Technically Speaking: Resources to Support COVID-19 Vaccination During Pregnancy

From the perspective of SARS-CoV-2 virus, it’s been a successful summer. The “7-day moving average” of COVID-19 cases has been increasing since March:

• 26,738 on March 20
• 100,103 on June 21
• 114,870 on August 4

For infants in the first six months of life, this is bad news. A study of more than 700,000 newborns born during March–December 2020 demonstrated that although only a small number were diagnosed with COVID-19 during the birth hospitalization (n=209), those infants were at greater risk of serious disease. Specifically, early preterm newborns (< 34 weeks gestation) with COVID-19 were more likely than their uninfected counterparts to require invasive ventilation, and late preterm/term newborns (> 34 weeks gestation) with COVID-19 had higher rates of ICU admission and sepsis when compared with uninfected late preterm/term newborns.

COVID-19 also puts pregnant women at increased risk of experiencing severe illness as well as early delivery (before 37 weeks gestation), stillbirth and other pregnancy complications.

For these reasons, the American College of Obstetrician and Gynecologists (ACOG) has recommended “that all eligible persons aged 6 months and older, including pregnant and lactating individuals, receive a COVID-19 vaccine or vaccine series.” To support healthcare providers who care for these patients, ACOG has posted a remarkable array of tools.

In this “Technically Speaking” column, I wanted to share some of these resources with the hope that you will find something useful for your practice. (Note: I was able to access all these pages even though I am not an ACOG member.)

ACOG webpages related to increasing maternal immunization rates (e.g., COVID-19, influenza, Tdap)

The gateway page gives you access to the following:

• “Pregnancy and Immunization: A Guide to Creating Patient Materials” — This is a terrific tool that could be used by departments and teams making their own patient materials.
• “Patient Education Videos: Routine Vaccination During Pregnancy”
• Two downloadable infographics — These are upbeat, attractive and simple with messages that are right on target.
  • Pregnant? Top 3 Reasons Why You Need the Flu Vaccine
  • Pregnant? Top 3 Reasons Why You Need the Tdap Vaccine
• “Summary of Maternal Immunization Recommendations”
• Three toolkits:
  • Maternal Immunization
  • Influenza Immunization during Pregnancy
  • Tdap Immunization
• “Immunization for Pregnant Women: A Call to Action”

Some key ACOG COVID-19 webpages

• “COVID-19 Vaccination Considerations for Obstetric-Gynecologic Care” is an ACOG practice advisory developed by the ACOG Immunization, Infectious Disease, and Public Health Preparedness Expert Work Group.
• “COVID-19 FAQs for Obstetrician-Gynecologists, Obstetrics” is a list of answers developed by several ACOG task forces composed of experts in obstetrics, maternal-fetal medicine, gynecology, gynecologic subspecialties, pediatric and adolescent gynecology, infectious disease, hospital systems, telehealth and ethics.
• “Addressing Health Equity During the COVID-19 Pandemic” provides tips on how to address health disparities to improve patient health and well-being
• “COVID-19 Vaccines and Pregnancy: Conversation Guide” offers key recommendations and messaging for clinicians (also available as a PDF).

Vaccine confidence training for healthcare professionals

While these six videos and their accompanying resources focus on COVID-19 vaccination, the lessons can be used to approach Tdap and influenza vaccines too. Note: You will need to create a free account to access these.

• Inform to Empower (7:44) — This video emphasizes the importance of ACOG’s “COVID-19 Vaccine Confident Conversations Training” for clinicians and explains how to access and use ACOG’s “Vaccine Confidence Toolkit.”
• COVID-19 Landscape: Data and Recommendations (14:34) — This video describes the impacts of COVID-19 on OB-GYN patients and details the available safety and efficacy data regarding COVID-19 vaccination for OB-GYN patients.
• Exploring Evidence Based Strategies (16:38) — This video helps viewers understand and apply the research on effective communication techniques for increasing vaccine confidence and demand.
• Leading Effective Vaccine Conversations (26:19) — This video is designed to help viewers apply evidence-based techniques to COVID-19 vaccine conversations with patients, including motivational interviewing and making a strong recommendation.
• Addressing COVID-19 Vaccine Misinformation (16:42) — This video defines mis- and disinformation as it relates to the COVID-19 pandemic and helps viewers apply techniques to confidently address these types of information with patients.
• Leading By Example (9:34) — This video describes the steps to becoming a vaccine provider and reviews concepts necessary to building a vaccine positive culture.

ACOG infographics on COVID-19 vaccination

• “Safety and Fertility Facts” highlights the safety of COVID-19 vaccines, describes how antibodies may pass to infants through breastmilk, and confirms that COVID-19 vaccines do not affect fertility (available in color or black and white).
• “Things to know after you get a vaccine” explains reactions individuals may experience after getting a COVID-19 vaccine (available in color or black and white).
• “Should I get a COVID-19 vaccine during pregnancy?” details why it is important for pregnant people to get the COVID-19 vaccine, including information on the risks of COVID-19 infection and the benefits of vaccination, (available in color or black and white).
• “COVID-19 Vaccine Facts” shares six facts about COVID-19 vaccine safety, effectiveness and availability to help patients make informed decisions about vaccination  (available in color or black and white).
• “Journey of a Vaccine” shows how vaccines are developed, approved and manufactured (available in color).
• “How to Talk to Your Patients about COVID-19 Vaccines” presents the motivational interviewing technique to communicate COVID-19 vaccine information with patients (available in color or black and white).

Other useful ACOG resources

• Social media posts are available for sharing to help increase confidence in COVID-19 vaccines. These are beautiful!
• “Top Ten Tips for a Media Interview” provides advice to help you prepare for a media interview, (available in color or black and white).
• “Training references” — If you want links to the 38 references on which the “Vaccine Confidence Training” is based, this will delight your academic heart.
• “My Vaccine Choice: How I Decided to Get a COVID-19 Vaccine During Pregnancy” is a personal account from an OB-GYN who discovered that she was pregnant with her first child in early summer 2020.

A few notable tools from other organizations

The resource section of ACOG’s “Vaccine Confidence Training” modules has many links to resources from other organizations.

The Centers for Disease Control and Prevention offers numerous great tools. Here are just three of their useful choices:

• Data on COVID-19 during pregnancy: severity of maternal illness — This resource provides data on COVID-19 related cases, deaths, hospitalizations and admissions to ICU among pregnant people.
• COVID-19 vaccination during pregnancy: Key messages — This is a good patient handout written in English (page 1) and Spanish (page 2).
• Talking with Patients about COVID-19 Vaccination: An Introduction to Motivational Interviewing for Healthcare Professionals — This resource is aimed at providers who want to learn about the motivational interviewing technique.

The UCLA Asian American Studies Center offers a collection of online links with important information about COVID-19 in 60 languages, including:

• Hispanic Faith Community Toolkit COVID-19 Vaccine Education Initiative (The Ad Council) includes messaging strategies and resources for Hispanic faith communities, including social and email graphics, sermons, guides, banners and videos.
• Fact Check Explorer (Google) is an online tool for fact-checking suspicious information.

There is not sufficient space in this column to review all of the materials included in the ACOG “Vaccine Confidence Training” modules. If you care for patients during pregnancy, train those who do, or have pregnant friends or family with questions, then exploring what ACOG has to offer is well worth your time.