A pharmacist, Pfizer, will try to answer that question with a clinical trial of its coronavirus vaccine in pregnant women, the company announced last week. The results have not been expected in months.
In the meantime, how can pregnant women decide whether to get the Covid-19 vaccine? What about those trying to get pregnant or those who are breastfeeding?
We asked CNN medical analyst Dr. Leana Wen for advice. Wen is not just an emergency physician and a public health specialist; she is also the mother of a 3-year-old son and a 10-month-old girl who was born during the pandemic.
Dr. Leana Wen: Technically it is not, but it is an option for pregnant women. Here’s why: Initial clinical trials did not include any pregnant or breastfeeding women. Some women became pregnant during the course of the tests, but since the research was not aimed at studying the effect of the vaccine on pregnancy, there was insufficient data for the Food and Drug Administration to authorize the injection in pregnant women.
CNN: If the vaccine is not specifically tested in pregnancy, why would pregnant women get it?
Wen: Pregnant women are at increased risk of serious complications due to Covid-19. There is a greater risk of being hospitalized and ending up in the ICU for pregnant women compared to non-pregnant women. The risk is even greater for pregnant patients with underlying medical conditions.
CNN: So, how do you recommend that a pregnant woman make that decision?
Wen: Here are the two things I urge my patients to consider. First, what is your risk of exposure to Covid-19? Let’s say my patient is a nurse or respiratory therapist who is treating patients with Covid-19. That person has significant occupational exposure and getting the vaccine can substantially protect them during pregnancy. Perhaps she has a spouse in a high-risk profession or lives in a home where she cannot keep a physical distance from a family member at risk of exposure. That would weigh in favor of getting the vaccine now.
Second, what is the risk of having a serious result if you contract Covid-19? Pregnancy alone already predisposes you to more serious illnesses, and if you have other underlying medical conditions, you are at even greater risk, because the risk is addictive. Conditions such as chronic lung, kidney or heart problems; diabetes; high pressure; and sickle cell disease can worsen the effects of the coronavirus. Patients who are pregnant and with these underlying medical conditions can benefit substantially from the vaccine.
The end result is that any risk of an adverse effect of the Covid-19 vaccine is theoretical and the risks of infection by Covid-19 are not. Based on what we know about the vaccine, there is no reason to believe that it will have a detrimental effect on pregnancy or the long-term health of the mother or baby. The lack of evidence does not mean that it cannot exist, but this type of very low theoretical risk needs to be assessed against the actual and potentially very high risk of a serious Covid-19 outcome.
This is the reason why many health professionals who are pregnant have received the vaccine.
CNN: What about breastfeeding women?
Wen: We have no data to say unequivocally that the vaccine is absolutely safe for breastfeeding people. However, there is no physiological reason why it would not be safe. Vaccines considered of concern are those that contain live viruses. The Covid-19 vaccines currently authorized in the United States – and those that are in clinical trials here – do not contain any live viruses. In fact, vaccines may have additional benefits for the baby. Some recent research suggests that protective antibodies can be transferred to the baby via breast milk.
CNN: You were pregnant at this time last year. Would you have had the vaccine if it was available to you when you were pregnant or breastfeeding?
Wen: I am a healthcare professional who cares for patients with high-risk occupational exposure and I also have asthma. So yes, I would have received the vaccine if it was available when I was pregnant. When the vaccines were approved, I had stopped breastfeeding. As soon as I stopped breastfeeding, I participated in a vaccine test. If I was still breastfeeding and had the opportunity to get the vaccine, I would not hesitate to get it.
CNN: What would you say to people who want to wait until there are clinical trials that prove the vaccine is safe for pregnant and lactating women?
Wen: I would say that this is a reasonable choice as well. Everyone needs to make the best decision for themselves. Much has been written about vaccine ethics in pregnancy. On the one hand, it makes sense not to include pregnant women in initial vaccine tests out of concern for them and their babies. On the other hand, it is not fair to deny an entire group of people the benefit of vaccines. Most health professionals are women of reproductive age, for example.
In fact, many other vaccines have not been tested specifically in pregnancy, but are administered routinely because the proven benefits outweigh any theoretical risk. I think that every patient needs to make the right decision for themselves and their family by consulting their doctor.
It is important to note that pregnant and lactating women are not in priority vaccination groups just because they are pregnant or in the postpartum period. If they are not prioritized to be vaccinated (for reasons such as a high-risk occupation or pre-existing health condition), they need to wait their turn to enter the eligible groups, just like everyone else.
CNN: There is some misinformation out there about the vaccine and fertility. Can you clarify that?
CNN: What would you say to women who are thinking about getting pregnant or trying to get pregnant? Should they get the vaccine?
Wen: If they are in priority groups to get the vaccine and can, I would say they should. There is no reason to wait. Of course, they should always consult their doctor, especially if they have medical procedures planned. For example, if they are planning IVF procedures – they may not want to schedule their vaccines on exactly the same day as their procedures to avoid simultaneous side effects.
Remember that vaccines are very effective in preventing Covid-19 disease – especially serious illness – but they are not 100% effective and we still don’t fully understand whether those who received the vaccine can transmit the virus. Even after receiving the vaccine, people should still be careful.
For pregnant patients, this means that they can breathe a little easier during prenatal consultations, but they should definitely still wear masks and follow the guidelines for physical distance in public places.
For breastfeeding women, they will have good immunity, but will not know if their babies have, so maintaining a good physical distance for their babies will still be important. And, for everyone, a lot of caution is a good idea until more people can be vaccinated and we are closer to achieving collective immunity.