Practice Protocols
At True North Birth Center, we still follow the standard of care for prenatal and postpartum appointments. We feel that in-person visits are most beneficial at detecting any potential complications, and prefer clients come in-person for their care. We are not restricting appointments to the pregnant person only, and immediate family members are welcome. We believe these appointments are important for support persons to attend. If COVID rates are above 100 weekly cases per 100,000 in Kitsap County, we will be screening all individuals wanting to enter the building at the door.
Per the Governor and the Department of Health for Washington, masks are still required for everyone ages 5 and up. Children ages 2-4 are recommended to wear a mask with adult supervision.
Masks are required for all individuals the entire time present at appointments. Medical exemptions are accepted for those unable to wear a mask due to a medical condition. We do not require masks during labor for the laboring person or their immediate family. Anyone outside of the immediate household must wear a mask if present during labor.
During labor, the pregnant person is welcome to have up to three total support people with them. This may include any combination of three individuals, such as their partner, child, doula, birth photographer, family member, friend etc. There will be no exceptions to this if COVID rates are above 100 weekly cases per 100,000. Anyone attending the birth is required to be in the birth suite with the laboring person, and will not be allowed to spend long periods of time in the lobby.
If you or anyone in your family has suspected or confirmed contact with someone who is COVID positive, are symptomatic, or are diagnosed with COVID, appointments will need to rescheduled according to the CDC's isolation and quarantine protocols. Anyone who is symptomatic or COVID positive at the time of delivery will not be allowed to attend at the birth center. If the pregnant person is COVID positive at the time of labor, transfer of care to St. Michaels will be necessary. If you have a planned home birth and individuals at your home are ill, we will not be able to attend, but a birth center birth can be accommodated, as long as the birthing person is COVID negative.
What if I am exposed to someone with known or suspected COVID-19 diagnosis
If you are vaccinated:
Per the CDC, if you are fully vaccinated- meaning 2 weeks after your final vaccination, you do not have to quarantine if you are not symptomatic. It is recommended that you mask when around others for 14 days and get tested between 3-5 days from exposure. If you are symptomatic, you need to be tested for COVID-19.
If you are not vaccinated:
Per the CDC, you should quarantine for 14 days and monitor for symptoms. If symptoms develop, you should get tested for COVID-19. In some cases, you may end quarantine between 7-10 days with a negative COVID-19 test AND no symptoms but should continue monitoring symptoms through day 14. (CDC, 2021)
What to do if I am sick?
If you have any of the following symptoms, please call the front office to reschedule your appointment, or to change to a telemedicine visit as needed. It is advised that you also be tested for COVID-19, which can be done at most Walgreens and Rite-Aid (with appointment) or at Urgent Care. Please self-isolate until your test results are returned. Anyone in close contact with you should quarantine as well. Reach out to your midwifery team for direct recommendations on immune support and safe medications during pregnancy.
Symptoms:
What if I am diagnosed with COVID?
If you are diagnosed with COVID-19, follow the advice from the CDC for all people with COVID-19:
Continue isolation until 10 days after the first day of symptoms AND no fever for 24 hours AND symptoms are improving.
Per the Governor and the Department of Health for Washington, masks are still required for everyone ages 5 and up. Children ages 2-4 are recommended to wear a mask with adult supervision.
Masks are required for all individuals the entire time present at appointments. Medical exemptions are accepted for those unable to wear a mask due to a medical condition. We do not require masks during labor for the laboring person or their immediate family. Anyone outside of the immediate household must wear a mask if present during labor.
During labor, the pregnant person is welcome to have up to three total support people with them. This may include any combination of three individuals, such as their partner, child, doula, birth photographer, family member, friend etc. There will be no exceptions to this if COVID rates are above 100 weekly cases per 100,000. Anyone attending the birth is required to be in the birth suite with the laboring person, and will not be allowed to spend long periods of time in the lobby.
If you or anyone in your family has suspected or confirmed contact with someone who is COVID positive, are symptomatic, or are diagnosed with COVID, appointments will need to rescheduled according to the CDC's isolation and quarantine protocols. Anyone who is symptomatic or COVID positive at the time of delivery will not be allowed to attend at the birth center. If the pregnant person is COVID positive at the time of labor, transfer of care to St. Michaels will be necessary. If you have a planned home birth and individuals at your home are ill, we will not be able to attend, but a birth center birth can be accommodated, as long as the birthing person is COVID negative.
What if I am exposed to someone with known or suspected COVID-19 diagnosis
If you are vaccinated:
Per the CDC, if you are fully vaccinated- meaning 2 weeks after your final vaccination, you do not have to quarantine if you are not symptomatic. It is recommended that you mask when around others for 14 days and get tested between 3-5 days from exposure. If you are symptomatic, you need to be tested for COVID-19.
