The clear recommendation for most individuals is to accept the coronavirus vaccine when it becomes available to them. The Moderna and Pfizer vaccines have been proved safe and effective, and mass vaccination is critical to reducing the spread of COVID-19.
However, for pregnant women, the choice may feel less certain.
As an obstetrician, whether or not to receive the COVID-19 vaccination is the most pressing topic in my discussions with expecting mothers at HSC Health, the clinical arm of The University of North Texas Health Science Center at Fort Worth. While there is currently no reason to believe the vaccine is not safe for pregnant women, there are some additional factors they may want to discuss with their clinical-care teams.
First, some background on the vaccines. The two COVID-19 vaccines currently available, Moderna and Pfizer, are mRNA vaccines. That means they do not contain live virus and therefore do not infect people with COVID-19.
This kind of vaccine also does not interact with or change a patient’s DNA. Based on what scientists know about mRNA vaccines, there is no biological reason to be concerned about its effects on pregnant women or breastfeeding mothers.
Second, we know that, while the absolute risk of developing severe illness from COVID-19 infection remains low even for pregnant women, they are at greater risk than the general public. Pregnant women face higher rates of hospitalization, intensive-care admissions, mechanical ventilation and even death from COVID-19 infection. Infections also may increase the risk of serious obstetrical outcomes, such as preterm birth.
However, no pregnant women or breast feeding mothers were included in the vaccine clinical trials that established efficacy and safety. Researchers are planning vaccine studies in pregnant women and actively monitoring people who participated in clinical trials and later became pregnant, according to the U.S. Centers for Disease Control and Prevention. But at the moment, we cannot tell patients with certainty that there is zero risk.
Despite that, the recommendation for breast-feeding mothers is to get vaccinated as soon as possible. The American College of Obstetrics and Gynecology, the Academy of Breastfeeding Medicine and the American Academy of Pediatrics agree that theoretical concerns about vaccine safety during breastfeeding do not outweigh the vaccine’s benefits.
In fact, antibodies created by the vaccine may transfer to infants though breast milk and help protect the child as well.
Pregnant women should work closely with their clinical-care team to assess their situation and risk factors to determine whether they feel most comfortable getting the vaccine now or waiting until there is more verifiable data. Here are the individual risk factors I discuss with my patients:
A job that brings a high risk of exposure to the virus
Sharing a household with someone at high risk of exposure
Current level of community spread
Race and ethnicity
Underlying medical conditions
All these factors, in addition to the known increased risk of severe infection in pregnancy, should be considered and weighed against each patient’s comfort level with the unknown or theoretical risks of receiving the vaccine while pregnant. And it is important for patients to remember that declining the vaccine is not declining risk; it is accepting risk of infection over possible risk of the vaccine.
After assessing their risk factors, patients should take time to think through their choices and talk to their partners or loved ones to ensure they are making thoughtful and well-informed decisions. Finally, whatever that decision is, each patient deserves the full support of her clinical care team and the best guidance on protecting her health and the baby’s health during this pandemic.
That, after all, is a goal we all share together.
Dr. Alison Pasciucco is an obstetrician for HSC Health at The University of North Texas Health Science Center at Fort Worth.