pregnant and Lactating Patients
Covid Vaccination if you are Pregnant or Breastfeeding

Ellington S, Strid P, Tong VT, Woodworth K, Galang RR, Zambrano LD, Nahabedian J, Anderson K, Gilboa SM. Characteristics of Women of Reproductive Age with Laboratory-Confirmed SARS-CoV-2 Infection by Pregnancy Status – United States, January 22-June 7, 2020. MMWR Morb Mortal Wkly Rep. 2020 Jun 26;69(25):769-775. doi: 10.15585/mmwr.mm6925a1. PMID: 32584795; PMCID: PMC7316319.
Link to Article

Lokken EM, Walker CL, Delaney S, Kachikis A, Kretzer NM, Erickson A, Resnick R, Vanderhoeven J, Hwang JK, Barnhart N, Rah J, McCartney SA, Ma KK, Huebner EM, Thomas C, Sheng JS, Paek BW, Retzlaff K, Kline CR, Munson J, Blain M, LaCourse SM, Deutsch G, Adams Waldorf KM. Clinical characteristics of 46 pregnant women with a severe acute respiratory syndrome coronavirus 2 infection in Washington State. Am J Obstet Gynecol. 2020 Dec;223(6):911.e1-911.e14. doi: 10.1016/j.ajog.2020.05.031. Epub 2020 May 19. PMID: 32439389; PMCID: PMC7234933.
Link to Article

Panagiotakopoulos L, Myers TR, Gee J, Lipkind HS, Kharbanda EO, Ryan DS, Williams JTB, Naleway AL, Klein NP, Hambidge SJ, Jacobsen SJ, Glanz JM, Jackson LA, Shimabukuro TT, Weintraub ES. SARS-CoV-2 Infection Among Hospitalized Pregnant Women: Reasons for Admission and Pregnancy Characteristics – Eight U.S. Health Care Centers, March 1-May 30, 2020. MMWR Morb Mortal Wkly Rep. 2020 Sep 23;69(38):1355-1359. doi: 10.15585/mmwr.mm6938e2. PMID: 32970660; PMCID: PMC7727498.
Link to Article

Delahoy MJ, Whitaker M, O’Halloran A, Chai SJ, Kirley PD, Alden N, Kawasaki B, Meek J, Yousey-Hindes K, Anderson EJ, Openo KP, Monroe ML, Ryan PA, Fox K, Kim S, Lynfield R, Siebman S, Davis SS, Sosin DM, Barney G, Muse A, Bennett NM, Felsen CB, Billing LM, Shiltz J, Sutton M, West N, Schaffner W, Talbot HK, George A, Spencer M, Ellington S, Galang RR, Gilboa SM, Tong VT, Piasecki A, Brammer L, Fry AM, Hall AJ, Wortham JM, Kim L, Garg S; COVID-NET Surveillance Team. Characteristics and Maternal and Birth Outcomes of Hospitalized Pregnant Women with Laboratory-Confirmed COVID-19 – COVID-NET, 13 States, March 1-August 22, 2020. MMWR Morb Mortal Wkly Rep. 2020 Sep 25;69(38):1347-1354. doi: 10.15585/mmwr.mm6938e1. PMID: 32970655; PMCID: PMC7727497.
Link to Article

Chinn J, Sedighim S, Kirby KA, Hohmann S, Hameed AB, Jolley J, Nguyen NT. Characteristics and Outcomes of Women With COVID-19 Giving Birth at US Academic Centers During the COVID-19 Pandemic. JAMA Netw Open. 2021 Aug 2;4(8):e2120456. doi: 10.1001/jamanetworkopen.2021.20456. PMID: 34379123; PMCID: PMC8358731.
Link to Article (and FULL FREE PDF)

Shimabukuro TT, Kim SY, Myers TR, Moro PL, Oduyebo T, Panagiotakopoulos L, Marquez PL, Olson CK, Liu R, Chang KT, Ellington SR, Burkel VK, Smoots AN, Green CJ, Licata C, Zhang BC, Alimchandani M, Mba-Jonas A, Martin SW, Gee JM, Meaney-Delman DM; CDC v-safe COVID-19 Pregnancy Registry Team. Preliminary Findings of mRNA Covid-19 Vaccine Safety in Pregnant Persons. N Engl J Med. 2021 Jun 17;384(24):2273-2282. doi: 10.1056/NEJMoa2104983. Epub 2021 Apr 21. PMID: 33882218; PMCID: PMC8117969.
Link to Article

Riley LE. mRNA Covid-19 Vaccines in Pregnant Women. N Engl J Med. 2021 Jun 17;384(24):2342-2343. doi: 10.1056/NEJMe2107070. PMID: 34133864; PMCID: PMC8220929.
Link to Article

Girolamo RD, Khalil A, Alameddine S, D’Angelo E, Galliani C, Matarrelli B, Buca D, Liberati M, Rizzo G, D’Antonio F. Placental histopathology after SARS-CoV-2 infection in pregnancy: a systematic review and meta-analysis. Am J Obstet Gynecol MFM. 2021 Aug 20:100468. doi: 10.1016/j.ajogmf.2021.100468. Epub ahead of print. PMID: 34425296.
Link to Article