If you are not vaccinated:
Per the CDC, you should quarantine for 14 days and monitor for symptoms. If symptoms develop, you should get tested for COVID-19. In some cases, you may end quarantine between 7-10 days with a negative COVID-19 test AND no symptoms but should continue monitoring symptoms through day 14. (CDC, 2021)
What to do if I am sick?
If you have any of the following symptoms, please call the front office to reschedule your appointment, or to change to a telemedicine visit as needed. It is advised that you also be tested for COVID-19, which can be done at most Walgreens and Rite-Aid (with appointment) or at Urgent Care. Please self-isolate until your test results are returned. Anyone in close contact with you should quarantine as well. Reach out to your midwifery team for direct recommendations on immune support and safe medications during pregnancy.
Symptoms:
- Fever or chills
- Cough
- Shortness of breath or difficulty breathing
- Fatigue
- Muscle or body aches
- Headache
- New loss of taste or smell
- Sore throat
- Congestion or runny nose
- Nausea, vomiting and/or diarrhea
What if I am diagnosed with COVID?
If you are diagnosed with COVID-19, follow the advice from the CDC for all people with COVID-19:
- Stay home except to get medical care. Avoid public transportation.
- Continue monitoring your symptoms. Get medical care right away if you feel worse or think it’s an emergency.
- Separate yourself from other people in your home.
- Wear a face mask when you are around other people and when you go to get medical care.
- Inform any close contacts from 48 hours prior to symptoms appearing of your diagnosis.
Continue isolation until 10 days after the first day of symptoms AND no fever for 24 hours AND symptoms are improving.
COVID-19 in Pregnancy
What is COVID-19?
Covid-19 is a disease caused by a novel virus called SARS-CoV-2. Most people diagnosed with COVID-19 have mild symptoms, but in some cases can become severely ill. COVID-19 is highly contagious, most typically spread by individuals in the two-days before and after showing symptoms. Symptoms typically include fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, loss of taste or smell, headache, sore throat, nausea or vomiting, and diarrhea. COVID-19 spreads by droplets when an infected person breathes, coughs or sneezes. People who are closer than 6-feet from the infected person are most likely to contract the disease. Symptoms typically present 2-14 days after infection, and a person is considered contagious until at least 10-days following initial symptoms with no fever for over 24 hours and with improving symptoms (CDC, 2021).
How does COVID-19 effect pregnancy?
Currently, researchers are still learning how COVID-19 affects pregnant and recently pregnant individuals. Some studies have shown that pregnant persons are more likely to develop severe illness, be admitted to the ICU due to COVID, and more likely to be intubated (Martinez-Portilla, et al., 2021). Studies also show an increased rate of preterm delivery. (Allotey, et. al., 2020) Contracting COVID-19 in pregnancy can lead to additional complications. Research has shown an increase in hypertension and preeclampsia and infections requiring antibiotics (Villar, Ariff, & Gunier, 2021)
Pregnancy is an independent risk factor for severe disease by the CDC
In addition to being pregnant, other risk factors such as obesity, heart disease, diabetes and age above 35 can increase the risk of severe disease. Persons of Hispanic, Latinx, and African American descent are disproportionately affected by severe COVID infection and death (Mutambudzi, et. al., 2020)
How can COVID-19 affect my baby?
Research is limited related to COVID-19 and affects of the fetus. However, it appears that vertical transmission of COVID-19 from the pregnant person to the fetus is rare. However, there are increased rates of preterm delivery, as well as increased rates of cesarean deliveries in those that contracted COVID-19 in pregnancy (Huntley et. al., 2020). In addition, a recent study found increased rates of babies that were small for gestational age and increased rates of fetal distress which could be related to placental insufficiency (Villar, Ariff, & Gunier, 2021)
How can I stay healthy?
We recommend the following daily immune support through pregnancy:
In addition to the above, it is important to also do the following:
Covid-19 is a disease caused by a novel virus called SARS-CoV-2. Most people diagnosed with COVID-19 have mild symptoms, but in some cases can become severely ill. COVID-19 is highly contagious, most typically spread by individuals in the two-days before and after showing symptoms. Symptoms typically include fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, loss of taste or smell, headache, sore throat, nausea or vomiting, and diarrhea. COVID-19 spreads by droplets when an infected person breathes, coughs or sneezes. People who are closer than 6-feet from the infected person are most likely to contract the disease. Symptoms typically present 2-14 days after infection, and a person is considered contagious until at least 10-days following initial symptoms with no fever for over 24 hours and with improving symptoms (CDC, 2021).
How does COVID-19 effect pregnancy?
Currently, researchers are still learning how COVID-19 affects pregnant and recently pregnant individuals. Some studies have shown that pregnant persons are more likely to develop severe illness, be admitted to the ICU due to COVID, and more likely to be intubated (Martinez-Portilla, et al., 2021). Studies also show an increased rate of preterm delivery. (Allotey, et. al., 2020) Contracting COVID-19 in pregnancy can lead to additional complications. Research has shown an increase in hypertension and preeclampsia and infections requiring antibiotics (Villar, Ariff, & Gunier, 2021)
Pregnancy is an independent risk factor for severe disease by the CDC
In addition to being pregnant, other risk factors such as obesity, heart disease, diabetes and age above 35 can increase the risk of severe disease. Persons of Hispanic, Latinx, and African American descent are disproportionately affected by severe COVID infection and death (Mutambudzi, et. al., 2020)
How can COVID-19 affect my baby?
