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.”
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.
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.”
A now-blocked Facebook post that went viral claimed the coronavirus vaccine could cause infertility.
It suggested incorrectly that the vaccine teaches the body to attack a protein involved in placental development.
In reality, the protein the vaccine spurs the body to make and attack bears little resemblance to the one in the placenta.
Although data is still lacking as to how the coronavirus vaccine works in pregnant women, experts expect it to be safe and say that women who are pregnant or of childbearing age should be able to get it if they want.
A post that was circulating on social media falsely claimed that Pfizer’s new coronavirus vaccine could cause infertility in women. The vaccine is “female sterilization,” an image in the post said, incorrectly attributing the myth to the “head of Pfizer research.”
The post, which has since been blocked by Facebook as “false information,” promoted an incorrect idea that the vaccine spurs the immune system to attack both a protein in the coronavirus and also a protein involved in the formation of the placenta – the organ that delivers oxygen and nutrients to the fetus during pregnancy.
But experts say there’s no evidence the vaccine could lead to infertility.
“Based on the way it’s made, it should be safe,” Dr. Zaher Merhi, an OB-GYN, reproductive endocrinology and infertility specialist, and the founder of Rejuvenating Fertility Center, told Insider.
The protein the vaccine teaches the body to fend off is not the same as the one involved in placental formation
According to USA Today, the post, written by an unidentifiable author, said: “The vaccine contains a spike protein (see image) called syncytin-1, vital for the formation of the human placenta in women.”
“If the vaccine works so that we form an immune response AGAINST the spike protein, we are also training the female body to attack syncytin-1, which could lead to infertility for an unspecified duration.”
That’s not true. First, the vaccine does not contain syncytin-1, but rather mRNA: genetic instructions that spur the body to produce, and therefore recognize, the unique spike protein that the novel coronavirus uses to latch onto cells.
While it’s true that syncytin-1 and the coronavirus’s spike protein share a small amino acid sequence, they are not interchangeable.
“It has been incorrectly suggested that COVID-19 vaccines will cause infertility because of a shared amino acid sequence in the spike protein of SARS-CoV-2 and a placental protein,” Pfizer spokeswoman Jerica Pitts said in an email to the Associated Press. “The sequence, however, is too short to plausibly give rise to autoimmunity.”
The theory also suggests that syncytin-1 is the one and only protein important for placental development, but it’s more complicated than that. A sibling protein, syncytin-2, for instance, helps prevent the mother’s immune system from attacking the fetus.
Plus, the vaccine prompts the body to produce antibodies very similar to the natural ones produced in response to infection. If those antibodies attacked the placenta, we’d to see high rates of placental complications and miscarriages among the more than 44,000 pregnant women who’ve gotten the coronavirus, Dr. Mary Jane Minkin, clinical professor of obstetrics and gynecology at Yale School of Medicine, told USA TODAY.
Pregnant women and those who may become pregnant can get the vaccine if they want to
Pregnant women were excluded from clinical trials, so we don’t know the real-world effects of the vaccine in that population. But experts say it should be safe, since the vaccine, like the flu vaccine, does not contain live virus.
The mRNA is “not going to be able to enter the cell of the baby and cause any problem, mechanistically speaking,” Merhi told Business Insider.
The organization, along with the Centers for Disease Control and Prevention and the Food and Drug Administration, says pregnant women who want the vaccine should be able to get it.
People who are in prioritized vaccination groups and are actively trying to become pregnant or are contemplating pregnancy should also get vaccinated, ACOG says. There’s no need to delay pregnancy after getting the vaccine, according to the group.
Getting COVID-19 while pregnant puts people at a higher risk of being admitted to the intensive-care unit, needing ventilators or life support, and dying than patients who aren’t pregnant, according to a November CDC report. So Dr. Rahul Gupta, chief medical and health officer at March of Dimes, previously told Insider anyone who could get pregnant should be a top priority for vaccination.
“We’ve got to make sure we make an active effort … to ensure that childbearing-age women, especially minorities, are able to get the vaccine even before they get pregnant,” he said.