COVID Vaccine and Pregnant and Nursing Mothers

As an OB/GYN, it is important to me that my pregnant and nursing patients and those who may become pregnant have all of the information they need to make a good decision about whether or not to receive the COVID-19 vaccine. Here’s what we know:

• During the COVID-19 pandemic we found out that pregnant women with COVID-19 disease are more likely to get a very severe infection.  According to the Society for Maternal Fetal Medicine, they are three times more likely to have to go to an intensive care unit, two to three times more likely to need advanced life support and a breathing tube, and sadly, they have a small increased risk of death due to COVID-19. They may have worse pregnancy outcomes, such as pregnancy loss, stillbirth, and preterm birth. It is difficult to know yet whether COVID infection causes these outcomes or whether they happened at the same time by chance.
• Similarly, COVID-19 can cause chronic inflammation, which could decrease fertility in both men and women.
• The Federal Drug Administration (FDA) has provided Emergency Use Authorization for the COVID-19 vaccine. It is recommended for everyone over the age of 16 who has not had an allergic reaction to the ingredients in the vaccine. Research has shown that the COVID-19 vaccine is 95% effective in preventing COVID-19 as soon as 28 days after the booster vaccine. These agencies directed all their effort to this work, day and night, which is how the vaccine was approved for use so quickly. No steps were skipped. 
• It is not possible to get COVID infection from the vaccine. The virus is not in the vaccine.  It is like the flu shot, which exposes the body to something that looks like the part of the virus, so our bodies do the natural process of making antibodies to protect against disease. 
• Many people have minor side effects, like tiredness, fever, muscle pain, headache, and pain where the shot was given. They could last a few days.  A few people feel very unwell. Having symptoms is a sign that the vaccine is working, and antibodies are being made.
• Pregnant women were not allowed to be part of the research, which is very common for medical research trials. There were no reports of negative outcomes among the trial participants who became pregnant during the trial.
• The vaccine does use a new technology called mRNA.  Two shots are required 3 weeks apart. Scientists believe that the mRNA can’t get into the placenta or the breast milk. The same kind of technology made vaccine against Ebola disease.  It has been given to pregnant and breastfeeding women.  No problems for mom or baby were found from this vaccine.
• The vaccine does not cause birth defects or infertility. While the spike proteins on the virus and those found on the cells of the placenta are similar, they do not share enough amino acid sequences for the immune system to become confused.
• The vaccine should also be offered to those who are breastfeeding/lactating. Like pregnant individuals, those who were breastfeeding were not included in the clinical trials for the vaccine. According to the Society for Maternal Fetal Medicine, the benefits of vaccination outweigh the very small safety concerns, and you do not have to stop breastfeeding because you get the vaccine.

Experts trusted by your providers recommend strongly that pregnant women be encouraged to get the vaccine.  We can’t tell you whether to get the shot, but we trust that you will make the right decision for you and your baby. Here are some points to consider as you decide:

• How many people are getting sick with COVID-19 in your community?
• What is your personal risk of getting COVID-19 based on your job or other exposures?
• What is your risk of getting very sick with COVID-19, and what is the possible harm to your baby? What other medical conditions could increase this risk? Diabetes, being overweight, having lung, kidney, heart or immune illnesses or taking medicine that depresses immune function ( like chemotherapy, methotrexate, prednisone). 
• Consider how well the vaccine is reported to work.  These vaccines work exceedingly well!
• What are the risks to other people in your household if you get sick, especially if you are living with people at risk for serious illness, like the elderly.
• How do you feel about the lack of scientific evidence about the vaccine’s safety and effectiveness for pregnant women?
• How do you feel you would manage the reported side effects of the vaccine?

Pregnant women who experience fever, either as a result of COVID-19 infector or following vaccination, should take acetaminophen (Tylenol) to treat fever, since a very high fever can harm a baby. A fever is far more likely as a result of COVID-19 infection than it is from vaccination.

If you have questions, please ask your OB/GYN. If you choose to get the vaccine, your health professional will give you information about enrolling in the V-Safe After Vaccination Health Checker. You can provide feedback on how the vaccine experience went for up to a week following your vaccination and get help with any concerns that may arise. Whatever you choose, be sure to continue with the important prevention steps like avoiding visits with those outside your household, masking and distancing when in public, and washing your hands frequently.

Kimberley Sampson, MD, FACOG, DABOM, is an OB/GYN at SVMC OB/GYN in Bennington.