Research is limited related to COVID-19 and affects of the fetus. However, it appears that vertical transmission of COVID-19 from the pregnant person to the fetus is rare. However, there are increased rates of preterm delivery, as well as increased rates of cesarean deliveries in those that contracted COVID-19 in pregnancy (Huntley et. al., 2020). In addition, a recent study found increased rates of babies that were small for gestational age and increased rates of fetal distress which could be related to placental insufficiency (Villar, Ariff, & Gunier, 2021)
How can I stay healthy?
We recommend the following daily immune support through pregnancy:
- 1000mg Vitamin C
- 5000IU Vitamin D
- 30mg Zinc
- 1 Tbsp Elderberry Syrup
In addition to the above, it is important to also do the following:
- Consider getting a COVID-19 vaccination
- Wear a mask or cloth face covering in public
- Limit contact with other people as much as possible
- Stay at least 6 feet away from other people and avoiding crowds if you need to go out
- Avoid contact with other people in places that do not offer fresh air from the outdoors (open windows and doors when possible)
- Wash hands often with soap and water for at least 20 seconds
COVID Vaccine in Pregnancy
The CDC (Center for Disease Control) and ACOG (American College of Obstetrics and Gynecology) recommend COVID-19 vaccination for all people aged 12 years and older, including people who are pregnant, breastfeeding, trying to get pregnant now, or might become pregnant in the future. Pregnant and recently pregnant people are more likely to get severely ill with COVID-19 compared with non-pregnant people. Getting a COVID-19 vaccine can protect you from severe illness from COVID-19.
How do COVID-19 vaccines work?
Currently, there are two types of vaccines approved for use. Both Pfizer and Moderna are Messenger RNA vaccinations, and Johnson & Johnson is a Vector vaccination.
Messenger RNA vaccinations contain genetically engineered mRNA that provide instructions to your cells on how to make the S protein found on the surface of the COVID-19 virus. Think of the mRNA as a recipe. Once your cells receive this recipe, they begin making the S protein, which are then displayed on the surface of your cells. Your immune system sees these proteins and begins making antibodies against the S protein. If you ever become infected with COVID-19, you now have these antibodies, and your body attacks the COVID-19 virus. As soon as the mRNA is read by your cells, it is destroyed. It never enters the nucleus of your cell where DNA is kept and does not become a permanent part of your DNA.
Vector vaccinations contain parts of the pathogen, the genetic material from the COVID-19 virus, that is placed in a different virus that has been modified to be safe. This is called a viral vector. This viral vector carries the genetic material into your cells and delivers the genetic material from the COVID-19 virus. The genetic material is read, like the mRNA, as a recipe which causes the cells to begin making the S protein. This S protein is displayed and triggers the immune system, just like the mRNA type of vaccine. Neither the viral vector nor the genetic material from the virus can make you sick and both are destroyed.
What are the vaccine options?
Currently, there are three FDA approved vaccinations: Pfizer, Moderna, and Johnson & Johnson.
A new study released Aug. 9, 2021 (that has yet to be peer reviewed) found that during the study period from January to July 2021, the Pfizer vaccination was 76% effective at preventing infection and 85% effective at preventing severe illness, where Moderna was found to be 81% effective at preventing infection and 91.6% effective at preventing severe illness. The study also found that in July with the increase of the Delta variant, effectiveness of preventing infection was lower, 76% for Moderna and only 42% for Pfizer, but that effectiveness at preventing severe illness remained high, Moderna being 81% effective and Pfizer being 75% effective (Puranik et. al., 2021).
Booster vaccinations are now recommended for both Pfizer and Moderna for those that are immunocompromised, as well as all persons 8-months following initial vaccination.
No vaccine offers 100% protection. Therefore, it is still important to continue masking, washing your hands frequently, and social distancing whenever possible.
What are the benefits of getting the vaccination?
COVID-19 may be more dangerous during pregnancy
Studies have shown that pregnant persons are more likely to develop severe illness, be admitted to the ICU due to COVID, and more likely to be intubated (Martinez-Portilla, et al., 2021). Studies also show an increased rate of preterm delivery. (Allotey, et. al., 2020)
Pregnancy is an independent risk factor for severe disease by the CDC
In addition to being pregnant, other risk factors such as obesity, heart disease, diabetes and age above 35 can increase the risk of severe disease. Persons of Hispanic, Latinx, and African American descent are disproportionately affected by severe COVID infection and death (Mutambudzi, et. al., 2020)
As discussed above, the vaccine is effective at preventing infection, and highly effective at protecting against severe illness. Recent studies also show that babies receive antibodies from the pregnant person that chooses to vaccinate during pregnancy.
