LIVE

The latest on what to know if you're pregnant during the pandemic, including new statements from the WHO and other public health groups.

By Claire Gillespie
Updated February 01, 2021
Advertisement

Even though COVID-19 vaccines are being administered to health care workers, residents of long-term care facilities, individuals in high-risk groups, and some individuals over 65, there is still much confusion surrounding whether or not pregnant women should get the vaccine.

Morbidity and Mortality Weekly Report (MMWR) study published in November found that they, too, are at increased risk for severe illness from COVID-19, though less so than those in other high-risk groups. The study found that pregnant people are more likely to be admitted to the intensive care unit (ICU), receive invasive ventilation and extracorporeal membrane oxygenation (the use of an artificial lung located outside the body that puts oxygen into the blood), and are at increased risk of death compared to non-pregnant people. The CDC has also warned that pregnant people with COVID-19 might be at increased risk for other adverse outcomes, such as preterm birth.

So that means pregnant people should get the vaccine too, right?

Unfortunately, it's not quite as simple as that. Pregnant people haven't been actively involved in late-stage clinical trials for any COVID-19 vaccines, including the Pfizer and Moderna vaccines. This lack of data resulted in the FDA not recommending the vaccines for pregnant people when they were first approved for use in the US. On December 2, the Advisory Committee on Immunization Practices (ACIP), the CDC's independent advisory council, also noted that there is currently "no data on the safety and efficacy of COVID-19 vaccines in [pregnant or breastfeeding people] to inform vaccine recommendations."

In late January, WHO released a statement that reiterated the lack of data on pregnant women receiving the COVID-19 vaccine. However, the next day, ACOG and the Society for Maternal-Fetal Medicine (SMFM) released a joint statement that seemed to muddy the waters. The statement, published January 27, reads: "The American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal Fetal Medicine (SMFM) are aware of the World Health Organization's (WHO) recommendation to withhold COVID-19 vaccines from pregnant individuals unless they are at high risk of exposure. ACOG and SMFM continue to stress that COVID-19 vaccines currently authorized by the US Food and Drug Administration should not be withheld from pregnant individuals who choose to receive the vaccine."

"In general, SMFM strongly recommends that pregnant [people] have access to COVID-19 vaccines in all phases of future vaccine campaigns, and that she and her health care professional engage in shared decision-making regarding her receipt of the vaccine," the society said. It also pointed out that the first available COVID-19 vaccines are likely to be mRNA vaccines, which don't contain a live virus but basically "trick" the body into producing some of the virus's molecules itself. According to SMFM, the theoretical risk of fetal harm from mRNA vaccines is "very low," and health care professionals should communicate this to their patients.

Christopher Zahn, MD, vice president of Practice Activities for the American College of Obstetricians and Gynecologists (ACOG), told Health in an emailed statement that the ACOG had "urged the US Food and Drug Administration as well as the Advisory Committee on Immunization Practices to address use of the vaccine on pregnant and lactating individuals."

It should be noted that the UK, the first country to approve the Pfizer vaccine, has taken a similar stance regarding pregnant people. In what the UK government describes as a "precautionary approach," the Joint Committee on Vaccination and Immunisation (JVCI) has advised that pregnant people don't get the vaccine due to a lack of data on safety. They've extended that advice to people who think they may be pregnant and people who are planning a pregnancy within three months of the first dose of the vaccine.

There's also the question of pregnant health care workers and whether they can or should get the vaccine. The ACIP has raised the point that due to the predominance of people of child-bearing potential among the health care workforce, a substantial number of health care workers are estimated to be pregnant or breastfeeding at any given time.

Is it common to exclude pregnant people from clinical trials?

Plainly, yes. In 2018, researchers writing for Trials said pregnant woman are "severely underrepresented in clinical research" and recommended the inclusion of pregnant people "at the earliest phases of the research process."

The ACOG has also long advocated for pregnant and lactating people to be included in clinical trials to provide the safety and efficacy data needed to let expectant moms make an informed decision regarding vaccination, Dr. Zahn said.

