COVID-19: Risks associated with unvaccinated pregnant women

During pregnancy, women are not only at high risk for severe progression of the disease, they also face an increased risk of premature births and stillbirths.

Immunization protects pregnant women against severe progression

During pregnancy, women are not only at high risk for severe progression of the disease, they also face an increased risk of premature births and stillbirths. Unvaccinated expectant mothers are hospitalized significantly more often than those vaccinated, according to a recent study from Scotland.

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Low rates of vaccination among pregnant women

At the population level, there are no data on how many pregnant women request COVID-19 vaccination and the consequences of SARS-CoV-2 infection in this group. For the first time, a recent study by Stock and colleagues outlines this situation in pregnant women in Scotland. The data were obtained from a national, prospective cohort for the entire population.

Since the beginning of the COVID-19 vaccination program in Scotland on December 8, 2020, a total of 25,917 COVID-19 vaccinations have been administered to 18,457 pregnant women through October 31, 2021. However, vaccination rates are still significantly lower among expectant mothers than in the general female population aged 18-44 years. Among the women who gave birth in October 2021, only 32.3% had received two shots of the vaccine. In comparison, 77.4% of all (non-pregnant) women in Scotland had been inoculated.

Higher risk of severe course in unvaccinated pregnant women

Among women who gave birth within 28 days of a COVID-19 diagnosis, the perinatal mortality rate was 22.6 per 1,000 births (95% CI: 12.9-38.5). In addition, a total of 77.4% of SARS-CoV-2 infections, 90.9% of SARS-CoV-2 infections that involved hospitalization, and a whopping 98% of SARS-CoV-2 infections that resulted in ICU admission were observed in pregnant women without immunization protection. This group (unvaccinated at the time of COVID-19 diagnosis) also accounted for all infant deaths. 

Higher vaccination rates in pregnant women prevent severe course of COVID-19

The low vaccination coverage among expectant mothers needs to be urgently improved, not only in Scotland. According to the study, the low vaccination rates in this patient group do not only apply to the United Kingdom, but also to the majority of Western industrialized nations, including Germany. According to the authors, the findings of this study also highlight the need to increase vaccination coverage, particularly in younger and more disadvantaged populations.

In addition, the percentage of pregnant women vaccinated each month actually declined during the summer of last year. While vaccination rates are currently slightly rising again due to the pandemic situation, they are still too low. This raises concerns that only a minority of pregnant women will in fact be fully vaccinated at the time of delivery.

Consequently, physicians need to address the hesitation of pregnant women to be vaccinated by providing more thorough patient education. Similarly, they must also consider the booster shots, which can provide at least some protection against severe courses of both Omicron and possible new variants.


Stock SJ et al., Nature Medicine 2022.