What are the risks?
Covid-19 vaccinations have not been specifically studied in pregnancy
So far, data from the US using Pfizer and Moderna vaccines have shown them to be safe overall. Though pregnant women were not involved in initial trails, data is beginning to come out regarding the safety in pregnancy.
A recent study which looked at data from the v-safe surveillance system and VAERS found rates of miscarriage to be 12.6%, with 92.3% occurring in 1st trimester, stillbirth rates 0.1%, preterm birth rates to be 9.4%, small for gestational age rates to be 3.2%, and major congenital anomalies to be 2.2% (none of which were vaccinated in the first trimester), which are all similar to the general population (Shimabukuro, et. al., 2021).
Another recent study found miscarriage rates to be 14.1%, concluding a similar rate to the general population and no increased risk of receiving the COVID-19 vaccination in pregnancy (Zauche et. al., 2021).
What are the side effects?
Common side effects reported with getting the vaccine include pain at injection site- sore arm, fatigue, headache, muscle pains, chills, joint pain and fever. More pronounced symptoms are commonly reported following the second vaccination. Symptoms are not an indication of being sick, but indicate your immune system is responding to the vaccine and are a sign of a healthy immune response. Symptoms tend to resolve within 24-48 hours. More severe anaphylactic reactions are rare. Tylenol can be taken by pregnant persons with above mild symptoms.
**There have been increased reports of low platelets and blood clots with the use of the Johnson & Johnson vaccine. The CDC states women under 50 years old should be especially aware of these rare risks (CDC, 2021).
When should I get the vaccine?
There are no recommendations based on research related to the timing of COVID-19 vaccination in pregnancy. Some pregnant persons may desire waiting until after the first trimester, when the fetus is most susceptible to teratogens. It is a known risk that contracting COVID-19 in pregnancy can lead to preterm delivery, so vaccinations would be most helpful prior to the third trimester. Therefore, an idea time to vaccinate may be the second trimester. In persons with increased risk of contracting COVID-19, such as healthcare workers, there is no evidence to delay vaccination until after the first trimester. If a person began the vaccination series prior to pregnancy, it is recommended to continue the series, regardless of early gestation (RCOG, 2021).
Making a Decision
Whether or not you choose to get vaccinated against COVID-19 is your medical right and personal choice. You may choose to get vaccinated right away, wait for more research to come out or until you are no longer pregnant, or choose not to vaccinate at all.
When weighing your options, consider your risk:
Your risks of getting sick from COVID-19 are higher if:
If you are not at a higher risk for COVID-19 and:
(University of Minnesota, 2020)
If you get vaccinated:
Please let your midwife know either by messaging through your chart, or in person at your next appointment. Please also consider registering at the following link to be a part of continued research on COVID-19 vaccination during pregnancy.
CDC V-Safe Program: vsafe.cdc.gov
V-safe is a smartphone-based tool that uses text messaging and web surveys to provide personalized health check-ins after you receive a COVID-19 vaccine. Through v-safe, you can quickly tell CDC if you have any side effects after getting a COVID-19 vaccine. Depending on your answers to the web surveys, someone from CDC may call to check on you and get more information. V-safe will also remind you to get your second COVID-19 vaccine dose if you need one.
Report an adverse event: https://vaers.hhs.gov/reportevent.html
How do COVID-19 vaccines work?
Currently, there are two types of vaccines approved for use. Both Pfizer and Moderna are Messenger RNA vaccinations, and Johnson & Johnson is a Vector vaccination.
Messenger RNA vaccinations contain genetically engineered mRNA that provide instructions to your cells on how to make the S protein found on the surface of the COVID-19 virus. Think of the mRNA as a recipe. Once your cells receive this recipe, they begin making the S protein, which are then displayed on the surface of your cells. Your immune system sees these proteins and begins making antibodies against the S protein. If you ever become infected with COVID-19, you now have these antibodies, and your body attacks the COVID-19 virus. As soon as the mRNA is read by your cells, it is destroyed. It never enters the nucleus of your cell where DNA is kept and does not become a permanent part of your DNA.
Vector vaccinations contain parts of the pathogen, the genetic material from the COVID-19 virus, that is placed in a different virus that has been modified to be safe. This is called a viral vector. This viral vector carries the genetic material into your cells and delivers the genetic material from the COVID-19 virus. The genetic material is read, like the mRNA, as a recipe which causes the cells to begin making the S protein. This S protein is displayed and triggers the immune system, just like the mRNA type of vaccine. Neither the viral vector nor the genetic material from the virus can make you sick and both are destroyed.
What are the vaccine options?
Currently, there are three FDA approved vaccinations: Pfizer, Moderna, and Johnson & Johnson.
- Pfizer: mRNA vaccine given in 2 doses 21 days apart. 95% effectiveness after phase 3 trials. This vaccine has full FDA approval.
