COVID-19 vaccination in pregnant, breastfeeding women: CDC guidance
USA: CDC and the Independent Advisory Committee on Immunization Practices (ACIP) have released information on vaccine considerations for people who are pregnant or breastfeeding.
ACIP recommends that certain groups (e.g., healthcare personnel, followed by other frontline essential workers) are offered vaccination during the first months of the COVID-19 vaccination program. People who are pregnant and part of a group recommended to receive the COVID-19 vaccine may choose to be vaccinated. If they have questions about getting vaccinated, a discussion with a healthcare provider might help them make an informed decision.
Observational data has suggested pregnant women with COVID-19 infection are at increased risk of severe illness including illnesses that results in mechanical ventilation, ICU admission, and death compared to non-pregnant women. Also, pregnant women with COVID-19 are at increases risk for adverse pregnancy outcomes including preterm birth compared to pregnant women without COVID-19.
Not much data is available on the safety of COVID-19 vaccines, including mRNA vaccines during pregnancy. CDC and the Food and Drug Administration (FDA) have safety monitoring systems in place to capture information about vaccination during pregnancy and will closely monitor reports.
mRNA vaccines cannot give COVID-19 to the one getting vaccinated as it does not contain the live virus. Also, mRNA vaccines do not interact with a person's DNA because the mRNA does not enter the nucleus of the cell. Cells break down the mRNA quickly. Based on how mRNA vaccines work, experts believe they are unlikely to pose a specific risk for people who are pregnant. However, the actual risks of mRNA vaccines to the pregnant person and her fetus are unknown because these vaccines have not been studied in pregnant women.
People who are pregnant and part of a group recommended to receive COVID-19 vaccine, such as healthcare personnel, may choose to be vaccinated. A conversation between pregnant patients and their clinicians may help them decide whether to get vaccinated with a vaccine that has been authorized for use under Emergency Use Authorization (EUA). While a conversation with a healthcare provider may be helpful, it is not required prior to vaccination.
Key considerations pregnant patients can discuss with their healthcare provider include:
· The likelihood of exposure to SARS-CoV-2, the virus that causes COVID-19
· Risks of COVID-19 to them and potential risks to their fetuses
· What is known about the vaccine: how well it works to develop protection in the body, known side effects of the vaccine, and lack of data during pregnancy
Pregnant patients who decide to get vaccinated should continue to follow the current guidelines to prevent the spread of COVID-19 after they are vaccinated. That means:
· Wearing a mask
· Staying at least six feet away from others
· Avoiding crowds
· Washing hands with soap and water for 20 seconds or using hand sanitizer with at least 60% alcohol
· Following CDC travel guidance
· Following quarantine guidance after exposure to COVID-19
· Following any applicable workplace guidance
Pregnant people who experience fever following vaccination may be counseled to take acetaminophen because fever has been associated with adverse pregnancy outcomes. Acetaminophen may be offered as an option for pregnant women experiencing other post-vaccination symptoms as well.
CDC recommends that all vaccine recipients, including pregnant people, should talk with their healthcare provider if they have a history of severe allergic reaction (e.g., anaphylaxis) to any other vaccine or injectable therapy (e.g., intramuscular, intravenous, or subcutaneous). Key considerations to inform these discussions include the unknown risks of developing a severe allergic reaction and the benefits of vaccination.
"There are no data on the safety of COVID-19 vaccines in lactating women or on the effects of mRNA vaccines on the breastfed infant or on milk production/excretion. mRNA vaccines are not thought to be a risk to the breastfeeding infant. People who are breastfeeding and are part of a group recommended to receive a COVID-19 vaccine, such as healthcare personnel, may choose to be vaccinated," wrote the authors.