OB-GYN Dr. Jessica Shepherd cannot think of a single pregnant person whom she’d tell to not get the COVID-19 vaccine.
“As an OB-GYN, as a physician, as a mom, I would definitely recommend for people who are hesitant about the vaccine to strongly consider it,” she said during a March webinar with Insider discussing COVID-19 shots in pregnancy.
Fellow panelist Dr. Jessica Madden, a pediatrician and neonatologist, agreed.
While there’s not yet have clinical trial data demonstrating the vaccines’ safety and efficacy in the pregnant and breastfeeding population, increasing evidence suggests they’re not only safe, but also beneficial for moms and their children.
The alternative – potentially contracting COVID-19 while pregnant – is more dangerous than the unknown risks of the vaccine.
“I feel more and more comfortable with the information that we’re gaining in terms of being a stronger advocate and a recommender of this vaccine for both pregnant moms and for breastfeeding moms,” Madden, who serves as medical director of Aeroflow Breastpumps, said.
But there are two exceptions.
First: If you’ve had a serious adverse reaction like anaphylaxis to a vaccine in the past, talk to your doctor about the risks and benefits of this one – whether or not you’re pregnant. People who’ve had a severe allergic reaction to any component of the COVID-19 vaccine shouldn’t receive it, period.
The other exception, Madden said, is “if you’re super fearful about this vaccine, then you should never feel like you are being forced into making the decision to get the vaccine.”
“If you really are feeling like, ‘I don’t want to do this. I’m just so scared about what might come,’ then please don’t get the vaccine,” she added. “There’s so many things to worry about when you’re pregnant or have a newborn baby and breastfeeding … you don’t want to add that to the mix.”
“I’m a proponent of the vaccine,” Madden said. “Obviously, I’m not a proponent of anybody feeling like they have to get this right now.”
Duke: Oh, boy. It’s a tough myth for patients to hear.
Eleswarapu: “Eating pineapple can increase fertility.”
Duke: Oh, that’s a good one. Pineapple by itself, if you have infertility, is unlikely to reverse your infertility.
I’m Dr. Cindy. I am a fertility specialist based in Las Vegas, Nevada. Hello,
Eleswarapu: I’m Dr. Sriram Eleswarapu, and I’m a urologist at UCLA. And today we’ll be debunking myths about infertility.
Duke: “Tight underwear is bad for sperm count.”
Eleswarapu: So, there’ve been a number of studies looking at this issue for many decades, and the inevitable question is boxers versus briefs. In truth, it doesn’t matter a whole lot, and we know that if the testicles are a little bit warmer that they are more at risk of having sperm-count issues or sperm-motility issues, but, in general, it shouldn’t matter too much. Just pick what’s comfortable.
Duke: “Sex position matters.”
Eleswarapu: So, that is a myth. No matter what position you engage in, if you ejaculate, you have the sufficient propulsion of the semen to make it up to the cervix, any way you do it.
Duke: People around the world have actually studied it, and no one position has been proven to be better than another.
Eleswarapu: “IVF guarantees pregnancy.”
Duke: Oh, boy. Yes, that is definitely a myth. And it’s a tough myth for patients to hear. IVF does present the highest chances of pregnancy, absolutely. There are a number of factors that play into IVF success. One of them has to do with the age of the eggs being used. It also has to do with the quality of the sperm and the egg when they come together. It has to do with the embryo that is ultimately formed. It also has to do with the genetics of the embryo. But then, on top of that, it has to do with the womb in which the embryo will be placed, and a number of factors are not yet fully known. So, we know the immune system plays a role. Diet, exercise probably play a role, but we’re still investigating that. Biggest thing to know is it’s not 100%.
Eleswarapu: “Stress causes miscarriages.”
I think we’re starting to get away from the term “miscarriages.” We’re starting to use the term “early pregnancy loss.” Is that right?
