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.