Should Pregnant Women Get the COVID-19 Vaccine?
Since the arrival of the COVID-19 vaccines, there’s been confusion around whether or not they’re safe for pregnant women. The reason: Early clinical trials of the vaccine did not include pregnant or breastfeeding women, making it impossible to know for sure if it’s safe for them to be immunized.
Reminder: Pregnant people are at an increased risk of severe illness from COVID-19, along with an increased risk of other adverse outcomes, like preterm birth, according to the Centers for Disease Control and Prevention (CDC).
At a press briefing in February, Anthony Fauci, M.D., the nation’s leading infectious disease expert, said that clinical trials for pregnant women (and children) are underway, so we should have more definitive answers soon. At the time of the briefing, approximately 20,000 pregnant women had received the COVID-19 vaccine “with no red flags,” Dr. Fauci said.
A new study also has promising news. Researchers found that pregnant and breastfeeding women who get vaccinated against COVID-19 have stronger immunity against the coronavirus than a natural infection and that they may be able to pass some of that on to their babies. (More on that in a bit.)
These revelations are exciting but if you’re pregnant (or a loved one is), you may still be wondering if it’s a good idea to get vaccinated.
Here’s everything you need to consider.
How does the COVID-19 vaccine work, again?
Both the Pfizer-BioNTech and Moderna vaccines use a newer technology called messenger RNA, or mRNA, which is genetic material from the virus, according to the CDC. (Note: It’s not the virus itself—just the genetic coding of the virus. The vaccine will not make you sick with COVID-19.)
The mRNA tells your body how to make a spike protein, which the novel coronavirus uses to latch onto human cells. When your body starts to pump out spike proteins, your system sees them as foreign and creates antibodies unique to the coronavirus. Your body eventually eliminates both the protein and the mRNA, but the antibodies stick around, providing you with protection from COVID-19 should you get infected in the future.
The single-dose Johnson & Johnson vaccine, which has been temporarily paused in the U.S., modifies an existing cold virus with the spike protein. (The resulting adenovirus doesn’t have the ability to reproduce in the human body, meaning it can’t cause COVID-19 or any other illnesses.) Similarly, the spike protein gene is eventually read by your cells, where it’s then copied into mRNA, prompting an immune response.
What do public health organizations say about getting the COVID-19 vaccine when you’re pregnant or breastfeeding?
Here’s where things got confusing. Both the American College of Obstetricians and Gynecologists (ACOG) and the CDC have largely said that pregnant and breastfeeding women should be able to get the COVID-19 vaccine, if they want it. However, both organizations stop short of actually recommending that pregnant women get 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 kind of vaccine, we don’t have any specific reason to believe there will be specific risks that would outweigh the benefits of vaccination for pregnant women.”
Before getting the vaccine, the ACOG recommends that pregnant women talk to their doctor about the following:
- the level of activity of the virus in the community
- the potential efficacy of the vaccine available to them
- the risk and potential severity of maternal disease, including the effects of disease on the fetus and newborn
- the safety of the vaccine for the pregnant patient and the fetus
However, the ACOG also states that a conversation with your doctor “should not be required,” as it can cause “unnecessary barriers” to vaccination. The organization also updated its statement on March 24 to address rumors that the vaccine can impact fertility. “Unfounded claims linking COVID-19 vaccines to infertility have been scientifically disproven,” the statement reads. “ACOG recommends vaccination for all eligible people who may consider future pregnancy.”
What does the latest research say about pregnant women and the COVID-19 vaccine?
In a recent study, which was published in the American Journal of Obstetrics & Gynecology, researchers analyzed data from 131 women of reproductive age who were vaccinated. That group included 84 pregnant women, 31 breastfeeding women, and 16 non-pregnant women. The researchers analyzed antibodies in their blood and breast milk (if they were breastfeeding) at baseline, two to six weeks after their second dose of the Moderna or Pfizer-BioNTech vaccine, and after delivery, if they were pregnant.
The researchers found that the antibodies produced by the vaccine in pregnant and breastfeeding women were “significantly higher” than those created after a COVID-19 infection during pregnancy. The antibodies from the vaccine were also discovered in umbilical cord blood and breast milk samples, suggesting these infection fighters could be passed on to babies.
The conclusion, per the researchers, is that vaccinating pregnant and breastfeeding women can cause “robust” immunity for both moms and their babies.
“The data further supports vaccination of pregnant woman as safe and effective,” says infectious disease expert Amesh A. Adalja, M.D., senior scholar at the Johns Hopkins Center for Health Security. “Getting vaccinated while pregnant is a crucial action to protect yourself and the developing fetus.”
So, is it safe for pregnant and breastfeeding women to get the COVID-19 vaccine?
Based on what has been studied so far, “there’s no reason to think that pregnant women or their fetus would be at risk from getting the COVID-19 vaccine,” says William Schaffner, M.D., an infectious disease specialist and professor at the Vanderbilt University School of Medicine. “Everything we know about the vaccine would indicate it should be safe. The RNA in the vaccine doesn’t go anywhere near human DNA—either the mother’s or the fetus’s.”
Statements from public health organizations (like the WHO) have been cautious but “everything we’ve seen from women who got pregnant during clinical trials or were already pregnant and got the vaccine is reassuring,” Dr. Adalja says.
Public health officials and organizations, including the ACOG, are “doing the best they can with what they have to work with,” explains Michael Cackovic, M.D., a maternal fetal medicine physician at The Ohio State Wexner Medical Center. “They’re saying, ‘We don’t have the data to make that recommendation,’ and that’s sound.”
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 work by inducing an immune response by the host,” he explains.
Plus, the fact that pregnant women are at a high risk of severe complications from COVID-19 makes the vaccine at least worth considering, says Joanne Stone, M.D., division director of maternal fetal medicine for the Mount Sinai Health System in New York. “It seems the benefits outweigh the risks, although a conversation with a health care professional may help in making an individual decision,” she explains. “And it’s important that women be informed of the lack of data regarding vaccine safety in pregnant women.”
Bottom line: Pregnant women should talk to their doctor about the COVID-19 vaccine.
Now that pregnant women are being included in vaccine trials, Dr. Cackovic says “ongoing conversations with your physician should include newly published information on the safety, efficacy, and availability for the vaccine in pregnancy.”
Dr. Adalja agrees. “I do think this is a decision between a doctor and a patient,” he says. “But, in most cases, pregnant women should be immunized.”
