Should pregnant women get the COVID-19 vaccine when eligible? We asked the experts what you need to know about the COVID vaccine and pregnancy.
There’s a lot to weigh when making the call. Data show that pregnant people who contract symptomatic COVID-19 are at higher risk of getting really sick, requiring ICU admission and intubation. Pregnant people also face a greater risk of dying from the disease compared with their nonpregnant peers. On top of that, pregnant women with COVID-19 may be at greater risk of poor pregnancy outcomes, including preterm birth, compared with pregnant women without COVID-19, according to the Centers for Disease Control and Prevention (CDC).
Getting vaccinated would, in theory, significantly reduce these risks. The caveat: Pregnant people were excluded from the Pfizer-BioNTech, Moderna, and newly FDA-approved Johnson & Johnson vaccine trials (which is currently common practice for first-round vaccine trials), so we don’t have as much data as we would like on how safe and effective these shots are in folks who are expecting.
So what do the official guidelines say? Guidance from the CDC reflects this murkiness; the organization says pregnant people may choose to get a COVID-19 shot but stops short of explicitly encouraging it. A practice advisory from the American College of Obstetricians and Gynecologists (ACOG) strikes a similar tone, stating that the COVID-19 vaccine “should not be withheld” from pregnant people. The American Society for Reproductive Medicine (ASRM) takes a more assertive stance by recommending pregnant people get vaccinated.
Still, given the scant information available on the COVID-19 shot and the lack of resounding endorsement from experts, how can those who are expecting make the best decision for themselves and their unborn babies? We posed this question to three doctors. Here’s what you need to know about the COVID vaccine and pregnancy.
Is it safe to get the coronavirus vaccine if you’re pregnant now?
The short answer is that we don’t have enough data yet to say that the COVID-19 vaccine is safe in pregnant women, says Jeanne S. Sheffield, M.D., director of the division of maternal-fetal medicine and professor of gynecology and obstetrics at Johns Hopkins. But the very limited information we do have is promising. Preliminary studies that tested the COVID-19 vaccines in pregnant animals were reassuring and did not reveal any safety concerns.
Anthony Fauci, M.D., the nation’s leading expert in infectious disease, said in a February 10 press conference that about 20,000 pregnant women in the U.S. had been vaccinated since the Food and Drug Administration authorized the two COVID-19 vaccines for emergency use in December. So far, Fauci said, there have been “no red flags” with these vaccinations.
A small group of women in the vaccine clinical trials became pregnant during the trials; 18 of those women were vaccinated, and two months later, none had miscarried. It’s too small a sample size to draw any meaningful conclusions, but so far there is no evidence to suggest the vaccine can cause miscarriage or birth defects.
More promising is that the “biologic plausibility” of the vaccine—meaning, what experts know about how the shot is designed and the way it works in the body—is “reassuring,” says Linda Eckert, M.D., professor of obstetrics and gynecology at the University of Washington and ACOG liaison to the Advisory Committee on Immunization Practices, the group that advises the CDC on vaccine recommendations. “We don’t see a reason to fear that this vaccine harms the fetus or the pregnant individual,” says Dr. Eckert, who helped develop ACOG’s advisory on pregnancy and COVID-19 vaccination.
More data on the safety and efficacy of the vaccine in pregnancy is expected in the coming months. Moderna is tracking pregnancy outcomes for people who receive their vaccine while pregnant. Last month Pfizer announced the start of a large, global clinical trial to study its vaccine’s safety and efficacy in pregnant people. The trial will include about 4,000 pregnant participants and is expected to finish by January 2023. Johnson & Johnson also announced plans to launch a clinical trial in pregnant women (following a trial that will test vaccine safety and efficacy in children and infants). “I’m really excited they are doing that,” says Nicole Sparks, M.D., an ob-gyn at North Atlanta Women’s Care. The trial results, she explains, will give her “something concrete” to tell her pregnant patients.
