Are People Who Are Pregnant Immunocompromised?

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

The Centers for Disease Control and Prevention (CDC) strongly urged pregnant people to get the COVID-19 vaccine, since they are more likely to become severely ill with COVID-19, compared to non-pregnant people.

If you are a pregnant person, you may be wondering—why? The CDC has strongly urged all Americans over the age of 6 months to get vaccinated against COVID-19 and particularly stressed how important it is for people who are immunocompromised to get the shot.

Does the guidance mean that pregnant people are immunocompromised? It's actually a little more complicated than most people realize. Here's what you need to know.

What Happens to Your Immune System When You're Pregnant?

During pregnancy, your body faces the challenge of protecting the fetus while also fighting against viruses and bacteria, according to this review from 2021 in Frontiers in Global Women's Health. So, there may be some adaptations that your body goes through in order to do both of these things.

"During pregnancy, there are many immunological and physiological changes that occur," said health expert Jennifer Wider, MD. "The immune system is often in flux and as a result, pregnant women may be more vulnerable to infections, including viral respiratory infections like COVID-19."

These immune changes are perfectly timed with the stages of pregnancy to help protect both you and your baby, while allowing you to carry the baby to term, according to the review.

Woman Dies of COVID After Emergency C-Section and Not Meeting Baby , Pregnant African American woman holding her stomach in hospital
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"The maternal immune system adapts and changes, depending on what stage of the pregnancy you're in," said Christine Greves, MD, ob-gyn at the Winnie Palmer Hospital for Women and Babies. "In the beginning, there's a pro-inflammatory state, which is helpful for implantation. Then it goes into an anti-inflammatory state, which is helpful for the growth of the baby. In the third trimester, it reaches another pro-inflammatory state to prepare for childbirth."

Most of these adaptations are good for both the fetus and the person who is pregnant. However, some of these changes can negatively affect the pregnant person, too. According to the review, the high levels of estrogen and progesterone can cause the respiratory tract to swell which may make them more susceptible to infections like COVID-19. So, are they immunocompromised?

What Does It Mean To Be Immunocompromised?

A person who is immunocompromised has a weakened immune system, according to the National Cancer Institute (NCI). These people have a lowered ability to fight infections and other diseases and conditions such as AIDS, cancer, diabetes, malnutrition, and certain genetic disorders. Immunosuppression can also be caused by some medicines or treatments like radiation therapy, organ transplant, and anti-cancer drugs.

Are Pregnant People Immunocompromised?

Not exactly. "It's kind of nuanced," said David F. Colombo, MD, a Michigan-based ob-gyn and division chief of maternal-fetal medicine at Spectrum Health. "The answer is no, but with an asterisk. Your immune system just works differently when you're pregnant."

"I don't think we should officially call pregnant women 'immunocompromised'—as for example, women who have cancer and are getting chemotherapy, or folks who are born with immunodeficiency diseases," said Mary Jane Minkin, MD, a clinical professor of obstetrics and gynecology and reproductive sciences at Yale Medical School. "However, many folks think of pregnant women as somewhat immunocompromised because they are 'tolerating' a foreign presence in their uterus." A fetus has genes from a totally different person as well, Dr. Minkin pointed out, and a pregnant person's immune system has to be able to tolerate that on an immunological level.

"Pregnant women are considered to be a 'special population group' due to the state of the immune system during pregnancy," Dr. Wider said. But while people who are pregnant aren't immunocompromised per se, "a pregnant person's body is undergoing immune system changes and is not operating the same way a non-pregnant person's is," Dr. Wider explained. As a result, "her body cannot defend against infections in the same way."

What Does This Mean for COVID-19?

In terms of COVID-19, Dr. Minkin said that pregnant people are susceptible to serious illness for reasons outside of their immune response. "One problem with COVID and related illnesses that has nothing to do with the immune system is that pregnant women have this 'thing' in their abdomens that pushes up the diaphragm, so lung space is compromised," Dr. Minkin said. "If a pneumonia sets in they will mechanically have worse problems ventilating."

People who are infected with COVID-19 have a higher prevalence of cesarean section (c-section) and premature birth, according to the review from 2021 in Frontiers in Global Women's Health. This may be due to changes, caused by the virus, in blood circulation in the placenta. Most of these people were asymptomatic or had mild symptoms of COVID-19.

What Can Pregnant People Do To Stay Healthy?

Dr. Colombo stressed the importance of getting vaccinated against COVID-19. "The biggest risk to pregnant women right now is catching COVID," Dr. Colombo said. "The vaccine is safe; COVID is not."

There's also this to consider, per Dr. Minkin: "Besides protecting the woman, there is evidence that [the mom] will pass on some antibodies to her baby."

It's also important to wear a mask when you're indoors in areas where there is a substantial or high rate of COVID-19 spread, wash your hands, and practice social distancing, Dr. Wider said. "Taking these precautions will go a long way in keeping a mom and her baby safe."

A Quick Review

While pregnant people aren't exactly immunocompromised, their immune system does work differently than people who are not pregnant. Because of this, they may want to be extra cautious regarding COVID-19. It is highly recommended by the CDC that pregnant people receive their vaccines and booster shots to protect themselves and the fetus.

Overall, Dr. Greves advised patients to be "as careful as possible because there are other infections floating around other than COVID-19 or the flu." But, Dr. Greves said, pregnant people also shouldn't panic over this. "Recognize that you're doing all you can do and try not to be too anxious about it," Dr. Greves said. "If you're doing all you can, enjoy your life and the beautiful baby growing inside."

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