- Pregnant people who are eligible for the coronavirus vaccine have to decide whether the benefits of the shot outweigh the unknown risks.
- About 30,000 pregnant women have been vaccinated in the US with no adverse effects.
- Transmission rates, occupation, lifestyle, and risk of serious complications from COVID-19 should all play into your decision to get vaccinated or not.
- Visit Business Insider’s homepage for more stories.
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.
That’s typical of any new vaccine, though some experts argue it shouldn’t be.
But on February 18, Pfizer-BioNTech started the first and only clinical trial in pregnant women for the COVID-19 vaccine. They aimed to enroll 4,000 participants who are 24 to 34 weeks pregnant.
While we wait for the trial data, it’s largely up to pregnant people who are eligible for the vaccines to decide for themselves if they want to get the shot.
The American College of Obstetricians and Gynecologists, for one, says “vaccines should not be withheld from pregnant individuals” in prioritized groups, while the Centers for Disease Control and Prevention concurs, saying eligible pregnant folks “may choose to be vaccinated.”
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.”