Pregnant women should consider taking the COVID-19 vaccine
The question of whether pregnant women should receive the COVID-19 vaccine is a rather basic one for Dr. Linda Eckert, an UW Medicine obstetrician and gynecologist and an infectious disease expert. The short answer is "likely, yes." But she'll quickly add some caveats to consider.
"If I were talking to my own patient, I'd be listening to that patient and trying to assess how she was feeling about the risk of acquiring COVID versus the concerns about the vaccine," said Eckert. "But overall, especially if she had significant medical risk factors, I would be saying, I think this vaccine could be a really good idea for you because we absolutely know how dangerous COVID can be for pregnant individuals."
If pregnant individuals catch COVID they will generally get sicker than non-pregnant individuals. They also more commonly end up on ECMO [heart-lung support], in the ICU or on ventilators, she noted. According to the CDC, an estimated 300,000 of the health care workers in the United States are pregnant, and will be facing this benefit-risk analysis soon, if they have not already, she noted.
Eckert, in her role as liaison for the American College of Obstetrics and Gynecology, sat in on the CDC/Advisory Committee on Immunization Practices meetings for both the Pfizer and Moderna vaccines and whether they should roll forward for public distribution. Specifically, the committee decided that pregnant individuals should be allowed to take the vaccine. In line with this, ACOG has recommended that pregnant individuals be offered vaccination and the decision be made by weighing the risks of acquiring COVID versus potential concerns the pregnant individual may have about being vaccinated.
Vaccine trials did not include pregnant women, but Eckert notes that animal trials have not raised any red flags. A Moderna study released in mid-December reviewed the effects of the vaccine on rats and showed no ill effects on pregnant animals or their offspring.
"Data in animals has been reassuring," she said.
On questions of fertility effects, Eckert said given the mechanism of action, COVID mRNA vaccines are not thought to cause any increased risks of infertility. Additionally, women who are planning pregnancy should be encouraged to receive the vaccine if they are in one of the priority populations for vaccination.
"The American Society of Reproductive Medicine also published a statement supporting use of the vaccine in women trying to become pregnant and in women undergoing fertility treatments. We don't feel like there is any worry about fertility concerns," Eckert said. "The mRNA stays in the lymph nodes and doesn't really travel through the bloodstream. We don't think that the COVID vaccine will impact the eggs or the implantation."
Nor should mothers who are breastfeeding worry, she added.
"We don't have any reason to fear harm in the babies of lactating women," Eckert said. "Studies are going to start looking at the transmission of the COVID antibodies through the breast milk after breastfeeding moms are vaccinated, but we don't have that data yet.
"But we do not have any concerns, nor does the American Academy of Pediatrics. It's recommended that lactating women strongly consider getting this vaccine," she added.
mRNA is not transferred in the placenta, she said Also, these vaccines do not enter the part of the cell where the DNA is held, and do not alter human DNA. As a result, mRNA vaccines cannot cause any genetic changes.
It's unknown how much antibody protection the infant will receive via the cord blood when the mother is vaccinated against the coronavirus while pregnant. Research has shown that when pregnant mothers receive the flu vaccine, the antibodies do show up in cord blood, and are transferred to the baby .
Although formal research and human trials regarding the vaccine and pregnant individuals are expected to start soon, one UW Medicine doctor wanted to jump start the issue. Dr. Alisa Kachikis, an UW Medicine obstetrician-gynecologist, has set up a registry for individuals who are pregnant, plan on getting pregnant, or are lactating, to record their experiences after they get the vaccine. The registry opened on Monday. So far 4,500 have signed up, she said.
From here, the researchers will start checking in with the individuals to record their experiences, probably sometime next year and will likely continue following women and their babies through 2021.
"The next step will be to set up the research," she said. "We'll be asking why they chose to get vaccinated, and any side effects they noticed."
The CDC has also launched a tracker app called v-safe, where those how have received the vaccine can download the app, and track any responses to the vaccine they experience.