- Moderna: mRNA vaccine given in 2 doses 28 days apart. 94.1% effectiveness after phase 3 trials. This vaccine is approved for use by the FDA under an Emergency Use Authorization.
- Johnson & Johnson- Vector vaccine given in a single dose. 66.1% effectiveness after phase 3 trials. This vaccine is approved for use by the FDA under an Emergency Use Authorization.
A new study released Aug. 9, 2021 (that has yet to be peer reviewed) found that during the study period from January to July 2021, the Pfizer vaccination was 76% effective at preventing infection and 85% effective at preventing severe illness, where Moderna was found to be 81% effective at preventing infection and 91.6% effective at preventing severe illness. The study also found that in July with the increase of the Delta variant, effectiveness of preventing infection was lower, 76% for Moderna and only 42% for Pfizer, but that effectiveness at preventing severe illness remained high, Moderna being 81% effective and Pfizer being 75% effective (Puranik et. al., 2021).
Booster vaccinations are now recommended for both Pfizer and Moderna for those that are immunocompromised, as well as all persons 8-months following initial vaccination.
No vaccine offers 100% protection. Therefore, it is still important to continue masking, washing your hands frequently, and social distancing whenever possible.
What are the benefits of getting the vaccination?
COVID-19 may be more dangerous during pregnancy
Studies have shown that pregnant persons are more likely to develop severe illness, be admitted to the ICU due to COVID, and more likely to be intubated (Martinez-Portilla, et al., 2021). Studies also show an increased rate of preterm delivery. (Allotey, et. al., 2020)
Pregnancy is an independent risk factor for severe disease by the CDC
In addition to being pregnant, other risk factors such as obesity, heart disease, diabetes and age above 35 can increase the risk of severe disease. Persons of Hispanic, Latinx, and African American descent are disproportionately affected by severe COVID infection and death (Mutambudzi, et. al., 2020)
As discussed above, the vaccine is effective at preventing infection, and highly effective at protecting against severe illness. Recent studies also show that babies receive antibodies from the pregnant person that chooses to vaccinate during pregnancy.
What are the risks?
Covid-19 vaccinations have not been specifically studied in pregnancy
So far, data from the US using Pfizer and Moderna vaccines have shown them to be safe overall. Though pregnant women were not involved in initial trails, data is beginning to come out regarding the safety in pregnancy.
A recent study which looked at data from the v-safe surveillance system and VAERS found rates of miscarriage to be 12.6%, with 92.3% occurring in 1st trimester, stillbirth rates 0.1%, preterm birth rates to be 9.4%, small for gestational age rates to be 3.2%, and major congenital anomalies to be 2.2% (none of which were vaccinated in the first trimester), which are all similar to the general population (Shimabukuro, et. al., 2021).
Another recent study found miscarriage rates to be 14.1%, concluding a similar rate to the general population and no increased risk of receiving the COVID-19 vaccination in pregnancy (Zauche et. al., 2021).
What are the side effects?
Common side effects reported with getting the vaccine include pain at injection site- sore arm, fatigue, headache, muscle pains, chills, joint pain and fever. More pronounced symptoms are commonly reported following the second vaccination. Symptoms are not an indication of being sick, but indicate your immune system is responding to the vaccine and are a sign of a healthy immune response. Symptoms tend to resolve within 24-48 hours. More severe anaphylactic reactions are rare. Tylenol can be taken by pregnant persons with above mild symptoms.
**There have been increased reports of low platelets and blood clots with the use of the Johnson & Johnson vaccine. The CDC states women under 50 years old should be especially aware of these rare risks (CDC, 2021).
When should I get the vaccine?
There are no recommendations based on research related to the timing of COVID-19 vaccination in pregnancy. Some pregnant persons may desire waiting until after the first trimester, when the fetus is most susceptible to teratogens. It is a known risk that contracting COVID-19 in pregnancy can lead to preterm delivery, so vaccinations would be most helpful prior to the third trimester. Therefore, an idea time to vaccinate may be the second trimester. In persons with increased risk of contracting COVID-19, such as healthcare workers, there is no evidence to delay vaccination until after the first trimester. If a person began the vaccination series prior to pregnancy, it is recommended to continue the series, regardless of early gestation (RCOG, 2021).
Making a Decision
Whether or not you choose to get vaccinated against COVID-19 is your medical right and personal choice. You may choose to get vaccinated right away, wait for more research to come out or until you are no longer pregnant, or choose not to vaccinate at all.
When weighing your options, consider your risk:
Your risks of getting sick from COVID-19 are higher if:
- You have contact with people outside your household who do not wear masks
- You are 35 years old or older
- You are overweight
- You have other medical problems such as diabetes, high blood pressure, or heart disease
- You are a smoker
- You are a racial or ethnic minority
- Your community has high rates of COVID-19 infections
- You work in a healthcare setting
If you are not at a higher risk for COVID-19 and:
- You are always able to wear a mask
- You and the people you live with can socially distance from others your whole pregnancy
- Your community does NOT have high or increasing COVID-19 cases
- You have had a severe allergic reaction to a vaccine
- You have other medical conditions that a primary care physician has recommended against vaccination
(University of Minnesota, 2020)
If you get vaccinated:
Please let your midwife know either by messaging through your chart, or in person at your next appointment. Please also consider registering at the following link to be a part of continued research on COVID-19 vaccination during pregnancy.