Villar J, Ariff S, Gunier RB, Thiruvengadam R, Rauch S, Kholin A, Roggero P, Prefumo F, do Vale MS, Cardona-Perez JA, Maiz N, Cetin I, Savasi V, Deruelle P, Easter SR, Sichitiu J, Soto Conti CP, Ernawati E, Mhatre M, Teji JS, Liu B, Capelli C, Oberto M, Salazar L, Gravett MG, Cavoretto PI, Nachinab VB, Galadanci H, Oros D, Ayede AI, Sentilhes L, Bako B, Savorani M, Cena H, García-May PK, Etuk S, Casale R, Abd-Elsalam S, Ikenoue S, Aminu MB, Vecciarelli C, Duro EA, Usman MA, John-Akinola Y, Nieto R, Ferrazi E, Bhutta ZA, Langer A, Kennedy SH, Papageorghiou AT. Maternal and Neonatal Morbidity and Mortality Among Pregnant Women With and Without COVID-19 Infection: The INTERCOVID Multinational Cohort Study. JAMA Pediatr. 2021 Aug 1;175(8):817-826. doi: 10.1001/jamapediatrics.2021.1050. PMID: 33885740; PMCID: PMC8063132.
Link to Article (and FULL FREE PDF)

Kachikis A, Englund JA, Singleton M, Covelli I, Drake AL, Eckert LO. Short-term Reactions Among Pregnant and Lactating Individuals in the First Wave of the COVID-19 Vaccine Rollout. JAMA Netw Open. 2021 Aug 2;4(8):e2121310. doi: 10.1001/jamanetworkopen.2021.21310. PMID: 34402893.
Link to Article (and free PDF)

Kharbanda EO, Haapala J, DeSilva M, Vazquez-Benitez G, Vesco KK, Naleway AL, Lipkind HS. Spontaneous Abortion Following COVID-19 Vaccination During Pregnancy. JAMA. 2021 Sep 8. doi: 10.1001/jama.2021.15494. Epub ahead of print. PMID: 34495304.
Link to Article and FULL FREE PDF

Magnus MC, Gjessing HK, Eide HN, Wilcox AJ, Fell DB, Håberg SE. Covid-19 Vaccination during Pregnancy and First-Trimester Miscarriage. N Engl J Med. 2021 Oct 20. doi: 10.1056/NEJMc2114466. Epub ahead of print. PMID: 34670062.
Link to Article

Goldshtein I, Nevo D, Steinberg DM, Rotem RS, Gorfine M, Chodick G, Segal Y. Association Between BNT162b2 Vaccination and Incidence of SARS-CoV-2 Infection in Pregnant Women. JAMA. 2021 Aug 24;326(8):728-735. doi: 10.1001/jama.2021.11035. PMID: 34251417; PMCID: PMC8276131.
Link to Article and FULL FREE PDF

Gray KJ, Bordt EA, Atyeo C, Deriso E, Akinwunmi B, Young N, Baez AM, Shook LL, Cvrk D, James K, De Guzman R, Brigida S, Diouf K, Goldfarb I, Bebell LM, Yonker LM, Fasano A, Rabi SA, Elovitz MA, Alter G, Edlow AG. Coronavirus disease 2019 vaccine response in pregnant and lactating women: a cohort study. Am J Obstet Gynecol. 2021 Mar 26:S0002-9378(21)00187-3. doi: 10.1016/j.ajog.2021.03.023. Epub ahead of print. PMID: 33775692; PMCID: PMC7997025.
Link to Article

Comparative profiles of SARS-CoV-2 Spike-specific milk antibodies elicited by COVID-19 vaccines currently authorized in the USA. Alisa Fox, Claire DeCarlo, Xiaoqi Yang, Caroline Norris, Rebecca L. Powell. medRxiv 2021.07.19.21260794; doi:
Link to Article

The Spike-specific IgA in milk commonly-elicited after SARS-Cov-2 infection is concurrent with a robust secretory antibody response, exhibits neutralization potency strongly correlated with IgA binding, and is highly durable over timeAlisa Fox, Jessica Marino, Fatima Amanat, Kasopefoluwa Oguntuyo, Jennifer Hahn-Holbrook, Benhur Lee, Florian Krammer, Susan Zolla-Pazner, Rebecca L. PowellmedRxiv 2021.03.16.21253731; doi:
Link to Article

Zambrano LD, Ellington S, Strid P, Galang RR, Oduyebo T, Tong VT, Woodworth KR, Nahabedian JF 3rd, Azziz-Baumgartner E, Gilboa SM, Meaney-Delman D; CDC COVID-19 Response Pregnancy and Infant Linked Outcomes Team. Update: Characteristics of Symptomatic Women of Reproductive Age with Laboratory-Confirmed SARS-CoV-2 Infection by Pregnancy Status – United States, January 22-October 3, 2020. MMWR Morb Mortal Wkly Rep. 2020 Nov 6;69(44):1641-1647. doi: 10.15585/mmwr.mm6944e3. PMID: 33151921; PMCID: PMC7643892.
Link to Article

Gonzalez DC, Nassau DE, Khodamoradi K, Ibrahim E, Blachman-Braun R, Ory J, Ramasamy R. Sperm Parameters Before and After COVID-19 mRNA Vaccination. JAMA. 2021 Jul 20;326(3):273-274. doi: 10.1001/jama.2021.9976. PMID: 34137808; PMCID: PMC8293015.
Link to Article and FULL FREE PDF

Morris RS. SARS-CoV-2 spike protein seropositivity from vaccination or infection does not cause sterility. F S Rep. 2021 Jun 2. doi: 10.1016/j.xfre.2021.05.010. Epub ahead of print. PMID: 34095871; PMCID: PMC8169568.
Link to Article

Li K, Chen G, Hou H, Liao Q, Chen J, Bai H, Lee S, Wang C, Li H, Cheng L, Ai J. Analysis of sex hormones and menstruation in COVID-19 women of child-bearing age. Reprod Biomed Online. 2021 Jan;42(1):260-267. doi: 10.1016/j.rbmo.2020.09.020. Epub 2020 Sep 29. PMID: 33288478; PMCID: PMC7522626.
Link to Article

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