Duke: That’s correct. And I think it’s because “miscarriage” also comes with certain connotations where blame is also ascribed, and the truth is, both early pregnancy losses, there’s nothing the individual could have done about it at all. So now we call it early pregnancy loss before the end of the first trimester, versus second- and third-trimester pregnancy loss. We do not believe stress causes loss. Many people around the world across millennia have gotten pregnant and remain pregnant despite tremendous stress. So we know it’s not simply stress. Nowadays, though, we know the No. 1 reason for pregnancy loss is chromosomal differences in the formed embryo. And so that’s called aneuploidy. 67% of first-trimester pregnancy losses are due to chromosomal issues within the embryo itself. Other reasons would be if the thyroid was not functioning well, if vitamin D is low, if there’s a fibroid in the uterus. If you have a uterus and you’ve had two or more pregnancy losses, you should be evaluated. We always expected that it would be the individual with the womb and the eggs to be the one that gets evaluated for a pregnancy loss. Now the tide is shifting, and individuals who contribute the sperm are also being evaluated when there’s a pregnancy loss in the couple. There’s emerging data that things like DNA fragmentation, where the DNA that are normally supposed to be very tightly wrapped up in the sperm are somehow unraveled and might have little breaks in the DNA strands, and those breaks can contribute to the pregnancy loss.
“Freezing your eggs guarantees that you can have kids later.”
Myth. And the myth is in the word “guaranteed.” If you freeze your eggs, you can stop the clock. And so you’re basically freezing the youngest version of yourself at that point. However, there’s no guarantee that eggs even when frozen will thaw and yield a live-born baby. So it’s really a conversation that needs to happen with your specialist based on your age, based on your egg number.
“Sperm quality doesn’t decline with age.”
Eleswarapu: There’s a lot of data now that is showing that individuals with sperm that is older, say in the fifth, sixth, seventh decades of life and beyond, is more at risk of forming embryos that have chromosomal abnormalities. Getting exercise, eating well are things that can improve the general biology of an individual. Certainly if it’s good for the heart and it’s good for the brain, then it’s probably good for the penis and the scrotum and the testicles as well. We talked about egg freezing, but sperm freezing has its role particularly for individuals who may not be in a relationship or may not be thinking of a family at this time but later on down the road they might want to produce a family.
“It’s impossible to get pregnant after 35.”
Duke: It is possible to get pregnant after 35. The truth is, though, that the chance of pregnancy progressively declines as the age of the egg increases. And so you might find greater and greater need for fertility treatments. When you’re born, if you’re someone born with ovaries, you’d have somewhere between 1 million to 2 million eggs in those ovaries, usually. By age 30, 70% of those eggs are gone, and by age 40, 97% of those eggs are gone. At the same time, those eggs are also aging. And so what we see is that the chance of pregnancy declines very quickly, and then for some people it declines even faster. So if you have endometriosis, if you’re someone who’s maybe had surgeries of the ovaries or needed to be on medications, chemotherapy, radiation, all of those things can also further the decline in the egg number. So my recommendation is, if you have ovaries, at age 30, you should at least be asking your doctor to do a check of your egg number, or what’s called your ovarian reserve.
“The best way to get pregnant is to have sex every day.”
Eleswarapu: It comes down to the ovulatory cycles and making sure that you’re sort of timing things and tracking things, particularly if you’re trying to conceive deliberately. We always get this question, and I want to know what your thoughts are. Should the couple be trying to conceive every other day during ovulation, or every day during ovulation? I say every other day. One, we need to give the sperm and semen enough time to sort of reaccumulate so we can get those millions of sperm. The other is sperm actually survive in the female genital tract for up to five days. So once the egg is released from the ovary, think of the fallopian tube as an arm with a catcher’s mitt at the end. The catcher’s mitt captures the egg, pulls it into the arm, and then the egg sits around there for 12 to 20 hours waiting for sperm. And then if you have intercourse anywhere within the next 24 hours, sperm will also get to the egg. So that’s why we say every other day around ovulation. There is this movement now, particularly on the internet, discussing what’s called abstinence from pornography, masturbation, and orgasm, or PMO. It’s also a movement called no NoFap. And those individuals say to have the best reserve of sperm or the best sort of power with erections or orgasm, that they should conserve for days, weeks, months at a time. This stuff is not scientific at all. And, in fact, after a week of storing up, the sperm may not necessarily be healthy.
“Eating pineapple can increase fertility.”
Duke: That’s a good one. Pineapple by itself, if you have infertility, is unlikely to reverse your infertility. We know that pineapples have bromelain inside of them, which is a compound that is known to be a blood thinner to a certain degree, but it’s very, very weak, and you’d have to eat so much pineapple to even have enough bromelain to have a little effect. You should be having a meal balancing protein, complex carbohydrates, and fiber. So getting your usual multivitamins and folate into your diet, because folate is really important for once you’re pregnant. But technically, no, pineapple by itself does not boost fertility. Infertility, while a daunting thought, really there are lots of options available. The first step is actually an evaluation. Fertility and infertility constitute this huge spectrum, and there are many, many ways to get pregnant and many things one can do to help facilitate that. And you don’t have to stay at home feeling embarrassed about it. If you talk to a specialist like myself, like Dr. Eleswarapu, we are experienced with this and know how to treat you or direct you to the right person who can help.