CDC V-Safe Program: vsafe.cdc.gov
V-safe is a smartphone-based tool that uses text messaging and web surveys to provide personalized health check-ins after you receive a COVID-19 vaccine. Through v-safe, you can quickly tell CDC if you have any side effects after getting a COVID-19 vaccine. Depending on your answers to the web surveys, someone from CDC may call to check on you and get more information. V-safe will also remind you to get your second COVID-19 vaccine dose if you need one.
Report an adverse event: https://vaers.hhs.gov/reportevent.html
References:
American College of Obstetricians and Gynecologists. (2021). Coronavirus (COVID-19), pregnancy, and breastfeeding: A message for patients. Retrieved from: https://www.acog.org/womens-health/faqs/coronavirus-covid-19-pregnancy-and-breastfeeding
Allotey, J., Stallings, E., Bonet, M., Yap, M., Chatterjee, S., Kew, T., Debenham, L., Llavall, A. C., Dixit, A., Zhou, D., Balaji, R., Lee, S. I., Qiu, X., Yuan, M., Coomar, D., Sheikh, J., Lawson, H., Ansari, K., van Wely, M., van Leeuwen, E., … for PregCOV-19 Living Systematic Review Consortium (2020). Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis. BMJ (Clinical research ed.), 370, m3320. https://doi.org/10.1136/bmj.m3320
Center for Disease Control (2021). COVID-19: Frequently asked questions. Retrieved from: https://www.cdc.gov/coronavirus/2019-ncov/faq.html#Spread
Center for Disease Control (2021). COVDI-19: Quarantine and isolation. Retrieved from: https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/quarantine.html
Huntley, B., Huntley, E. S., Di Mascio, D., Chen, T., Berghella, V., & Chauhan, S. P. (2020). Rates of Maternal and Perinatal Mortality and Vertical Transmission in Pregnancies Complicated by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-Co-V-2) Infection: A Systematic Review. Obstetrics and gynecology, 136(2), 303–312. https://doi.org/10.1097/AOG.0000000000004010
Martinez-Portilla, R. J., Sotiriadis, A., Chatzakis, C., Torres-Torres, J., Espino Y Sosa, S., Sandoval-Mandujano, K., Castro-Bernabe, D. A., Medina-Jimenez, V., Monarrez-Martin, J. C., Figueras, F., & Poon, L. C. (2021). Pregnant women with SARS-CoV-2 infection are at higher risk of death and pneumonia: propensity score matched analysis of a nationwide prospective cohort (COV19Mx). Ultrasound in obstetrics & gynecology: the official journal of the International Society of Ultrasound in Obstetrics and Gynecology, 57(2), 224–231. https://doi.org/10.1002/uog.23575
Mutambudzi, M., Niedwiedz, C., Macdonald, E., Leyland, A., Mair, F., Anderson, J., Celis-Morales, C., Cleland, J., Forbes, J., Gill, J., Hastie, C., Ho, F., Jani, B., Mackay, D., Nicholl, B., O’Donnell, C., Sattar, N., Welsh, P., Pell, J., Katikireddi, S., & Demou, E. (2020). Occupation and risk of severe covid-19: prospective cohort study of 120 075 UK biobank participants. Occoup Environ Med 0:1-8, doi: 10.1136/oemed-2020-106731.
Villar, J., Ariff, S., & Gunier, R. (2021). Maternal and neonatal morbidity and mortality among pregnant women with and without COVID-19 Infection: The INTERCOVID multinational cohort study. JAMA Pediatrics 75(8):817–826. doi:10.1001/jamapediatrics.2021.1050
Allotey, J., Stallings, E., Bonet, M., Yap, M., Chatterjee, S., Kew, T., Debenham, L., Llavall, A. C., Dixit, A., Zhou, D., Balaji, R., Lee, S. I., Qiu, X., Yuan, M., Coomar, D., Sheikh, J., Lawson, H., Ansari, K., van Wely, M., van Leeuwen, E., … for PregCOV-19 Living Systematic Review Consortium (2020). Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis. BMJ (Clinical research ed.), 370, m3320. https://doi.org/10.1136/bmj.m3320
Center for Disease Control. (2021). Covid-19 vaccines while pregnant or breastfeeding. Retrieved from: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/pregnancy.html.
Mayo Clinic. (2021). Different types of covid-19 vaccines: How they work. Retrieved from: https://www.mayoclinic.org/diseases-conditions/coronavirus/in-depth/different-types-of-covid-19-vaccines/art-20506465.