"Since the summer, ACOG has advocated for pregnant patients who fall into an ACIP-identified high-priority group to have the freedom to make their own decisions regarding receipt of [the COVID-19] vaccine in conjunction with their clinical care team," Dr. Zahn said.

However, in a discussion during Columbia University's Grand Rounds 2020 event, as reported by CNBC, Dr. Anthony Fauci shared that drugmakers and US regulators plan to launch clinical trials in 2021 to test COVID-19 vaccines on pregnant people and children. Dr. Fauci, the director of the National Institute of Allergy and Infectious Diseases, said that the trials won't necessarily be looking at efficacy, but rather safety and immunogenicity [the vaccine's ability to provoke an immune response] in those two populations, "to bridge to the efficacy in the adult non-pregnant population."

But what about other vaccines—pregnant people get those, don't they?

Yes, some vaccines are known to be safe during pregnancy. "Flu vaccines are recommended in pregnancy—and have been for a very long time," Dr. Brightman says. The CDC advises pregnant people to get the flu shot at any time during their pregnancy to help protect them and their baby. The same goes for the whooping cough vaccine, which should be administered early in the third trimester. However, despite the CDC recommendations, only 1 in 4 pregnant people in the US get both the flu and whooping cough vaccines.

The difference is that lots of studies have shown these vaccines to be safe during pregnancy (for both mom and baby), but we still don't have that data for the COVID-19 vaccine.

So what do ob-gyns think of this—and what should pregnant people do right now?

Clinicians in the maternal health field are, like pregnant people, kind of in a watchful waiting phase right now. Rebecca C. Brightman, MD, a gynecologist in private practice in NYC and an assistant clinical professor of obstetrics, gynecology, and reproductive Medicine at the Icahn School of Medicine at Mount Sinai, tells Health that she's received no information about the COVID-19 vaccination during pregnancy or in relation to pregnancy planning. "We'll follow guidelines from the American College of Obstetricians and Gynecologists (ACOG) when these are issued," Dr. Brightman says.

Sherry Ross, MD, OB/GYN and women's health expert at Providence Saint John's Health Center in Santa Monica, California, says there's just not enough medical research to ensure that pregnant people and their unborn babies are safe from any harmful effects of the new COVID-19 vaccines. "At this point, there's too much uncertainty about the safety of the COVID-19 vaccine and pregnant [people]."

The best way to protect pregnant people from getting the COVID-19 virus is to follow the CDC's advice and practice social distancing, avoid indoor gatherings and wear masks—and that goes for everybody, not just the pregnant people themselves. "Reducing cases of COVID-19 in the general population is still the smartest strategy to protect pregnant [people] from this unpredictable and potentially deadly virus," Dr. Ross says.

There's also the question of herd immunity possibly protecting pregnant people down the line, but we're still a long way from that. The nation's leading infectious disease expert, Dr. Anthony Fauci, says at least 75% of people would need to be vaccinated or infected to produce herd immunity.

Of course, there may be people who receive the vaccine and are unaware that they're pregnant. During a JAMA Network Conversations with Dr. Bauchner episode, Paul A. Offit, MD, from the Children's Hospital of Philadelphia, pointed out that "you never actually exclude pregnant people from studies because there are people that didn't know they were pregnant that entered the study… so there will be at least some data in those." He also said that the CDC's new Vaccine Safety Assessment for Essential Workers (V-SAFE) app will track everyone who gets the vaccine for adverse reactions, including people who don't know they're pregnant when they get the vaccine.

The information in this story is accurate as of press time. However, as the situation surrounding COVID-19 continues to evolve, it's possible that some data have changed since publication. While Health is trying to keep our stories as up-to-date as possible, we also encourage readers to stay informed on news and recommendations for their own communities by using the CDCWHO, and their local public health department as resources.

To get our top stories delivered to your inbox, sign up for the Healthy Living newsletter