Pregnant people in the US are in prioritized groups for vaccination in many states, and yet many aren’t sure they want to sign up.
On the one hand, we don’t yet have clinical trial data demonstrating the shots’ safety and efficacy in the pregnant population, and (scientifically inaccurate) theories have swirled linking the vaccine in pregnancy to ill effects like infertility.
Dr. Jessica Shepherd, an OB-GYN and minimally invasive surgeon serves as the chief medical officer of VeryWell Health
Dr. Jessica Madden, a pediatrician and neonatologist, serves as medical director of Aeroflow Breastpumps
They talked about why they highly recommend the vaccines in pregnant women, as well as those who are breastfeeding or trying to conceive; whether there’s an ideal time in pregnancy to get the shot; what potential long-term risks of the vaccine might be; whether one of the vaccines may be better for pregnant women than others; and more.
The COVID-19 vaccines by Pfizer and Moderna are effective in pregnant women, bolstering their immune response to the disease and even passing protective antibodies to their babies, according to a new preprint study.
The study, published Thursday in the American Journal of Obstetrics and Gynecology, looked at 131 women who received one of the two vaccines between December and March, of whom 84 were pregnant and 31 were lactating.
Researchers, from centers including Harvard, MIT, and Brigham and Women’s Hospital, found pregnant and lactating women had as strong an immune response to the vaccines as the 16 women who were not pregnant or lactating.
What’s more, they found the vaccines were much better than exposure to the coronavirus at giving babies secondary antibodies. Testing umbilical cord blood and the placenta, they found babies born to women who received the vaccine had “strikingly higher” levels of COVID-fighting antibodies than babies born to women who previously had COVID-19, the researchers wrote.
The research supports vaccinating pregnant women
The research adds to a growing body of research that indicates getting a COVID-19 vaccine is a good idea for pregnant women. In March, the CDC said there were no adverse results in its study on 30,000 vaccinated pregnant women across the US.
Pregnant people were not included in the clinical trials studying any of the COVID-19 vaccines. As a result, when US regulators authorized the first COVID-19 vaccine in early December (by Pfizer BioNTech), health officials said it was a decision for pregnant women to make with their doctor.
As research mounts, that decision-making process is getting easier for pregnant people and OBGYNs, Dr. Andrea Edlow, a maternal-fetal medicine expert at Massachusetts General Hospital in Boston who co-authored the study, told NBC.
“This study is one piece of the puzzle that’s essential to try to give pregnant and lactating women evidence-based counseling around the vaccine,” Edlow said.
What we know about the Pfizer and Moderna shots in pregnancy
Studies are underway, both in clinical trial settings and real-world settings, as more and more pregnant people choose to get the shot.
Pending that data, the CDC notes that studies in pregnant animals found no safety issues tied to receiving mRNA vaccines – i.e. the vaccine technology used in both the Pfizer and Moderna COVID-19 shots.
There has been plenty of misinformation spread about mRNA vaccines, which uses messenger RNA (mRNA) to train the body to recognize the virus and mount an immune response.
Anti-vaccine activists like Robert F Kennedy, Jr. have promoted a myth that the vaccine interferes with DNA – a physiological impossibility since the vaccines do not enter your genetic material.
The American College of Obstetricians and Gynecologies (ACOG) issued an advisory to pregnant and lactating people debunking this myth: “These vaccines do not enter the nucleus and do not alter human DNA in vaccine recipients. As a result, mRNA vaccines cannot cause any genetic changes.”
Vaccines seem to protect babies, too
A small peer-reviewed study in January found that pregnant women vaccinated against COVID-19 passed antibodies onto their unborn babies.
In February, researchers said a baby born to a woman who had only received one of the two Moderna shots tested positive for protective antibodies.
When researchers collected blood samples from 30 pregnant women in San Francisco, they expected to find evidence of common environmental chemicals.
Chemicals known as PFAS (per- and polyfluoroalkyl substances) are found in the bloodstreams of 99% of Americans. Other toxic substances, like flame retardants and pesticides, often show up in human blood samples as well.
