April 8, 2021
We 100% support you getting vaccinated!
It’s a long awaited episode: COVID vaccines in pregnancy & lactation, and why Dr. Jenn & Dr. Erica 100% support you getting that vax! We’ll dive deep into everything we know and don’t know so far, and even bring in some patriarchy-infused history (like we do) about why pregnant and lactating people were actively excluded from the trials. Here. We. Go.
COVID-19 VACCINE & PREGNANCY / LACTATION
Information obtained from the following organizations and governing bodies: The Centers for Disease Control (CDC); the Federal Drug Administration (FDA); the World Health Organization (WHO); the American College of Obstetricians and Gynecologists (ACOG); and the Society for Maternal Fetal Medicine (SMFM).
Is the COVID-19 vaccine safe for pregnant people?
CDC:
Although the overall risk of severe illness is low, pregnant people are at an increased risk for severe illness from COVID-19 when compared to non-pregnant people. Severe illness could result in intensive care admission, mechanical ventilation, or death. Additionally, pregnant people with COVID-19 might be at increased risk of adverse pregnancy outcomes, such as preterm birth, compared with pregnant women without COVID-19.
No pregnant or lactating people were included in the initial trials for any of the available COVID-19 vaccines.
However, based on how these vaccines work, experts believe they are unlikely to pose a specific risk for people who are pregnant. However, there are currently limited data on the safety of COVID-19 vaccines in pregnant people
Clinical trials that look at the safety and how well the COVID-19 vaccines work in pregnant people are underway or planned. Vaccine manufacturers are also monitoring data from people in the clinical trials who received the vaccine and became pregnant.
Studies in animals receiving a Moderna, Pfizer-BioNTech, or Johnson & Johnson’s Janssen (J&J/Janssen) COVID-19 vaccine before or during pregnancy found no safety concerns. CDC and the FDA have safety monitoring systems in place to gather information about vaccination during pregnancy and will closely monitor that information.
The Moderna and Pfizer-BioNTech vaccines are mRNA vaccines that do not contain the live virus that causes COVID-19 and, therefore, cannot give someone COVID-19. Additionally, mRNA vaccines do not interact with a person’s DNA or cause genetic changes because the mRNA does not enter the nucleus of the cell, which is where our DNA is kept.
The J&J/Janssen COVID-19 Vaccine is a viral vector vaccine, meaning it uses a modified version of a different virus (the vector) to deliver important instructions to our cells. Vaccines that use the same viral vector have been given to pregnant people in all trimesters of pregnancy, including in a large-scale Ebola vaccination trial. No adverse pregnancy-related outcomes, including adverse outcomes that affected the infant, were associated with vaccination in these trials.
The Centers for Disease Control and Prevention (CDC) is tracking more than 30,000 vaccine recipients who were pregnant at the time of vaccination. Nearly 1,800 have provided detailed descriptions of symptoms after vaccination and pregnancy outcomes. So far, pregnant people appear to have the same vaccine side effects as nonpregnant individuals. No miscarriages, stillbirths, or preterm births linked with the vaccines have been reported.
Level of COVID-19 community transmission
Personal risk of contracting COVID-19
Risks of contracting COVID-19 to the pregnant person and potential risks to the fetus
Efficacy of the vaccine
Known side effects of the vaccine
Lack of data about the vaccine during pregnancy
https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/pregnancy.html
SMFM (Society of Maternal Fetal Medicine):
SMFM strongly recommends that pregnant and lactating people have access to COVID-19 vaccines and that they engage in a discussion about potential benefits and unknown risks together their with healthcare providers regarding receipt of the vaccine. SMFM acknowledges that data do not exist regarding COVID-19 vaccine safety in pregnant and lactating people, and has long advocated that pre-clinical studies be conducted and that these populations be included in clinical trials. As data emerge, counseling and clinical recommendations will likely shift, as some vaccines may be more suitable for pregnant women.
https://s3.amazonaws.com/cdn.smfm.org/media/2726/WHO_Response.pdf
ACOG (American College of Obstetricians & Gynecologists):
ACOG recommends that COVID-19 vaccines should not be withheld from pregnant individuals who meet criteria for vaccination. While safety data on the use of COVID-19 vaccines in pregnancy are not currently available, there are also no data to indicate that the vaccines should be contraindicated, and no safety signals generated from DART (reproductive toxicity) studies for the Pfizer-BioNtech vaccine.