Martinez-Portilla, R. J., Sotiriadis, A., Chatzakis, C., Torres-Torres, J., Espino Y Sosa, S., Sandoval-Mandujano, K., Castro-Bernabe, D. A., Medina-Jimenez, V., Monarrez-Martin, J. C., Figueras, F., & Poon, L. C. (2021). Pregnant women with SARS-CoV-2 infection are at higher risk of death and pneumonia: propensity score matched analysis of a nationwide prospective cohort (COV19Mx). Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology, 57(2), 224–231. https://doi.org/10.1002/uog.23575
Mutambudzi, M., Niedwiedz, C., Macdonald, E., Leyland, A., Mair, F., Anderson, J., Celis-Morales, C., Cleland, J., Forbes, J., Gill, J., Hastie, C., Ho, F., Jani, B., Mackay, D., Nicholl, B., O’Donnell, C., Sattar, N., Welsh, P., Pell, J., Katikireddi, S., & Demou, E. (2020). Occupation and risk of severe covid-19: prospective cohort study of 120 075 UK biobank participants. Occoup Environ Med 0:1-8, doi: 10.1136/oemed-2020-106731.
Puranik, A., Lenehan, P., Silvert, E., Niesen, M., Corchado-Garcia, J., O’Horo,, J., >>> Soundararajan, V. (2021). Comparison of two highly effecrive mRNA vaccines for COVID-19 during periods of Alpha and Delta variant prevalence. medRxiv 2021.08.06.21261707. doi: https://doi.org/10.1101/2021.08.06.21261707
Royal College of Obsetricians and Gynaecologists. (2021) Coronavirus (COVID-19) vaccination in pregnancy. Retrieved from: https://www.rcog.org.uk/globalassets/documents/guidelines/2021-06-30-coronavirus-covid-19-vaccination-in-pregnancy.pdf
Shimabukuro, T., Kim, S., Meyers, T., Moro, P., Oduyebo, T., Panagiotakopoulos, L., Marquez, P., Olson, C., Liu, R., Chang, K., Ellington, S., Burkel, V., et al. (2021). Preliminary findings of mRNA Covid-19 vaccine safety in pregnant persons. New England Journal of Medicine, 384:2273-2282. DOI: 10.1056/NEJMoa2104983.
University of Minnesota. (2020). Shared decision making: COVID vaccination in pregnancy. Retrieved from: https://www.cidrap.umn.edu/sites/default/files/public/downloads/pregnancy_covid_vacine_decision_aid.pdf
Zauche, L., Wallace, B., Smoots, A., Olson, C., Oduyebo, T., Kim, S., Peterson, E., Ju, J., Beauregard, J., Wilcox, A., Rose, C., Meaney-Delman, D., & Ellington, S. (2021). Recoept of mRNA covid-19 vaccines preconception and during pregnancy and risk of self-reported spontaneous abortions, CDC v-safe covid-19 vaccine pregnancy registry 2020-21. DOI: 10.21203/rs.3.rs-798175/v1.
American College of Obstetricians and Gynecologists. (2021). Coronavirus (COVID-19), pregnancy, and breastfeeding: A message for patients. Retrieved from: https://www.acog.org/womens-health/faqs/coronavirus-covid-19-pregnancy-and-breastfeeding
Allotey, J., Stallings, E., Bonet, M., Yap, M., Chatterjee, S., Kew, T., Debenham, L., Llavall, A. C., Dixit, A., Zhou, D., Balaji, R., Lee, S. I., Qiu, X., Yuan, M., Coomar, D., Sheikh, J., Lawson, H., Ansari, K., van Wely, M., van Leeuwen, E., … for PregCOV-19 Living Systematic Review Consortium (2020). Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis. BMJ (Clinical research ed.), 370, m3320. https://doi.org/10.1136/bmj.m3320
Center for Disease Control (2021). COVID-19: Frequently asked questions. Retrieved from: https://www.cdc.gov/coronavirus/2019-ncov/faq.html#Spread
Center for Disease Control (2021). COVDI-19: Quarantine and isolation. Retrieved from: https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/quarantine.html
Huntley, B., Huntley, E. S., Di Mascio, D., Chen, T., Berghella, V., & Chauhan, S. P. (2020). Rates of Maternal and Perinatal Mortality and Vertical Transmission in Pregnancies Complicated by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-Co-V-2) Infection: A Systematic Review. Obstetrics and gynecology, 136(2), 303–312. https://doi.org/10.1097/AOG.0000000000004010
Martinez-Portilla, R. J., Sotiriadis, A., Chatzakis, C., Torres-Torres, J., Espino Y Sosa, S., Sandoval-Mandujano, K., Castro-Bernabe, D. A., Medina-Jimenez, V., Monarrez-Martin, J. C., Figueras, F., & Poon, L. C. (2021). Pregnant women with SARS-CoV-2 infection are at higher risk of death and pneumonia: propensity score matched analysis of a nationwide prospective cohort (COV19Mx). Ultrasound in obstetrics & gynecology: the official journal of the International Society of Ultrasound in Obstetrics and Gynecology, 57(2), 224–231. https://doi.org/10.1002/uog.23575
Mutambudzi, M., Niedwiedz, C., Macdonald, E., Leyland, A., Mair, F., Anderson, J., Celis-Morales, C., Cleland, J., Forbes, J., Gill, J., Hastie, C., Ho, F., Jani, B., Mackay, D., Nicholl, B., O’Donnell, C., Sattar, N., Welsh, P., Pell, J., Katikireddi, S., & Demou, E. (2020). Occupation and risk of severe covid-19: prospective cohort study of 120 075 UK biobank participants. Occoup Environ Med 0:1-8, doi: 10.1136/oemed-2020-106731.