But to their surprise, the researchers discovered 55 chemicals never before reported in people.
A few of those chemicals contained recognizable compounds: Two belonged to the PFAS family, one was a pesticide, and 10 more were plasticizers – substances that make plastic durable and flexible.
The remaining 42 substances were labeled “mystery chemicals,” since the researchers couldn’t find a way to categorize them. The chemicals were identified in all 30 pregnant woman – as well as their babies after they were born, according to the researchers’ new study.
“We’re finding them, but we don’t know where they’re coming from and we don’t have any information about their potential toxicity,” Tracey Woodruff, the study’s senior author, told Insider.
The researchers were particularly concerned by evidence that the chemicals could pass from one generation to next.
“The majority of the chemicals we see are able to cross the placenta, suggesting that the placenta is not efficient at preventing these exposures and it’s not efficient at removing these chemicals from the fetus,” Dimitri Panagopoulos Abrahamsson, the study’s co-author, said.
He added: “Because they appeared to be both in the moms and in the babies, these chemicals would be expected to remain in the population for a very long time.”
Some mystery chemicals may be linked to consumer goods
The Environmental Protection Agency (EPA) maintains a database of nearly 900,000 chemicals and their uses, but chemical manufacturers aren’t legally required to disclose every compound they create. That makes it difficult to hunt down substances that could potentially pose a risk to human health.
Even when the EPA prohibits the use of a certain chemical, manufacturers have been known to develop spin-off chemicals that aren’t subject to the same regulations. For instance, companies must seek EPA approval to manufacture or import products that use PFAS with eight carbon atoms, but they’re free to manufacture or import PFAS with six carbon atoms. (Research suggests that both versions might be linked to cancer.)
The San Francisco researchers found four types of PFAS that weren’t previously identified in human blood. In general, such chemicals are found in food packaging, clothing, carpets, and cookware.
The researchers think several of the “mystery chemicals” they found may hail from consumer goods as well, since items like furniture, electronics, and cosmetics are known to contain chemicals.
“There are some chemicals that appeared to be at higher levels in people with a higher socioeconomic background,” Abrahamsson said. “Our best educated guess about this is that when you can afford more products, when you have a higher buying power, you introduce a lot more products to your home.”
He added that some of the mystery chemicals his team identified may be impurities – chemicals either purposely or accidentally added to common substances used by manufacturers.
“In these cases, it’s even trickier to know where these chemicals are being used because they’re not the main chemical used in the product,” Abrahamsson said.
Potential threats to fetal development
In general, chemicals pose a greater health risk in higher doses, or when people are exposed more regularly. But Woodruff said it will take a while before scientists know what levels of these mystery chemicals, if any, are potentially hazardous to humans.
“Given that they’re mystery chemicals, they’re probably not even on EPA’s radar in terms of identifying their potential health risk or setting any type of levels that would be of more or less concern,” she said.
Already, pregnant women in the US are widely exposed to environmental chemicals like pesticides or flame retardants, which may threaten the development of a fetus. In some cases, this exposure can lead to birth defects, childhood cancer, or health problems in adulthood such as reproductive issues, obesity, and diabetes.
For that reason, Woodruff said, it’s important for scientists to keep studying unidentified substances in people’s blood. But these studies are bound to hit a wall, she added, if companies don’t report all the substances they’re using.
“We are only covering the tip of the iceberg on chemicals that we need to be focused on,” Woodruff said. “There are many of them, and we anticipate that there’s reason to be concerned.”
Pregnant people are at risk of more severe complications from COVID-19 than their non-pregnant peers, and yet official guidelines neither recommend nor discourage them from getting a vaccine.
That’s because we don’t yet have clinical trial data demonstrating the shots’ safety and efficacy in the pregnant population, so women are largely left on their own to weigh the pros and cons.
Based on the way the vaccines are made, CDC data tracking pregnant people who’ve received them, and small studies out so far, experts believe the shots are safe and likely beneficial to both moms and their future children.
But some moms-to-be want to wait until there’s more rigorous data, especially if they’re able to protect themselves against COVID-19 by, for example, working from home.
Join us on Friday, March 26, at 2pm ET/11am PT as Insider senior health reporter Anna Medaris Miller hosts a live panel discussion with maternal and child health specialists about what we know, and don’t, about the COVID-19 vaccine in pregnancy.
