She didn’t know her pregnancy meant she could get a COVID-19 booster. She got the virus instead.

Rebecca Pipkin wishes she’d known that being pregnant meant she qualified to get a COVID-19 vaccine booster shot in Utah.

“I would have much preferred a booster to getting COVID,” the 33-year-old from Midvale said.

Despite being careful and receiving the Pfizer vaccine earlier this year, Pipkin tested positive for the virus in mid-November, when she was 37 weeks pregnant.

Luckily, Pipkin’s symptoms are much milder than her husband’s, who has been bedridden. Meanwhile, she has had some congestion and lost her sense of taste of smell.

But worries swirl through her mind, she said. Should she take time off from work so close to her maternity leave to take care of her toddler, who didn’t catch the virus? Can her midwives come to her home when she gives birth if she’s still sick? Will she have to have a cesarean section if her baby is still in a breach position when it’s time to deliver? In that case, can her husband join her in the hospital if he hasn’t recovered by then?

“It’s like a weird guilt and shame. Did I do something wrong? Why did I get COVID?” Pipkin said. Then she remembers that the virus doesn’t discriminate, or pick “good” or “bad” people to infect.

To prevent her illness from getting any worse, Pipkin drove to Orem on Nov. 11 to receive monoclonal antibody therapy — another treatment she wasn’t aware she could receive in Utah since she’s pregnant. She found out when a health care worker called about her positive COVID-19 test result.

The Utah Department of Health is trying get the message out that pregnant women are included in the prioritized groups that are eligible to get COVID-19 boosters and monoclonal antibodies, said Deputy Director Dr. Michelle Hofmann.

While the department did not have data available specifically for Utah, there has been some hesitancy among expecting mothers nationally to get the coronavirus vaccine, she said.

As of late September, “only 31% of pregnant people have been vaccinated against COVID-19,” according to the Centers for Disease Control and Prevention. The highest rates were among pregnant Asian people (45.7%), and the lowest were Black pregnant people (15.6%).

The CDC “strongly recommends,” though, that women get the vaccine before or during pregnancy.

Mothers want to do what’s best for their babies, said Dr. Tori Metz, vice chair of research, obstetrics and gynecology at the University of Utah Health, and she tells her patients that getting vaccinated is “the best thing they can do for themselves and their pregnancy.”

Utah’s COVID-19 cases in pregnant people

Laurel White, of Provo, was five weeks pregnant when she got COVID-19 last Thanksgiving. Like Pipkin, White lost her sense of taste and smell. A few days later, she started bleeding, and White worried she was miscarrying. White learned she was having a subchorionic hemorrhage, something she had experienced in her previous pregnancies.

“I felt overwhelmed. I thought I was losing the baby,” the 33-year-old said. She wondered if having COVID was a factor, and she said she’s still not sure if it was. But her baby was fine, and was born in August.

There were 2,952 COVID-19 cases among female Utahns ages 15 to 49 who were pregnant between March 2020 and the end of September this year, according to data that The Salt Lake Tribune requested from the Utah Department of Health.

“This number is likely a large underestimate,” though, the department said, because pregnancy status was not a required field in case investigations until April 5 of this year, “and 73.8% of female cases in this age range have no information” about whether they were pregnant.

From April 2020 through September 2021, 436 pregnant people with COVID-19 cases were hospitalized. This does not include patients who were admitted for labor and delivery, were asymptomatic and were only tested due to hospitalized screening policies, according to the department.

Between one and four pregnant people who had COVID-19 have died in Utah since March 2020. (The department’s data privacy policies “do not allow for reporting of numbers less than 5.”)

In Utah, pregnant white Utahns have seen the highest number of cases and hospitalizations for COVID-19, followed by pregnant women who identify as Hispanic and Latino. When looking at the data by age, 15- to 29-year-olds have had the most cases and hospitalizations.