For now, though, “we really are still very limited on what we know about the vaccine in pregnancy,” says Dr. Sheffield, adding that it will be years until we have data on the long-term safety of the vaccine in anyone.
How doctors are advising pregnant patients about COVID-19 vaccination
Given the lack of information about the COVID-19 vaccine in pregnancy, both the CDC and ACOG say that pregnant people may find it helpful to discuss with their doctor the risks and benefits of both taking and forgoing the shot before making a decision.
These conversations aren’t one-size-fits-all, says Dr. Sparks. “You have to look at each patient case individually,” she says, and weigh factors including the COVID-19 transmission rate in a pregnant person’s area, how much potential exposure to COVID-19 they might have through their job or lifestyle, and other health issues like diabetes or obesity that would further increase their risk of getting severely sick from COVID-19. For example, a pregnant restaurant worker with chronic kidney disease might have more reason to get vaccinated than a pregnant social media manager who works from home and has no underlying health conditions.
Race and ethnicity also play a role, says Dr. Sparks. She cites data that show COVID-19 has disproportionately affected communities of color and that Black Americans have died from the disease at 1.4 times the rate of white Americans. That data, in part, informed Dr. Sparks’s decision as a Black woman to get vaccinated despite initial hesitation she had over how the vaccine might impact her if she were to get pregnant this year (a possibility she says she and her husband have discussed). Her eventual choice to take the shot “came from knowing that I probably have a higher chance of dying from COVID than from having any long-term, lasting effects of the vaccine if I do decide to get pregnant later,” she explains. Sparks adds that she now feels very comfortable with her decision to get the vaccine, especially after learning there is no evidence so far that the shot causes miscarriage or harm during pregnancy—facts she reiterates to her pregnant patients. (There is also no evidence that the shot impacts fertility; ASRM recommends vaccination for women who are contemplating pregnancy.)
Dr. Eckert also discusses with pregnant patients whether getting vaccinated will make them feel more comfortable having support people around to help after the baby is born. “The postpartum time is so difficult that it is often very useful to not increase the isolation that we’re all feeling with COVID plus the isolation you have in the postpartum time,” she explains.
Another thing to consider: Vaccination during pregnancy could potentially benefit the fetus, the experts say. Dr. Eckert points to emerging evidence that shows there could be an increased transfer of antibodies from the mom to the fetus when the mom is vaccinated against COVID-19. That means the baby could be born with COVID antibodies, which would help protect them from the disease. “We don’t have a lot of data on that yet,” Dr. Eckert cautions, but antibody transfer does occur with other vaccines routinely given during pregnancy, including influenza and tetanus shots. Dr. Sparks says she points out this potential benefit of the COVID-19 shot when counseling pregnant patients. “You could be doing your unborn an advantage by providing them with antibodies,” she says.
There are documented side effects of COVID-19 vaccination, including fever, chills, tiredness, and headache, plus pain and swelling in the arm where you got the shot. The most problematic of these for pregnant women is fever. “We know that there can be harmful effects to a fetus if you have a high sustained fever in the first trimester,” explains Dr. Sparks. The good news: Taking Tylenol—which is safe to do during pregnancy—will likely bring down the fever, says Dr. Eckert. Also worth noting: Fever doesn’t seem to be too common of a side effect; according to data from the Pfizer-BioNTech and Moderna clinical trials, less than 15% of participants experienced fever after vaccination.
In general, Dr. Eckert counsels her pregnant patients to weigh the known risks of COVID-19 to pregnant women and their fetuses against the unknown risk of getting the shot during pregnancy. “I lean on the side of ‘Tell me why you don’t want to be vaccinated,’ because personally, I think most individuals benefit from being vaccinated,” she explains. “But I never would tell a person that they have to be vaccinated. That’s not my job.”
Dr. Sparks takes the approach of telling pregnant patients what she would do if she were in their position without deciding for them. “Your doctor should support you whether you do want it or whether you don’t want it,” she says.
Originally Appeared on Glamour