More than 26 million doses of the Pfizer or Moderna COVID-19 vaccine have been administered in the United States, but questions about who should take it first – and who should avoid it entirely – continue to circulate.
This week, the World Health Organization has further muddied the waters with provisional guidance stating that the vaccine “is currently not recommended” for pregnant women, unless they are “at risk of high exposure”. The decision is at odds with that of the Centers for Disease Control and Prevention, which insists the vaccine is safe for pregnant women, saying it is “unlikely to pose a risk”.
Dr. Myra Wick, an obstetrician-gynecologist at the Mayo Clinic, says she currently follows the guidance of the American College of Obstetricians and Gynecologists (ACOG), which stands firm in its position that the vaccine should be offered to all pregnant women. Dr. Christopher Zahn, vice president of practical activities at ACOG, told Yahoo Life that the organization “remains firm in its orientation that both COVID-19 vaccines currently authorized by the FDA should be made available to pregnant women who choose to receive vaccine”.
So why are WHO and CDC at odds? Here’s what you need to know.
WHO does not recommend vaccines for pregnant women due to lack of data
In an email to Yahoo Life, a WHO spokesman expanded his position, sharing a similar explanation for the Pfizer and Moderna vaccines. “The available data on mRNA vaccination in pregnant women is insufficient to assess the effectiveness of the vaccine or the risks associated with the vaccine in pregnancy,” wrote the WHO. “More studies are planned on pregnant women in the coming months. As data from these studies become available, vaccination recommendations will be updated accordingly. “
Despite requests from ACOG and others, pregnant women were not part of the clinical trials for any of the vaccines. The WHO believes that until data on pregnant women are collected, getting the vaccine may – for many – be a choice that carries more risks than benefits. “At the moment, WHO does not recommend vaccinating pregnant women,” the WHO told Yahoo Life. “This position will be reviewed and may evolve as more data becomes available.”
The CDC and ACOG disagree, noting that mRNA vaccines do not contain live viruses
On its website, the CDC specifically states that “pregnant women can safely get inactivated vaccines”, mentioning the flu vaccine and Tdap, a pertussis vaccine, which Wick says is routinely and safely administered. The organization notes that the type of vaccine used is important. “Although the studies have not yet been done, experts believe that mRNA vaccines such as the COVID-19 vaccines should not pose a risk to pregnant women,” wrote the CDC in a tweet on 29 December.
MRNA (short for messenger RNA) vaccines work by encoding the spike protein on the surface of SARS-CoV-2, the virus that causes COVID-19, and using it to trigger an immune response. Wick says it increases his confidence about his safety. “Mechanically, there is no reason to think that they will be harmful,” she says. “People are concerned with ‘Is this going to integrate into my genome?’ It is not. It remains in the part of the cell where the DNA is not housed … so mechanically, it looks like it should be safe. “
Zahn and ACOG agree with this sentiment. “Both Pfizer-BioNTech and Moderna vaccines are not live virus vaccines,” says Zahn. “They do not enter the nucleus and cannot cause any genetic changes. The safety of these vaccines has been demonstrated in clinical trials with non-pregnant individuals, and similar results are expected in pregnant individuals. “
The vaccine was not tested specifically on pregnant women, but they were present in the trials
Although neither Pfizer nor Moderna intentionally included pregnant women in their clinical trials, both companies ended up with more than a few. According to reports, 23 women in the Pfizer study and 13 in the Moderna study were unknowingly pregnant at the time the study started or became pregnant during the study.
Of the pregnant women in the Pfizer study, 12 received the vaccine and 11 the placebo. No pregnancy-related side effects were reported in the vaccine group, but two miscarriages occurred in the placebo group. Among the Modern cohort, six of the pregnant women reportedly received the vaccine and seven received a placebo. None of those who received the vaccine reported side effects from pregnancy. In the placebo group, one woman had a miscarriage and another chose to have an abortion.
According to a report this week from the CDC, at least 15,000 pregnant women have received the vaccine so far. The organization is closely monitoring the adverse effects, but said the safety data that has been collected so far is “reassuring and consistent with that seen in pre-authorization clinical trials”.
The WHO position is that, without data, the risks of the vaccine may outweigh the benefits
Central to the new WHO guidelines, it seems, is the concept that, in the absence of data, pregnant women may be putting themselves at risk. “WHO recommends not to use [the COVID-19 vaccine] in pregnancy, unless the vaccination benefit of a pregnant woman outweighs the potential risks of the vaccine, such as in healthcare workers at high risk of exposure and pregnant women with comorbidities that place them in a high-risk group for severe COVID-19 ”, Writes the organization. “Information and, if possible, advice on the lack of safety and efficacy data for pregnant women should be provided.”
The side effects of the vaccine that have been reported are probably not dangerous for pregnant women
It has been well recorded that the Pfizer and Moderna vaccines are likely to produce some temporary side effects – most commonly, pain, fatigue and headache. Experts say the reactions are a good sign, showing that the vaccine is “triggering an immune response”.
Gynecologists pay close attention to these reactions, says Wick, but the ones being described pose no danger to pregnant women. “We are concerned about high fever, but most of the reported fevers are low grade and it is safe to take Tylenol to help reduce fever in pregnancy,” she notes. “Most of the other side effects – muscle and headaches – are not pleasant, but they are not harmful to the mother or baby.”
Rather than worrying about the risks of the vaccine, doctors and experts say the focus should be on the known dangers of COVID-19 during pregnancy
A study of more than 1,200 pregnant women released on Thursday by the Society for Maternal-Fetal Medicine found that pregnant women who had a severe case of the virus were more likely to die as a result of the infection, as well as more likely to experience pregnancy complications. , such as premature delivery, cesarean section, postpartum hemorrhage and hypertension.
Wick treated patients like this first hand and, for that reason, suggests that all pregnant women talk to their doctor about whether the vaccine is right for them. “Women who are pregnant and who contract COVID are at greater risk of requiring hospitalization, ICU care and even intubation,” says Wick. “There is definitely a greater risk – especially for those who are at greatest environmental risk or have [health conditions] this can make them more vulnerable. They should consider vaccination, because we have no reason to think it is unsafe. “
Zahn agrees. “Each person must make the best decision for themselves, together with their clinical team, when feasible, based on the information and data currently available,” he tells Yahoo Life. “For now, some may decide that the risks outweigh the benefits, but ACOG firmly believes that pregnant women deserve autonomy and should have the option of being vaccinated in the face of a potentially fatal virus and in the absence of reliable data that would suggest that it would hurt. “
To latest coronavirus news and updates, go together on https://news.yahoo.com/coronavirus. According to experts, people over 60 and immunocompromised remain the most at risk. If you have questions, consult the CDC‘sand Who is it resource guides.
Originally published