From the Guidelines
Flu, RSV, and COVID-19 infections during the third trimester of pregnancy pose significant risks and should be taken seriously, with vaccination being strongly recommended as the safest approach, specifically the flu vaccine and COVID-19 vaccine (including boosters) considered safe and effective during pregnancy. These respiratory infections can be more severe during pregnancy due to natural changes in the immune system and increased strain on the heart and lungs.
Key Considerations
- For pregnant women in the third trimester, the benefits of vaccination outweigh the risks, with the goal of preventing severe illness and potential complications for both mother and fetus 1.
- The COVID-19 vaccine, in particular, has been shown to reduce the risk of severe morbidity and mortality in pregnant women, with studies indicating that vaccinated pregnant mothers can pass IgG antibodies to their offspring, providing protection against COVID-19 1.
- The RSV vaccine may also be recommended depending on the season and risk factors, although its use is more nuanced and dependent on individual patient circumstances.
Treatment and Prevention
- If infection occurs, prompt medical attention is essential, with treatment options varying by infection: for influenza, oseltamivir (Tamiflu) may be prescribed; for COVID-19, certain antivirals like nirmatrelvir/ritonavir (Paxlovid) might be considered under medical supervision; for RSV, treatment is typically supportive 1.
- Preventive measures are crucial, including hand hygiene, mask-wearing in high-risk settings, avoiding sick contacts, and staying well-hydrated, to reduce the risk of infection and complications.
Recommendations
- Pregnant women should be informed of the potential benefits of vaccination for themselves, their fetuses, and infants and should be proactively offered routinely recommended vaccines to allow timely administration before delivery of the infant 1.
- Healthcare providers should be provided with sufficient training to support pregnant women throughout the decision-making process, addressing any concerns they may have regarding the safety of these vaccines during pregnancy.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Risks Associated with Flu, RSV, and COVID-19 in the Third Trimester
- The severity of COVID-19, influenza, and RSV can vary, with COVID-19 being associated with higher long-term mortality 2.
- A study comparing the severity of COVID-19, influenza, and RSV found that RSV remained a milder illness, while COVID-19 was associated with higher long-term mortality 2.
- Vaccination can attenuate differences in disease severity and long-term mortality, highlighting the importance of vaccination against these illnesses 2, 3, 4.
Vaccination Coverage and Recommendations
- The Advisory Committee on Immunization Practices recommends annual influenza and COVID-19 vaccination for all persons aged ≥6 months, including adults aged ≥18 years 3, 4.
- RSV vaccine is recommended for persons aged ≥60 years using shared clinical decision-making, and for pregnant persons 3.
- Vaccination coverage varies by demographic characteristics, with lower coverage among younger adults and those without health insurance 3, 4.
Disease Severity Among Hospitalized Adults
- A cohort study found that RSV disease was less common but similar in severity compared with COVID-19 or influenza disease among unvaccinated patients 5.
- However, RSV disease was more severe than COVID-19 or influenza disease among vaccinated patients for the most serious outcomes of invasive mechanical ventilation or death 5.
- These findings highlight the importance of considering vaccination status when assessing the severity of RSV, COVID-19, and influenza disease 5.