Andrea Shields, MD, MS, Maternal Fetal Medicine; Shad Deering, MD, CHSE, COL(ret) USA, Maternal Fetal Medicine; Maria Pierce, MD, Neonatal Intensive Care
This week, after months of research and clinical trials, the first Pfizer-BioNTech COVID-19 vaccines will be administered to a select group of individuals including healthcare workers. This is the first step in the fight against the COVID-19 pandemic, but many questions remain unanswered. When will the general population receive the vaccine? What does this mean for those who are planning to get pregnant, or are currently pregnant or breastfeeding?
To put it simply, the guidance for pregnant and lactating women or those wanting to become pregnant is not clear. While pregnant women were not included in the initial clinical trials, it does not mean they cannot get the vaccine. According to Pfizer, about two dozen people who got the vaccine became pregnant while participating in the studies and none of those women reported complications.
Since the onset of the COVID-19 pandemic, doctors have learned that if a pregnant woman contracts COVID-19 they are at a higher risk of serious complications from the virus. A pregnant woman with COVID-19 may develop severe symptoms such as pneumonia and the need for supplemental oxygen. They have a higher chance of needing to be intubated and admission to the intensive care unit.
Because of these potentially serious risks, the American College of Obstetricians and Gynecologists (ACOG) advises that those who are pregnant should be allowed to receive the vaccine after consulting with their physician. According to the CDC, the following considerations should be discussed when talking to your physician.
- Level of COVID-19 community transmission (if there is a high rate of COVID in the community where you live, the risk of getting infected goes up and the vaccine may be more important for protection.)
- Your personal risk of contracting COVID-19 (which may differ based on your job or other activities)
- The risks of COVID-19 to you (which are increased during pregnancy) and potential risks to your fetus
- The effectiveness of the vaccine (currently it is believed that the initial vaccines will be at least 90% effective in preventing COVID and it looks like even if someone gets COVID after vaccination, they are unlikely to develop severe disease.)
- The known side effects of the vaccine
- The lack of data about the vaccine during pregnancy
According to the CDC, the mRNA vaccines, such as the ones developed by Pfizer and Moderna do not contain live virus vaccines and do not alter human DNA in those who receive the vaccine.
What this means for our patients is that because the COVID-19 vaccine was proven safe and effective in both the phase II and phase III Pfizer clinical trials for non-pregnant patients, we believe the results would be similar in our pregnant patients. However, since these trials were not done specifically with pregnant or lactating patients, we do not fully know the potential risks to the pregnant mom or the fetus which is why each patient should discuss the pros and cons of getting the vaccine with their physician. We do, however, still believe the benefits of the vaccine for the mom and the fetus outweighs the risks.
In general, vaccines are one of the greatest health achievements of the 20th century saving millions of lives and protecting our population from many diseases that have been eradicated today such as polio, mumps and measles. Vaccines can reduce the risk of contracting conditions such as pertussis and influenza which can cause significant health issues and even death. These vaccines have been given to pregnant and lactating moms for decades and have proven to be safe.
According to ACOG, the CDC will soon be providing additional guidance for pregnant and lactating moms. The CDC is encouraging pregnant or lactating individuals who are part of a high-risk group (i.e., healthcare personnel, or someone with an underlying health condition) and want to receive a vaccine may choose to be vaccinated. A discussion with their physician can help them make an informed decision. The general population will likely not start receiving the vaccine until the Spring and we hope by that time more research will be released regarding COVID-19 vaccination of pregnant and lactating women.
The Pfizer-BioNTech COVID-19 vaccine requires two doses 21 days apart for full protection. If a woman takes the first dose and becomes pregnant before the second dose, ACOG is recommending that she proceeds to take the second dose to gain the maximum benefits of the vaccine.
ACOG also states that while there has been a worldwide attempt to develop COVID-19 vaccines rapidly, this does not mean that any safety standards have been relaxed. In fact, there are additional safety monitoring systems to track and monitor these vaccines, including real-time assessment. ACOG will continue to monitor new developments and has urged the FDA to consider additional clinical trials focused on pregnant and lactating moms. However, ACOG feels strongly that the vaccine should not be withheld from these individuals, especially those in high-risk groups, which includes those who are pregnant.
We know our patients will have lots of questions and encourage them to come talk to us. We can help our patients make the right decision for their situation by providing information about the COVID-19 vaccines.
Ultimately, whether or not a pregnant patient gets the vaccine will be a personal choice. Even if a pregnant mom decides to get the vaccine, it will still be important that they remain vigilant about taking preventative measures against the virus such as washing their hands, social distancing and wearing a mask in public until the COVID-19 pandemic is over.
About the Authors
Andrea Shields, MD, MS, Women’s Services division at The Children’s Hospital of San Antonio Dr. Shields is the Chair of the Department of Obstetrics & Gynecology and Chief of Clinical Research and Education at The Children’s Hospital of San Antonio. She is an Associate Professor from Baylor College of Medicine.
Shad Deering, MD, CHSE, COL(ret) USA , Women’s Services division at The Children’s Hospital of San Antonio Dr. Deering has served as the COVID-19 Medical Incident Commander for The Children’s Hospital of San Antonio during this pandemic. He is a Maternal Fetal Medicine specialist and Professor with Baylor College of Medicine and has worked with local and national organizations to create simulation training resources for COVID care of pregnant patients.
Dr. Maria Pierce, Women’s Services division at The Children’s Hospital of San Antonio Dr. Pierce is a graduate of the University of Michigan Medical School and completed her internship, residency and fellowship at the University of Miami. After completing her fellowship in Perinatal-Neonatal Medicine, she joined the medical staff at Tulane Medical Center. She has been a practicing neonatologist at The Children’s Hospital of San Antonio since 1997. She is the mother of three adult children.