Pregnant? What You Should Know about COVID-19 Vaccinations

Pregnant women need to consult with their doctor to weigh the risk of being infected by COVID-19 against the benefit/risk ratio of receiving the COVID-19 vaccinations.

Tara Bennett, MD, Memorial Medical Center’s chair of Obstetrics and Gynecology and Megan Forshee, DO, are both OB-GYNS with our healthcare partner Springfield Clinic. They weigh in here.

Why should pregnant women consider receiving the COVID-19 vaccination?

There is increasing evidence that COVID-19 poses severe risk to women who are pregnant and their babies. Women are at higher risk of severe disease if they have a body mass index (BMI) greater than 35 or if they have diabetes, heart disease or are older. Women of color, specifically Latina and Black patients, are also at higher risk of severe complications from COVID-19.

Pregnant women with COVID-19 are three times more likely to be hospitalized in the intensive care unit (ICU) and are at a higher risk of dying from COVID-19 than non-pregnant women of the same age. There also appears to be an increased risk of stillbirth and preterm birth.

What gives you confidence that this vaccine is a good choice for some/many pregnant women?

Pregnant women need to balance any theoretical risks of the vaccine with the known risks of getting COVID-19 while pregnant. The theoretical risk of harm to the fetus is low. This vaccine is not a live virus. The risk from mRNA vaccines—like the Pfizer and Moderna vaccines currently being administered—is thought to be particularly low because the mRNA is quickly destroyed by the body’s natural processes.

How are you guiding your patients through this decision?

A detailed discussion with each patient about their risks of being infected with COVID-19 is important especially if they are in a profession like healthcare where they have a higher probability of being in contact with an infected person. Together we discuss the risks of COVID-19 infection versus the benefits of receiving the vaccination. Ultimately, it is up to my patient to decide, and I will support their decision.

As of Nov. 30, there have been 42,000 reported cases of COVID-19 in pregnant women and 57 maternal deaths related to COVID-19 in the United States (update?). Your risk of getting COVID-19 depends on how frequently you come in contact with an infected person. The risk is obviously higher for those who are in direct contact with COVID-19 patients or PUIs, including healthcare workers. For those people in direct contact, the benefit of receiving the vaccination may outweigh any risks.

Has the vaccine been tested in pregnant women?

The vaccine has not been tested in pregnant women. This is not unusual, since pregnant women are not usually allowed to take part in clinical trials of vaccines and other medications. A few women who were pregnant have already received the vaccine and will continue to be monitored throughout their pregnancies. There have been no reported problems with these pregnancies. The Food and Drug Administration (FDA) and Centers for Disease Control and Prevention (CDC) are gathering information about the vaccine’s safety and effectiveness during pregnancy. Pregnant women can participate in this effort by enrolling in V-Safe After-Vaccination Health Checker, which allows anyone who is vaccinated to report any issues directly to the CDC.

What about breastfeeding? Are there risks to the infant through the breast milk after vaccination?

Although breastfeeding patients were not allowed in the clinical trials, based on other vaccines, the benefits of vaccination outweigh the very small safety concerns. It is unlikely that the contents of the vaccine would enter the bloodstream and reach the breast tissue. There is no need to avoid or stop breastfeeding if you are vaccinated.

If a pregnant woman is vaccinated, would the antibodies that protect her against COVID-19 pass to her baby as well?

Probably not. There is only a very small chance that the vaccine crosses the placenta, so it is unlikely that the fetus would receive these antibodies. We are hoping for more information in the coming months.

The American College of Obstetricians and Gynecologists has updated its position on COVID-19 vaccination to say that the group “strongly recommends” that all pregnant and breastfeeding women get vaccinated. The group also stated that “claims linking COVID-19 vaccines to infertility are unfounded and have no scientific evidence supporting them.” This group had previously supported vaccination but is now speaking out even more strongly. COVID-19 poses serious risks to pregnant women if they contract it and are not vaccinated.

References:
Society for Maternal Fetal Medicine: COVID Vaccine Advice if You are Pregnant or Breastfeeding, SMFM: Provider Considerations for Engaging in COVID-19 Vaccine Counseling with Pregnant and Lactating Patients 12/15/2020

American College of Obstetricians and Gynecologists: Vaccinating Pregnant and Lactating Patients Against COVID-19, Practice Advisory, December 2020.