Dr. Jessica Shepherd, an OB-GYN, founded and runs the wellness concierge practice Sanctum Med + Wellness. Dr. Jessica Madden, a pediatrician and neonatologist, serves as medical director of Aeroflow Breastpumps.
Together, they will discuss whether there is a “better” COVID-19 vaccine for pregnant people than others, if there’s an ideal time in pregnancy to get vaccinated, how to interpret emerging research on vaccines in pregnancy, and more.
Pregnant people who get the COVID-19 vaccine seem to pass vaccine-generated antibodies to their babies in utero and through breastmilk, potentially offering the newborns protection from the virus when they’re most vulnerable.
The results, which come from several studies that have yet to be peer-reviewed, help tip the scale in favor of vaccines in pregnancy – something researchers are just beginning to assess in clinical trials.
The studies found antibodies in umbilical cord blood and breastmilk
In one preprint, researchers looked at 131 vaccinated women – 84 were pregnant and 31 were lactating. They tested their blood, umbilical cord blood, and breastmilk for COVID-19 antibodies after both vaccine doses, and again two to six weeks after the second one. (All women received either the Pfizer or Moderna vaccine.)
They found pregnant people had just as robust an immune response as their non-pregnant counterparts, and that umbilical cord blood and breastmilk samples contained vaccine-generated antibodies. They also found moms who got the vaccine were better protected against COVID-19 than those who developed antibodies after being infected with the virus.
When comparing the Moderna to the Pfizer vaccine, the study authors found Moderna’s gave moms a bigger boost of one type of antibody, and the bump from Pfizer’s vaccine was less robust. That could have to do with the differences in length of time between doses. More research is needed to understand if one vaccine is better than others in pregnancy.
In another study out of Israel, researchers looked at 20 moms and their babies who received both vaccine doses within about a month of delivery. They all had antibodies in their blood and umbilical cord blood. The more recently they’d gotten their vaccines, the stronger the immune response.
“Getting the vaccine later in pregnancy can better guarantee antibody protection to babies via both the placenta and mothers’ breast milk,” Dr. Jessica Madden, a pediatrician and neonatologist who serves as medical director of Aeroflow Breastpumps, previously told Insider.
Even getting a single dose of the vaccine before delivery can help, one case study showed. In it, doctors detailed how a baby born three weeks after her mom’s first dose of the Moderna vaccine had antibodies generated from the shot.
We don’t yet have rigorous data on the COVID-19 vaccine in pregnancy
The findings aren’t especially surprising, as other vaccines like for the flu are recommended in pregnancy to protect both mom and baby.
But there’s still a lot to learn about how strong and long-lasting vaccine-generated protection from COVID-19 is in babies, and clinical trials are evaluating the safety and efficacy of getting the shot while pregnant, though experts believe they’re safe.
“Based on how the [Pfizer and Moderna] COVID vaccine works, there should be very little risk to a developing baby,” Madden said.
Harvard experts say the Johnson and Johnson vaccine, which is not made from mRNA but rather a harmless form of the common cold virus called adenovirus, should be safe in pregnancy too, though clinical trials still need to be conducted.
Risk getting COVID-19 – or accept the unknown risks of the COVID-19 vaccine? That’s the question many pregnant people are asking.
On the one hand, while most people who contract COVID-19 in pregnancy end up doing fine and delivering healthy babies, they’re still at higher risk for hospitalization, ICU admission, and even death than infected non-pregnant women.
On the other, the coronavirus vaccine may come with its own risks, most of which are unknown since pregnant people weren’t enrolled in the clinical trials that led to the vaccines’ emergency-use authorization. (A trial looking at the Pfizer vaccine in this population is underway.)
But based on what we know so far, the risks of getting COVID-19 in pregnancy seem to outweigh the potential risks of the vaccine. Here’s a breakdown showing why.
COVID-19 in pregnancy is linked to serious complications
If infected, pregnant people are at increased risk for serious complications when compared to nonpregnant women with the disease, a November report out of the Centers for Disease Control and Prevention – the largest of its kind to date – found.
The analysis looked at data from about 400,000 15- to 44-year-old women who had symptomatic COVID-19 between late January and early October. They found that pregnant women with COVID-19 were nearly four times as likely to need ventilation and twice as likely to die than nonpregnant women with COVID-19 of the same age.
The overall risks for COVID-19 complications in pregnancy were low: 1.5% of pregnant women went to the ICU, 0.29% needed ventilation, 0.07 required life support, and 0.15% died.
