“A light at the end of the tunnel.”

“A shot of hope.”

These comments were used to describe the most recent breakthrough in what is hoped to be the beginning of the end of this pandemic: a vaccine. Just this past weekend, the U.S. Food and Drug Administration (FDA) issued an Emergency Use Authorization for Pfizer’s mRNA vaccine for use against the novel coronavirus. The FDA may authorize a similar vaccine by Moderna later this week. On Monday, an ICU worker in Queens, New York, was among the first in the United States to get the Pfizer vaccine.

pregnant woman wearing mask - Pregnancy after Loss and the COVID-19 Vaccine

Vaccinations for health care workers are occurring across the United States over the next few weeks. It’s expected that 20 million Americans will be inoculated by the end of the year. This is the medical news of the week.

The Pfizer and Moderna vaccines are ones that are nearly 95% effective in preventing COVID-19. They were developed differently than other vaccines in that they do not contain a live virus. Instead, they contain genetic material from the virus, called RNA, that causes COVID-19. As science writer, Carl Zimmer, from the New York Times explained during The Daily podcast in November, the vaccine designed by Pfizer and Moderna delivers instructions to our cells to make the protein from the coronavirus. Once our body’s cells make the proteins, they are released into our bodies and immune cells are triggered to make antibodies in response. He noted that the coronavirus protein generated in your cells is not enough to make a person sick because it lacks all the other genetic material that allows the virus to hijack a cell and reproduce. More information on the development of the vaccine can be found on the CDC website or here.

Now that Pfizer has been authorized for use, and Moderna is following close by, officials are determining who gets vaccinated first.

Chances are that unless you are a pregnant health care worker or an essential worker, you will not be getting vaccinated until late spring 2021. There are currently a limited number of doses – roughly 40 million –  which actually means only 20 million Americans will be inoculated right away. Thus, officials have prioritized who gets the vaccine and the general consensus is that health care workers and the residents of long-term care facilities are first in line. After that, essential workers and those with underlying conditions will receive the vaccine. Again, it’s expected that the general public – including most of the women in the PALS community – won’t get inoculated until April or May of next year. Of note: children under 16 are currently not included in the recommended groups to get the vaccine.

The vaccines require two doses to be separated by 3-4 weeks depending on the one you receive. Public health officials believe that the vaccine may not fully protect you until one week after the second dose.

Naturally, as news of the pending approval of the vaccine hit last month, we at PALS were busy trying to figure out one thing: what does this mean for our pregnant moms?

Throughout the pandemic, we’ve been discussing the impact of the disease on pregnant women, specifically moms expecting again after loss, with our resident PALS doc, Dr. Kristen Sharp. So as the vaccinations roll out this month, I turned to her yet again for advice on this continually evolving situation. She also pointed me to other information about the vaccine.

Generally speaking, the conventional wisdom coming from obstetricians is:

  • Pregnant and lactating women should not be excluded from vaccinations; they should be allowed to receive the vaccine if they so choose
  • The vaccine does not contain a live virus and therefore is not expected to pose any risk to mom or baby
  • Pregnant women should still practice social distancing, wear masks, and wash hands often

The studies undertaken for the vaccine did not include pregnant or lactating women.

This is normal as pregnant and lactating women are generally not included in the early stages of vaccination trials until the vaccines are considered safe for their nonpregnant counterparts. Medical professionals, however, are quick to point out that the lack of data in this population, does not mean the vaccine should be withheld from pregnant and breastfeeding women. Especially for pregnant women, because they’re at an increased risk of more severe illness or death if they contract COVID-19, the benefits of vaccination significantly outweigh not getting vaccinated.

Dr. Kristen Sharp is a loss mom, an OB/Gyn, who runs the only pregnancy after loss clinic in the U.S., and a PALS Board member.

I reached out to her again about the vaccine and asked what she’s recommending for her pregnant patients who are in line for the vaccine (noting, again, that at this time, that group of women are likely to be pregnant health care workers). She said, “Unfortunately, no pregnant women were included in the vaccine trials. However, from a theoretical perspective and extrapolating safety data from other vaccines, the risks of this vaccine to a pregnant woman and her baby are low. Given that pregnant women are at higher risk for severe infection with COVID, our institution’s Maternal-Fetal Medicine Specialists are recommending that pregnant health care providers receive the COVID vaccine.”

