New and pregnant mothers are navigating a swamp of science and medicine as they try to mitigate the risks of COVID-19 for themselves and their babies.
Why it matters: Pregnancy can be difficult in normal times, but there is an extra layer of uncertainty during the pandemic, as COVID-19 poses unique risks for pregnant women.
Driving the news: NIAID director Anthony Fauci said on Wednesday that about 20,000 pregnant women have been vaccinated in the United States so far and no complications have been observed.
- But “it takes a little time to follow the woman and her fetus and then her baby and see how things are going to end,” Geeta Swamy, associate professor of OB / GYN and an associate vice president of research at Duke, he points out.
- The Pfizer BioNTech and Moderna vaccines authorized for use in the United States do not use live or attenuated viruses, and studies with pregnant animals suggest they are safe, experts say. However, pregnant and lactating women were not included in the initial vaccine trials.
- “No one predicts that there will be an impact on fetal development or growth,” Swamy told Axios. But some are concerned about the possible side effects of the vaccine, including fever and inflammation, which may cause stress in the fetus.
- “We have good theoretical data and these risks are not high, but in the end, individuals need to make that choice and that is difficult,” says Naima Joseph, a specialist in maternal internal medicine at Emory University School of Medicine.
Between the lines: This makes pregnant women weigh the risks. The CDC does not take a position, stating: “People who are pregnant and are part of a group recommended to receive the COVID-19 vaccine can choose to be vaccinated”.
On the one hand: The data show that pregnant women are at greater risk of developing severe COVID-19 compared to women of the same age who are not pregnant, and there appears to be a risk of premature birth.
- Pregnant women are “more likely to be hospitalized, need intensive care, ECMO, be ventilated and die, unfortunately,” Denise Jamieson of Emory Healthcare told a JAMA webcast on Monday.
On the other hand: Clinical trials, including those for COVID-19 vaccines, typically do not include people who are pregnant or breastfeeding, leaving a gap in knowledge about the effect of one of the most important tools for combating the pandemic.
- Catherine Spong, head of the Maternal-Fetal Medicine Division and vice president of UT Southwestern’s obstetrics / gynecology department, told the webcast that many experts are “absolutely” disappointed with pregnant women or nursing mothers who were not included in phase III studies. .
- A Congressional task force met for years and presented recommendations and an implementation plan on how to include these two groups, and “yet again, they were not included in something where they were clearly at greatest risk,” said Spong, who co-authored an article in JAMA this week, on the vaccination COVID-19 for pregnant and lactating women.
An open question is whether a baby is protected if its pregnant mother is vaccinated.
- Pregnant women are recommended to get flu and Tdap vaccines because the newborn will have some immunity during the first few months, Swamy said.
- A handful of recent studies, including one from Joseph, have found COVID-19 antibodies to infection crossing the placenta.
- But the antibodies were not transferred at such a high rate as “we know what the placenta can do” in studies of other pathogens, says Joseph. “We don’t know what that means for vaccines yet,” but we are now conducting studies.
Other urgent issues …
- Can the mother’s infection affect the fetus? “We think the infection can occur, but it is very rare,” says Joseph. “Over the course of a year of data and deliveries, there does not appear to be an increased risk of birth defects or anything other than premature birth”, especially in people with severe illness.
- Can caregivers like grandparents help safely? Jamieson and Spong recommend that caregivers be vaccinated and wait two weeks after the second injection (for mRNA vaccines). They must wear masks and practice good hygiene.
- Breastfeeding women can safely get the vaccine, Swamy says, who is supported by the Academy of Breastfeeding Medicine.
What to watch: Pfizer and J&J, which have applied for emergency use authorization for their vaccine COVID-19, plan to start clinical trials on pregnant women, and the CDC is monitoring all vaccinated people through its v-safe program.
- Moving forward, Joseph says, “the highest priorities are maternal inclusion in studies that examine adaptive immunity because that is the only way to develop rational vaccines for this population.”