A study presented in January 2021 including 1,200 infected pregnant women across 33 US hospitals found that the 12% with critical or severe symptoms tended to be most at risk for complications and death, and were also more likely to have other risk factors like a higher body mass, asthma, diabetes, and hypertension.
Getting a COVID-19 vaccine during pregnancy is not linked to complications or worse side effects
By contrast, there is no evidence of the COVID-19 vaccine leading to death in anyone, pregnant or not. And pregnant women in particular haven’t suffered any worse side effects from the vaccine than in non-pregnant women, according to the latest CDC vaccine safety report, published March 1, which includes over 30,000 vaccinated pregnant women.
There hasn’t been an uptick in pregnancy-related complications, like stillbirth and miscarriage, among pregnant women who’ve gotten the shot, either.
“We do have science that clearly indicates that vaccination does decrease disease process, disease progression, and death,” OB-GYN Dr. Jessica Shepherd told ABC. “Risk vs. benefit, in the end at this point, is transmission and death vs. protection.”
COVID-19 can cause long-term symptoms
Pregnant or not, getting COVID-19 can mean experiencing any number of side effects, from a mild fever and aches to debilitating fatigue, shortness of breath, heart palpitations, and a loss of taste and smell.
While most people recover after a few weeks, research suggests about 10% become “long haulers,” or people whose symptoms last months – or now, even more than a year – after their initial illness has passed and they test negative.
Long-haulers often grapple with fatigue, body aches, difficulty sleeping, and mental health issues including delirium, anxiety, and brain fog or memory loss.
The vaccine can lead to short-term side effects
The available COVID-19 vaccines, by comparison, can come with side effects, though they’re usually mild and last only a day or two.
Some of the the most commonly reported side effects, usually among women, include headaches, fatigue, chills, nausea, and dizziness, according to a January CDC report analyzing safety data on the nearly 13 million people who’d received a vaccine.
In about 1% of people, the vaccine leads to a fever, which, if persistent and above 102 F, can raise the risk of birth defects and miscarriage in the first trimester. For that reason, experts at the University of Massachusetts Medical School – Baystate say it’s reasonable to delay your vaccine until you’re past 12 weeks’ gestation.
However, that is not an official recommendation. The American College of Obstetricians and Gynecologists says a fever can be treated with Tylenol, which is safe in pregnancy and doesn’t seem to affect how the vaccines work.
We still need more data on the shot in pregnant people
Researchers don’t have clinical trial or long-term data on the vaccine risks to pregnant people, though research is underway.
“Based on how the [Pfizer and Moderna] COVID vaccine works, there should be very little risk to a developing baby,” Dr. Jessica Madden, a pediatrician and neonatologist who serves as medical director of Aeroflow Breastpumps, told Insider. That’s because, like the flu vaccine, the coronavirus vaccines are do not contain live virus.
“The mRNA in the vaccine acts locally, in the muscle cells surrounding the injection site,” she said. “It cannot enter into cells’ nucleus, thus it has no effect on DNA. “Plus, limited data from animal studies haven’t revealed any harms during pregnancy.”
Harvard experts say the Johnson and Johnson vaccine, which is not made from mRNA but rather a harmless form of the common cold virus called adenovirus, should also be safe in pregnancy, though clinical trials still need to be conducted.
The modified adenovirus can’t can’t replicate or cause illness, did not affect pregnancy in animal studies, and similar vaccines that have been tested in pregnancy haven’t yielded any negative pregnancy outcomes.
Ultimately, in the states where pregnancy makes you eligible for the vaccine, it’s up to women to decide if they want it, with or without the consultation of a healthcare provider.
ACOG says the decision should be informed by transmission rates in the community, as well as the individual’s risk of severe disease from COVID-19.
A pregnant person’s occupation and pregnancy complications matter too. It makes more sense, for example, for a pregnant bus driver in a city with high coronavirus rates to get the vaccine than someone who works from home in a small town where transmission is low. Likewise, a pregnant person with gestational diabetes would benefit from the vaccine more than one with a low-risk pregnancy.
Whatever you choose, Madden said, “you should feel like your decision is respected, and please know that if you choose not to get the vaccine right now, or in the future, that it is OK.”
A baby girl born three weeks after her mom got the first dose of Moderna’s COVID-19 vaccine has antibodies against the virus, a February pre-print paper reported.
After getting the shot, the mom, a healthcare worker in Florida, developed COVID-19 antibodies.
