Are People Who Are Pregnant Immunocompromised?

Here’s what healthcare professionals have to say and what it means in terms of COVID-19.

Pregnancy is a profound journey, one marked by excitement, anticipation, and, often, a heightened concern for the well-being of both the expectant mother and her developing baby. In the wake of the COVID-19 pandemic, these concerns have been further amplified, prompting questions about the immunity of pregnant individuals. The Centers for Disease Control and Prevention (CDC) has strongly recommended that pregnant people receive the COVID-19 vaccine, citing an increased risk of severe illness if they contract the virus. This recommendation has led to discussions about the immune status of pregnant individuals and whether they can be considered immunocompromised. In this comprehensive exploration, we will delve into the intricate interplay between pregnancy and immunity, addressing the implications for COVID-19 and offering guidance on how to maintain a healthy pregnancy amidst these challenges.

The Immune System in Pregnancy

Pregnancy is a remarkable biological process that challenges the maternal body to protect the developing fetus while simultaneously defending against potential threats from viruses and bacteria. A 2021 review in Frontiers in Global Women’s Health highlights the dynamic immunological and physiological changes that occur during pregnancy. Jennifer Wider, MD, a prominent health expert, underscores the fact that the immune system experiences fluctuations throughout pregnancy, potentially rendering pregnant individuals more susceptible to infections, including viral respiratory illnesses such as COVID-19.

These immune changes are carefully orchestrated to align with the different stages of pregnancy, serving a dual purpose of safeguarding both the mother and the developing fetus. Christine Greves, MD, an OB-GYN at the Winnie Palmer Hospital for Women and Babies, elucidates that the maternal immune system undergoes distinct phases during pregnancy. Initially, a pro-inflammatory state facilitates implantation, followed by an anti-inflammatory state that supports fetal growth. Finally, in the third trimester, another pro-inflammatory state readies the body for childbirth.

While many of these adaptations are advantageous for both the mother and the fetus, some changes can potentially make the pregnant person more vulnerable to infections, as noted in the 2021 review. Elevated levels of estrogen and progesterone, common during pregnancy, can lead to swelling in the respiratory tract, increasing susceptibility to respiratory infections like COVID-19.

The Complex Notion of Immunocompromised

To ascertain whether pregnant individuals can be classified as immunocompromised, it is essential to understand the concept of immunosuppression. The National Cancer Institute (NCI) defines an immunocompromised person as someone with a weakened immune system, resulting in reduced resistance to infections, diseases, and conditions such as HIV, cancer, diabetes, malnutrition, and specific genetic disorders. Certain medical treatments and interventions, such as radiation therapy, organ transplantation, and anti-cancer drugs, can also induce immunosuppression.

So, are pregnant individuals immunocompromised? The answer, as experts concur, is nuanced. David F. Colombo, MD, an OB-GYN and division chief of maternal-fetal medicine, emphasizes that pregnancy brings about distinct alterations in the immune system, but it does not strictly align with the conventional definition of immunocompromised.

Mary Jane Minkin, MD, a clinical professor of obstetrics and gynecology and reproductive sciences at Yale School of Medicine, adds that while pregnant individuals may not fit the traditional immunocompromised profile, they are considered a “special population group” due to the unique state of their immune system during pregnancy. Dr. Minkin further points out that pregnant individuals must tolerate a foreign presence (the fetus) on an immunological level, which sets them apart from those with standard immune function.

Jennifer Wider, MD, emphasizes that while pregnant individuals may not be classified as immunocompromised, their immune system undergoes distinct changes that differentiate it from that of non-pregnant individuals. Consequently, their ability to defend against infections may be altered.

Implications for COVID-19

When considering COVID-19 in the context of pregnancy, Dr. Minkin highlights that pregnant individuals face heightened susceptibility to severe illness due to factors unrelated to their immune response. The physical changes accompanying pregnancy, such as the displacement of the diaphragm by the growing fetus, can compromise lung capacity. If pneumonia develops in individuals with COVID-19, their respiratory challenges are exacerbated, underscoring the need for vigilance in this population.

The 2021 review further reveals that COVID-19 infection among pregnant individuals is associated with a higher prevalence of cesarean section (c-section) deliveries and premature births. These outcomes may be linked to changes in placental blood circulation caused by the virus. Notably, many of these individuals with COVID-19 experience mild or asymptomatic infections.

Protecting Pregnant Individuals During COVID-19

Amidst the unique challenges posed by COVID-19 and pregnancy, Dr. Colombo emphasizes the critical importance of COVID-19 vaccination for pregnant individuals. He underscores that the primary risk to pregnant individuals currently is contracting COVID-19 itself, making vaccination the safer choice.

Additionally, Dr. Minkin highlights a compelling benefit of vaccination for pregnant individuals—the potential transfer of protective antibodies to the fetus. This secondary protection adds another layer of defense for the developing baby.

To further safeguard themselves and their unborn children, pregnant individuals are advised to adhere to preventive measures such as mask-wearing in indoor settings with substantial or high COVID-19 transmission, frequent handwashing, and practicing social distancing, as recommended by Dr. Wider.

A Recapitulation of Key Points

In summary, while pregnant individuals may not fit the traditional medical definition of being immunocompromised, it is essential to recognize that their immune systems undergo unique and dynamic changes throughout the course of pregnancy. These notable alterations set them apart as a “special population group” with distinct immunological characteristics that warrant careful consideration. Therefore, it is advisable for pregnant individuals to exercise a heightened level of caution and prioritize COVID-19 vaccination as a proactive and protective measure for both themselves and the well-being of their unborn children.

Dr. Greves offers a comforting and reassuring perspective, emphasizing the importance of taking reasonable precautions without succumbing to undue anxiety. By acknowledging their diligent efforts in maintaining a healthy pregnancy, expectant mothers can fully embrace and cherish the remarkable journey of nurturing a growing life within them. In this delicate balance of vigilance and optimism, the path to a healthy pregnancy amidst the backdrop of the ongoing COVID-19 pandemic unfolds as a testament to the resilience of the human spirit and the enduring strength of maternal love.