How pregnant women can get monoclonal antibodies

Expecting mothers have a higher risk of severe illness from COVID-19 than people who are not pregnant. According to the CDC, pregnant people who are showing symptoms from the virus are twice as likely to be admitted into an intensive care unit, and 70% more likely to die.

The Utah Department of Health still encourages pregnant people to get vaccinated as the “first and best option” to ward off COVID-19, Hofmann said. But monoclonal antibody therapy is another step that can help prevent people from adding to Utah’s already overwhelmed hospital system.

In order to receive monoclonal antibodies, pregnant people have to show symptoms of COVID-19 and not need oxygen or to be hospitalized, according to Hofmann. They also have to receive the antibodies within 10 days — but preferably within seven days, when it’s most effective — of testing positive for the coronavirus, she said.

Utahns do not need a doctor’s referral to receive monoclonal antibodies, according to Hofmann. Instead, you can take a survey on the Utah Department of Health’s website (bit.ly/3kKRhlF) to see if you qualify. And it’s usually a one-time treatment, she said.

“Monoclonal antibodies are given to people through an intravenous (IV) infusion,” according to the department, usually at an outpatient center. It takes about one hour to administer, plus another hour for a health care worker to monitor for any potential side effects.

Pipkin said the therapy felt similar to when she has donated blood and plasma. To pass the time, she took headphones and listened to podcasts, and she was able to drive herself home. The treatment was free, and she said she had to show proof she had COVID-19, as well as provide some basic information about her birthdate and any underlying conditions.

Monoclonal antibodies have been offered in Utah for more than a year through emergency use authorization, according to Hofmann.

There isn’t as much known about monoclonal antibodies for COVID-19 during pregnancy as there is with the vaccines, Metz said, simply because vaccines have been used more during the pandemic. But similar medications and treatments are already used during pregnancy, so doctors feel comfortable using it for COVID-19, she said.

Metz also said she thinks monoclonal antibody therapy is not as well known to the general public as vaccines are, partly because it’s only been used for targeted groups. And pregnant people are probably less hesitant to get monoclonal antibody therapy than the vaccine, she said, because once they have COVID-19, they want to reduce their chances of having a bad case.

It’s ‘difficult’ to be pregnant right now

Similar to Pipkin and White, Jenna Kenison, 31, of Lehi, had a mild case of COVID-19 after catching the virus last November when she was in her second trimester. Sometimes, she said, it was hard to tell which symptoms were from the virus and which were from being pregnant.

“It’s like, OK, I’m exhausted ... but I’m exhausted all the time,” Kenison laughed.

Through her pregnancy, Kenison said, she felt like there were a lot of unknowns and changing information about how COVID-19 affected pregnancy. Ultimately, she decided to wait until after giving birth to get vaccinated, when she felt confident and ready.

“If you feel like something’s wrong or you have a question, don’t be afraid to reach out and ask your doctors or other people who have gone through it,” she said.

White, meanwhile, chose to get the Johnson & Johnson shot in April before having her daughter. “I just felt like it was doing something safe for me, for my family, for those ... around me,” she said.

“This is a really difficult time to be pregnant,” said Metz. Anecdotally, the doctor said she has seen uncertainty in some pregnant women in Utah about receiving the vaccine, partly because they are getting many opinions from different sources, along with misinformation.

But once Metz sits down and explains the science and research that has been done that shows the vaccines are safe during pregnancy, “then a lot of them are actually willing to go ahead and get vaccinated,” Metz said.

Metz also recommends that pregnant women get the COVID-19 booster. Some of her patients who got their first doses were excited to have an opportunity for extra protection from the virus, she said.

By getting the vaccine and monoclonal antibodies, Pipkin said “it’s a comforting thought” to her that she could potentially help her baby stay safe and healthy.

Becky Jacobs is a Report for America corps member and writes about the status of women in Utah for The Salt Lake Tribune. Your donation to match our RFA grant helps keep her writing stories like this one; please consider making a tax-deductible gift of any amount today by clicking here.