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GrÜnebaum A, McCullough LB, Litvak A, Chervenak FA. Inclusion of pregnant individuals among priority populations for COVID-19 vaccination for all 50 US States. Am J Obstet Gynecol. 2021 Feb 2:S0002-9378(21)00081-8. doi: 10.1016/j.ajog.2021.01.026. Epub ahead of print. PMID: 33545113.

Objective: The American College of Obstetricians and Gyncologists (ACOG)1 recommends that COVID-19 vaccines should not be withheld from pregnant individuals who meet criteria for vaccination based on the Advisory Committee on Immunization Practices (ACIP)-recommended priority groups, which include pregnancy in priority Phase 1c to receive the vaccine (“.. persons aged 16-64 years with high-risk medical conditions..”).2 Final prioritization for COVID-19 vaccinations is based on individual states’ guidelines. The objective of this study was to review whether pregnant persons were uniformly included in individual states’ priority COVID-19 vaccination Phase 1 allocations.

Study design: We accessed COVID-19 vaccination prioritization on the official state websites for each of the 50 US states and for the District of Columbia (DC) to confirm whether pregnant individuals are presently included among the Phase 1 priority groups. Because we used publicly available data and without patient information, no IRB approval was needed RESULTS: Table 1 shows the results of prioritization for pregnant individuals for each US state and DC.The majority of US states 36/51 (71%) encompassing 71% of the US population, does not include pregnant individuals among their priority populations. Only 6/13 of the states which mentioned pregnancy as a priority indication for COVID-19 vaccination and none of the 36 states not including pregnancy in priority groups, linked back to the CDC definition of pregnancy as increased risk of severe illness.3 CONCLUSIONS: We found significant variations in how pregnancy is classified for COVID-19 vaccination by US states and the District of Columbia.ACIP includes pregnancy among the Phase 1 groups, defined as: “Adults of any age with certain underlying medical conditions are at increased risk for severe illness from the virus that causes COVID-19. Severe illness from COVID-19 is defined as hospitalization, admission to the ICU, intubation or mechanical ventilation, or death.”3 By stark contrast, the majority of US states excludes pregnancy from their priority populations. Pregnant individuals are at increased risk of severe illness and death form COVID-19 infections.1,2,3 Excluding them from Phase 1 priority will unnecessarily increase adverse outcomes for pregnant individuals. This becomes even more important if physicians recommend COVID-19 vaccinations to all pregnant persons.4 US states and the District of Columbia should reconsider their COVID-19 priority vaccination and include immediately pregnant individuals among their Phase 1 priority groups. A more effective approach toward eliminating variation in priorities of the states would be for the federal government to mandate this change.

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