Testing revealed those antibodies passed through the placenta to offer some potential protection to her future child, according to the authors at Florida Atlantic University.
While past reports have shown how moms who’ve had COVID-19 can deliver babies with antibodies, the authors believe theirs is the first to record how vaccines during pregnancy may do the same.
It’s not clear how protective or long-lasting the antibodies are
Authors Dr. Paul Gilbert and Dr. Chad Rudnick called their report a lucky “opportunity study,” since they were able to find, and follow, a pregnant person who never tested positive for COVID but got the vaccine late in pregnancy and early in the rollout.
When the baby – “a vigorous, healthy, full-term girl,” according to the paper – was born, the doctors tested her cord blood for antibodies made from the vaccine, along with conducting other typical tests like for blood type.
They were able to detect COVID-19 IgG antibodies (the type that indicate recovery), suggesting the baby has some protection against the virus, though how much or how long it lasts isn’t clear. Future research should illuminate if there’s an ideal time for a pregnant person to get vaccinated to maximize protection against the virus for her child.
The authors say their results were expected based on what’s known about how the vaccine, and others recommended during pregnancy like the flu vaccine, work.
Past research has shown COVID-19 antibodies seem to cross the placenta
Past studies have suggested that COVID-positive mothers can pass on IgG antibodies against the virus to their fetuses in utero.
One March 2020 paper of six women who tested positive for the virus at delivery, for instance, found five had elevated levels of IgG antibodies even though none had COVID-19.
An October case report also describes an infant born to a mom with asymptomatic COVID-19 who had IgG antibodies but a negative COVID test, demonstrating “passive immunity” through the placenta, the authors write.
Still, more research is needed to understand how severity of illness affects antibody levels, how time of infection during pregnancy plays a role, and how strong and long-lasting babies’ presumed immunity is.
Even more research is needed on vaccinations in pregnant women, who were excluded from the first clinical trials. While the shots are expected to be safe in pregnancy and no increase in complications have been reported, it will take time for thorough trial data to be collected and published.
Until then, most professional and governmental organizations encourage pregnant people to make a decision that’s right for them, based on their occupation, rates of transmission in their community, underlying health conditions, and other factors.
Whatever the choice, “you should feel like your decision is respected,” Dr. Jessica Madden, a pediatrician and neonatologist who serves as medical director of Aeroflow Breastpumps, previously told Insider.
Monica Ramirez didn’t touch her daughter, Emiliana, until the infant was six weeks old. Emiliana had been delivered via emergency C-section while Ramirez, who had a near-fatal case of COVID-19, was in a medically induced coma.
“I feel very blessed that I have made it,” Ramirez, a school staffer near Los Angeles, previously told Insider. “Not everyone has the same outcome.”
Had a vaccine been available and given to Ramirez when she was pregnant, her experience might have looked a lot different.
But pregnant people still have a complicated choice to make now that three vaccines are authorized for emergency use in the US. And now that President Joe Biden announced every American will be eligible by May 1, more pregnant people need to decide: Get the vaccine despite knowing little about its potential risks to them, or skip it and risk contracting COVID-19, which is more likely to lead to complications and death in pregnant people.
The Centers for Disease Control and Prevention’s latest vaccine safety report, published March 1, says over 30,000 vaccinated women have reported pregnancies.
According to the CDC, pregnant vaccinated women have not reported different or more severe side effects compared to non-pregnant women who received a COVID-19 vaccine. What’s more, the agency said there has not been an uptick in pregnancy-related complications, like stillbirth and miscarriage – the rate remains the same for all pregnant women, whether they got a vaccine or not.
Governmental organizations have so far avoided taking a strong stance in either direction, though experts say the way the vaccine is made suggests it’s safe in that population.
Ashley McFarland, a 34-year-old registered nurse in Boise, Idaho, says she doesn’t know how to help other women make the decision – one she, as a healthcare worker who’s trying to get pregnant, will soon have to make herself.
“Even as an educated medical professional, I don’t know how the vaccine effects pregnant women and their fetuses,” she told Insider. “Hopefully this critical and pertinent information becomes more understood as more research is completed.”
Many organizations encourage women and their providers to make individual decisions
Many organizations encourage women and their providers to make individual decisions the Pfizer, Moderna, and Johnson & Johnson vaccines, now authorized for emergency use in the US, weren’t tested on pregnant people because researchers first want to know how vaccines behave in healthy, non-pregnant people. Only then can they make recommendations about whether certain vaccines should be trialed among expectant parents.