Villar, J., Ariff, S., & Gunier, R. (2021). Maternal and neonatal morbidity and mortality among pregnant women with and without COVID-19 Infection: The INTERCOVID multinational cohort study. JAMA Pediatrics 75(8):817–826. doi:10.1001/jamapediatrics.2021.1050
Allotey, J., Stallings, E., Bonet, M., Yap, M., Chatterjee, S., Kew, T., Debenham, L., Llavall, A. C., Dixit, A., Zhou, D., Balaji, R., Lee, S. I., Qiu, X., Yuan, M., Coomar, D., Sheikh, J., Lawson, H., Ansari, K., van Wely, M., van Leeuwen, E., … for PregCOV-19 Living Systematic Review Consortium (2020). Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis. BMJ (Clinical research ed.), 370, m3320. https://doi.org/10.1136/bmj.m3320
Center for Disease Control. (2021). Covid-19 vaccines while pregnant or breastfeeding. Retrieved from: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/pregnancy.html.
Mayo Clinic. (2021). Different types of covid-19 vaccines: How they work. Retrieved from: https://www.mayoclinic.org/diseases-conditions/coronavirus/in-depth/different-types-of-covid-19-vaccines/art-20506465.
Martinez-Portilla, R. J., Sotiriadis, A., Chatzakis, C., Torres-Torres, J., Espino Y Sosa, S., Sandoval-Mandujano, K., Castro-Bernabe, D. A., Medina-Jimenez, V., Monarrez-Martin, J. C., Figueras, F., & Poon, L. C. (2021). Pregnant women with SARS-CoV-2 infection are at higher risk of death and pneumonia: propensity score matched analysis of a nationwide prospective cohort (COV19Mx). Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology, 57(2), 224–231. https://doi.org/10.1002/uog.23575
Mutambudzi, M., Niedwiedz, C., Macdonald, E., Leyland, A., Mair, F., Anderson, J., Celis-Morales, C., Cleland, J., Forbes, J., Gill, J., Hastie, C., Ho, F., Jani, B., Mackay, D., Nicholl, B., O’Donnell, C., Sattar, N., Welsh, P., Pell, J., Katikireddi, S., & Demou, E. (2020). Occupation and risk of severe covid-19: prospective cohort study of 120 075 UK biobank participants. Occoup Environ Med 0:1-8, doi: 10.1136/oemed-2020-106731.
Puranik, A., Lenehan, P., Silvert, E., Niesen, M., Corchado-Garcia, J., O’Horo,, J., >>> Soundararajan, V. (2021). Comparison of two highly effecrive mRNA vaccines for COVID-19 during periods of Alpha and Delta variant prevalence. medRxiv 2021.08.06.21261707. doi: https://doi.org/10.1101/2021.08.06.21261707
Royal College of Obsetricians and Gynaecologists. (2021) Coronavirus (COVID-19) vaccination in pregnancy. Retrieved from: https://www.rcog.org.uk/globalassets/documents/guidelines/2021-06-30-coronavirus-covid-19-vaccination-in-pregnancy.pdf
Shimabukuro, T., Kim, S., Meyers, T., Moro, P., Oduyebo, T., Panagiotakopoulos, L., Marquez, P., Olson, C., Liu, R., Chang, K., Ellington, S., Burkel, V., et al. (2021). Preliminary findings of mRNA Covid-19 vaccine safety in pregnant persons. New England Journal of Medicine, 384:2273-2282. DOI: 10.1056/NEJMoa2104983.
University of Minnesota. (2020). Shared decision making: COVID vaccination in pregnancy. Retrieved from: https://www.cidrap.umn.edu/sites/default/files/public/downloads/pregnancy_covid_vacine_decision_aid.pdf
Zauche, L., Wallace, B., Smoots, A., Olson, C., Oduyebo, T., Kim, S., Peterson, E., Ju, J., Beauregard, J., Wilcox, A., Rose, C., Meaney-Delman, D., & Ellington, S. (2021). Recoept of mRNA covid-19 vaccines preconception and during pregnancy and risk of self-reported spontaneous abortions, CDC v-safe covid-19 vaccine pregnancy registry 2020-21. DOI: 10.21203/rs.3.rs-798175/v1.