Objective
The American College of Obstetricians and Gynecologists
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recommends that coronavirus disease 2019 (COVID-19) vaccines should not be withheld from pregnant individuals who meet the criteria for vaccination based on the Advisory Committee on Immunization Practices (ACIP)–recommended priority groups, which include pregnancy in priority phase 1C to receive the vaccine (“. . . persons aged 16–64 years with high-risk medical conditions..”).2
Final prioritization for COVID-19 vaccinations is based on individual states’ guidelines. The objective of this study was to review whether pregnant persons were uniformly included in individual states’ priority COVID-19 vaccination phase 1 allocations.Study Design
We accessed COVID-19 vaccination prioritization on the official state websites for each of the 50 states in the United States and for the District of Columbia (DC) to confirm whether pregnant individuals are presently included among the phase 1 priority groups. Because we used publicly available data and without patient information, no institutional review board approval was needed.
Results
The results of prioritization for pregnant individuals for each state in the United States and DC are presented in the Table. Most states in the United States (36 of 51; 71%) encompassing 71% of the population in the United States do not include pregnant individuals among their priority populations. Only 6 of 13 states that mentioned pregnancy as a priority indication for COVID-19 vaccination and none of the 36 states not including pregnancy in priority groups linked back to the Centers for Disease Control and Prevention definition of pregnancy as an increased risk of severe illness.
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TablePriority classification of pregnant individuals by states in the United States
Grünebaum. Inclusion of pregnant individuals among priority populations for all 50 US states. Am J Obstet Gynecol 2021.
Conclusion
We found substantial variations in how pregnancy is classified for COVID-19 vaccination by states in the United States and DC. ACIP includes pregnancy among the phase 1 groups, defined as: “Adults of any age with certain underlying medical conditions are at increased risk for severe illness from the virus that causes COVID-19. Severe illness from COVID-19 is defined as hospitalization, admission to the ICU, intubation or mechanical ventilation, or death.”
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By stark contrast, most states in the United States exclude pregnancy from their priority populations. Pregnant individuals are at an increased risk of severe illness and death from COVID-19 infections.1
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Excluding them from phase 1 priority will unnecessarily increase adverse outcomes for pregnant individuals. This becomes even more important if physicians recommend COVID-19 vaccinations to all pregnant persons.4
States in the United States and DC should reconsider their COVID-19 priority vaccination and include immediately pregnant individuals among their phase 1 priority groups. A more effective approach toward eliminating variation in priorities of the states would be for the federal government to mandate this change.References
- Vaccinating pregnant and lactating patients against COVID-19. 2020.(Available at:) (Accessed Jan. 27, 2021)
- The Advisory Committee on Immunization Practices' Updated Interim Recommendation for Allocation of COVID-19 Vaccine - United States, December 2020.MMWR Morb Mortal Wkly Rep. 2021; 69: 1657-1660
- People with certain medical conditions.(Available at:)https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html(Accessed Jan. 27, 2021)
- Professionally responsible coronavirus disease 2019 vaccination counseling of obstetrical and gynecologic patients.Am J Obstet Gynecol. 2021; 224: 470-478
Article info
Publication history
Published online: February 02, 2021
Footnotes
The authors report no conflict of interest.
This study was supported by departmental funds.
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