Both say that while discussing the pros and cons with a provider can be helpful, it shouldn’t be required.
The World Health Organization previously recommended against using COVID-19 vaccines during pregnancy, but has shifted its guidance after some backlash. Now, the organization says pregnant people with a high risk of exposure to COVID-19 or who have health conditions that increase their risk of severe disease may be vaccinated.
Pros and cons of getting the vaccine if you’re pregnant
Getting the vaccine means being almost entirely protected from contracting COVID-19. If infected, pregnant people have a higher risk of intensive-care unit admission, ventilation, life support, and death than patients who aren’t pregnant, though the overall risk is still low, a November report from the CDC found. They’re also more likely to deliver prematurely.
Pregnant women of color are particularly at risk for contracting the disease and experiencing related complications.
But getting the vaccine also means taking a bit of a gamble. Researchers don’t have good data on the risks to pregnant people, though healthcare and public health professionals expect that they’re low.
“Based on how the COVID vaccine works, there should be very little risk to a developing baby,” Dr. Jessica Madden, a pediatrician and neonatologist who serves as medical director of Aeroflow Breastpumps, told Insider. That’s because, like the flu vaccine, the coronavirus vaccines are do not contain live virus.
“The mRNA in the vaccine acts locally, in the muscle cells surrounding the injection site,” she said. “It cannot enter into cells’ nucleus, thus it has no effect on DNA.”Plus, limited data from animal studies haven’t revealed any harms during pregnancy.
But the vaccine could possibly lead to a fever as a side effect, which can be problematic to the developing fetus early in pregnancy. However, ACOG says it can be treated with Tylenol, which is safe in pregnancy and doesn’t seem to affect how the vaccines work.
Risk of exposure, pregnancy complications and community transmission rates all matter
Anita Kashyup, a clinical pharmacy specialist in Wauwatosa, Wisconsin, who’s trying to get pregnant, decided to get vaccinated after weighing the pros and cons.
“For me, the potential benefits (being protected against getting covid and hopefully then preventing passing it on to others) felt more strongly supported than the potential (unknown) risk with pregnancy,” she said, adding that the few women who did get pregnant while enrolled in the vaccines’ clinical trials reported no complications.
But other healthcare workers have decided against it, Dr. Zaher Merhi, an OB-GYN, reproductive endocrinology and infertility specialist, and the founder of Rejuvenating Fertility Center, told Insider.
The pregnant people he’s offered the vaccine to have by and large turned him down. “For them, it’s like, ‘I’ve been fine since March or I got COVID and it’s fine. Why do I need to take something that to me, right now, I don’t know the risks?'”
“But on the other hand,” he added, “they’re not seeing pregnant women who are dying from the disease, so it’s a battle.”
ACOG says the decision should be informed by transmission rates in the community, as well as the individual’s risk of severe disease from COVID-19. A pregnant person’s occupation and pregnancy complications matter too, Madden said.
It makes more sense, for example, for a pregnant bus driver in a city with high coronavirus rates to get the vaccine than someone who works from home in a small town where transmission is low. Likewise, a pregnant person with gestational diabetes would benefit from the vaccine more than one with a low-risk pregnancy.
For now, these scenarios are theoretical, as most people aren’t eligible for the vaccine. But in certain states, pregnancy will soon be a qualifying condition.
Some states include pregnant people in Phase 1b of vaccine rollout
Some states list pregnancy as a high-risk condition that qualifies people to receive COVID-19 vaccines.
In New York, pregnant people were included in Phase 1b of vaccine rollout, which began February 15. Illinois has also opened up its eligibility criteria to include pregnant people on February 25, and other states, such as Mississippi, listed pregnancy as a qualifying condition Phase 1b in early February.
For those pregnant people who do have the option to get vaccinated, Madden said it’s important to consult with a doctor or midwife, but not feel forced into a choice.
“You should feel like your decision is respected,” she said, “and please know that if you choose not to get the vaccine right now, or in the future, that it is OK.”
And for those who don’t yet qualify, more information is on the way to help them decide what to do.
“For women who are pregnant now, but not in prioritized groups, by the time the vaccine is available to them, most will no longer be pregnant,” Madden said. “There should be a lot more information available about the safety of the vaccine in pregnancy by the time most of them are eligible to receive it.”