Statements from the Society for Maternal-Fetal Medicine (SMFM) and the American College of Obstetricians and Gynecologists (ACOG)

Dr. Sharp also pointed me to a statement released on December 1, 2020, by the Society for Maternal-Fetal Medicine (SMFM), which also advocated for pregnant women to get the vaccine. SMFM “strongly recommends that pregnant women have access to COVID-19 vaccines in all phases of future vaccine campaigns, and that she and her healthcare professional engage in shared decision-making regarding her receipt of the vaccine.” The organization goes on to point out that the type of vaccine, one not containing a live virus, is noteworthy, and “Healthcare professionals should also counsel their patients that the theoretical risk of fetal harm from mRNA vaccines is very low.”

After news of the EUA for the Pfizer vaccine, the American College of Obstetricians and Gynecologists (ACOG) followed suit on December 13, 2020, and published its practice advisory in support of pregnant women getting vaccinated.  ACOG “recommends that COVID-19 vaccines should not be withheld from pregnant individuals who meet criteria for vaccination…” ACOG, as with many other providers agrees that “pregnant individuals should be free to make their own decision [about receiving the vaccine] in conjunction with their clinical care team.”

The advisory continued:

“Individuals considering a COVID-19 vaccine should have access to available information about the safety and efficacy of the vaccine, including information about data that are not available. A conversation between the patient and their clinical team may assist with decisions regarding the use of vaccines approved under EUA for the prevention of COVID-19 by pregnant patients. Important considerations include the level of activity of the pandemic in the community, the potential efficacy of the vaccine, the potential risk and severity of maternal disease, including the effects of disease on the fetus and newborn, and the safety of the vaccine for the pregnant patient and the fetus. While a conversation with a clinician may be helpful, it should not be required prior to vaccination as this may cause unnecessary barriers to access.

Clinicians should review the available data on risks and benefits of vaccination with pregnant patients, including the risks of not getting vaccinated in the context of the individual patient’s current health status, and risk of exposure, including the possibility for exposure at work or home and the possibility for exposing high-risk household members. Conversations about risk should take in to account the individual patient’s values and perceived risk of various outcomes and should respect and support autonomous decision-making

Pregnant patients who decline vaccination should be supported in their decision.

Regardless of their decision to receive or not receive the vaccine, these conversations provide an opportunity to remind patients about the importance of other prevention measures such as hand washing, physical distancing, and wearing a mask.”

ACOG further recommends that lactating women be offered the vaccine if they so choose, as well as women who are trying to conceive.

The CDC agrees whether to vaccinate against COVID-19 is the expecting mom’s personal choice. It lists things to consider about the vaccination and also lists other ways for pregnant women to stay safe and healthy during the pandemic.

As vaccinations continue through the United States over the next six months to a year, we will know more about the vaccines and its effects, particularly on pregnant and lactating women. In fact, by the time most of the population gets the shots, we will have more data on the vaccines and how it affects our PALS community.

As of now though, doctors seem to agree that there is no evidence or reason to believe that the COVID vaccine would be dangerous for a pregnant woman and her baby.

Pregnant women do get vaccines all the time – Tdap and the flu for example. When expecting moms are vaccinated, some protective immunity is transferred to her baby. Still, it’s important for expecting moms to discuss this new vaccine with their providers – particularly if they’re in line for vaccination in the next few months – to make an informed decision that feels right for them and their babies. This is a new situation for all of us, and the information is continually evolving. Open communication with your OB throughout this time is incredibly important.

In the meantime, we know that pregnant women are at higher risk of severe illness if they get infected with the virus, so it is crucial that pregnant women remain diligent about the protective measures we already know protect against the virus: social distancing, wearing masks, and washing hands often.

Stay safe and healthy, courageous mamas!

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For more information about the vaccine rollout in the U.S., please visit these web pages:

Other articles of interest on pregnancy and the COVID-19 vaccine for our pregnant after loss mamas:

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Are you pregnant after loss during the pandemic and need extra support or resources? Join one of our Facebook peer-to-peer support groups and see these articles:

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Please note that the information in this article is not a substitute for medical advice from your own obstetrician or midwife. Your care provider is most familiar with your personal situation, your region’s response to COVID-19, the vaccination schedule for your area, and is best equipped to answer your specific questions and address your concerns. These questions and answers are intended for informational purposes only. Please do not use this article as a substitute for medical advice, diagnosis, or treatment.

 

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