This article was reviewed clinically by Carolyn Swenson, MD, assistant professor of obstetrics and gynecology and a member of the Prevention Medical Review Board.
Since the arrival of the COVID-19 vaccines, there has been confusion about whether or not they are safe for pregnant women. The reason: the first clinical trials of the vaccine did not include pregnant or breastfeeding women, making it impossible to be sure whether it is safe for them to be immunized.
Reminder: According to the Centers for Disease Control and Prevention (CDC), pregnant women are at an increased risk of serious illnesses due to COVID-19, along with an increased risk of other adverse outcomes, such as premature birth.
At a recent press conference, Anthony Fauci, MD, the country’s leading infectious disease specialist, said clinical trials for pregnant women (and children) are underway, so we should have more definitive answers soon. And in the meantime, approximately 20,000 pregnant women received the COVID-19 vaccine “with no warning signs,” said Dr. Fauci.
These revelations are promising, but if you are pregnant (or a loved one is), you may still be wondering if it is a good idea to vaccinate pregnant women. Here’s what you need to know.
How does the COVID-19 vaccine work, again?
The Pfizer-BioNTech and Moderna vaccines use a newer technology called messenger RNA, or mRNA, which is the genetic material of the virus, according to the CDC. (Note: it’s not the virus itself – just the virus’s genetic code. The vaccine no make you sick with COVID-19.)
The mRNA tells the body how to make a peak protein, which the new coronavirus uses to attach to human cells. When your body starts pumping peak proteins, your system sees them as foreign and creates antibodies unique to the coronavirus. Your body eventually clears the protein and mRNA, but the antibodies remain, providing protection against COVID-19 if you become infected in the future.
What do public health organizations say about getting the COVID-19 vaccine when you are pregnant or breastfeeding?
This is where things get messy. Both the American College of Obstetricians and Gynecologists (ACOG) and the CDC have widely stated that pregnant and breastfeeding women should be able to get the COVID-19 vaccine if they want to. However, both organizations fail to recommend that pregnant women be vaccinated.
Meanwhile, the World Health Organization (WHO) initially advised women against getting the vaccine. But in late January, the organization revised its recommendation, stating: “Based on what we know about this type of vaccine, we have no specific reason to believe that there will be specific risks that would outweigh the benefits of vaccination for pregnant women. “
Before receiving the vaccine, ACOG recommends that pregnant women talk to their doctor about the following:
- the level of virus activity in the community
- the potential effectiveness of the vaccine available to them
- the risk and potential severity of maternal disease, including the effects of the disease on the fetus and the newborn
- vaccine safety for pregnant patient and fetus
However, ACOG also states that a conversation with your doctor “should not be required” as it can cause “unnecessary barriers” to vaccination.
So, is it safe for pregnant and lactating women to get the COVID-19 vaccine?
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“In the absence of any data from pregnant and lactating women, it is difficult to openly recommend an intervention,” says Emily S Miller, MD, MPH, assistant professor in the department of obstetrics and gynecology at Northwestern Medicine.
But based on what has been studied so far, “there is no reason to think that pregnant women or their fetuses are at risk of receiving the COVID-19 vaccine,” says William Schaffner, MD, an infectious disease specialist and professor at Vanderbilt College University of Medicine. And, he points out, studies in pregnant animals have found no cause for concern.
“Everything we know about the vaccine indicates that it must be safe,” says Dr. Schaffner. “The vaccine’s RNA is nowhere near human DNA – neither the mother nor the fetus.”
Statements by public health organizations (such as WHO) have been cautious, but “everything we saw from women who became pregnant during clinical trials or were already pregnant and received the vaccine is comforting,” said infectious disease specialist Amesh A Adalja, MD, senior scholar at the Johns Hopkins Center for Health Security.
Public health officials and organizations, including ACOG, are “doing the best they can with what they have to work with,” explains Michael Cackovic, MD, a physician in maternal and fetal medicine at The Ohio State Wexner Medical Center. “They are saying, ‘We don’t have the data to make that recommendation’, and that is valid.”
At the same time, Dr. Cackovic points out that this type of vaccine is considered safer for pregnant women than other types of vaccines. “The COVID-19 mRNA vaccine does not contain a live virus, and these types of vaccines are considered more compatible in pregnancy, as they act to induce an immune response from the host,” he explains.
In addition, the fact that pregnant women are at a high risk of serious COVID-19 complications makes the vaccine at least worth considering, says Joanne Stone, MD, director of Mount’s maternal and fetal medicine division Sinai Health System in New York. “It seems that the benefits outweigh the risks, although a conversation with a health professional can help in making an individual decision,” she explains. “And it is important that women are informed about the lack of data on the safety of the vaccine in pregnant women.”
Conclusion: pregnant women should talk to their doctor about the COVID-19 vaccine.
Now that pregnant women are being included in vaccine tests, Dr. Cackovic says that “ongoing conversations with your doctor should include newly published information about the safety, effectiveness and availability of the vaccine in pregnancy.”
Dr. Adalja agrees. “I really think this is a decision between a doctor and a patient,” he says. “But in most cases, pregnant women must be immunized.”
This article is correct at the time of publication. However, as the COVID-19 pandemic evolves rapidly and the scientific community’s understanding of the new coronavirus develops, some of the information may have changed since the last update. While our goal is to keep all of our stories up to date, visit the online resources provided by CDC, WHOit’s yours local department of public health to stay informed about the latest news. Always speak to your doctor for professional medical advice.
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