ACOG recommends vaccination of individuals who are actively trying to become pregnant or are contemplating pregnancy and meet the criteria for vaccination. Additionally, it is not necessary to delay pregnancy after completing both doses of the COVID-19 vaccine.
If an individual becomes pregnant after the first dose of the COVID-19 vaccine series, the second dose should be administered as indicated. If an individual receives a COVID-19 vaccine and becomes pregnant within 30 days of receipt of the vaccine, participation in CDC’s V-SAFE program should be encouraged (see below for more information on CDC’s V-SAFE program).
The Academy of Breastfeeding Medicine:
There are no clinical data regarding the safety of this vaccine in nursing mothers. However, there is little biological plausibility that the vaccine will cause harm, and antibodies to SARS-CoV-2 in milk may protect the breastfeeding child. The vaccine is made of lipid nanoparticles that contain mRNA for the SARS-CoV-2 spike protein. During lactation, it is unlikely that the vaccine lipid would enter the blood stream and reach breast tissue. If it does, it is even less likely that either the intact nanoparticle or mRNA transfer into milk. In the unlikely event that mRNA is present in milk, it would be expected to be digested by the child and would be unlikely to have any biological effects. While there is little plausible risk for the child, there is a biologically plausible benefit. Antibodies and T-cells stimulated by the vaccine may passively transfer into milk. Following vaccination against other viruses, IgA antibodies are detectable in milk within 5 to 7 days. Antibodies transferred into milk may therefore protect the infant from infection with SARS-CoV-2.
What are the risks of COVID-19 in pregnancy?
MotherToBaby California
Recent studies have suggested that pregnant women who have COVID-19 might have a higher chance of becoming very sick compared to women who are not pregnant, including a higher chance of being admitted to intensive care and needing to be put on a ventilator (machine that helps you breathe).
Having severe symptoms or complications from any illness might require pregnant women to deliver their babies sooner than expected (called preterm birth, or delivery before 37 weeks), which can be associated with long-term health problems for babies.
https://mothertobaby.org/pregnancy-breastfeeding-exposures/covid-19/
Other Things To Know:
If you would like to speak to someone about COVID-19 vaccination during pregnancy, please contact MotherToBaby. MotherToBaby experts are available to answer questions in English or Spanish by phone or chat. The free and confidential service is available Monday–Friday 8am–5pm (local time). Call 1-866-626-6847.
It is recommended that you wait 2 weeks between receiving the COVID-19 vaccine and any other vaccine in pregnancy, like the flu shot or Tdap vaccine. Please talk to us about how to space these vaccines.
There are no current recommendations about which trimester is safest in which to receive the vaccine.
We recommend taking acetaminophen (Tylenol) with either dose of the vaccine if you develop muscle soreness or fever.
Vaccine side effects
Side effects can occur after receiving any of the available COVID-19 vaccines, especially after the second dose for those that require two doses. Pregnant people have not reported different side effects from non-pregnant people after vaccination with mRNA vaccines (Moderna and Pfizer-BioNTech vaccines). If you experience fever following vaccination you should take acetaminophen because fever has been associated with adverse pregnancy outcomes. Learn more at : https://www.cdc.gov/coronavirus/2019-ncov/vaccines/expect/after.html
If you have an allergic reaction after receiving a COVID-19 vaccine during pregnancy, you can receive treatment for it.
If you are pregnant and have already received the vaccine
Please consider participating in the following studies so that we may continue to learn more about the vaccine’s safety in pregnancy:
MotherToBaby California COVID-19 Study:
MotherToBaby is seeking volunteers to participate in an observational study to better understand coronavirus (COVID-19) infection in pregnancy. Participants can have confirmed or suspected COVID-19 infection. All of our research is conducted by phone — no changes to your normal routine or travel are required. Qualifying pregnancies may also be eligible for optional, no-cost antibody testing up to two times in pregnancy if you are willing to travel to a near-by lab. Antibody testing can tell you if you’ve had a past infection with SARS-CoV-2, the virus that causes COVID-19.
https://mothertobaby.org/ongoing-study/coronavirus-covid-19/
University of Washington COVID-19 Study:
You are invited to participate in an online registry of persons who receive the COVID-19 vaccine and who are also pregnant, postpartum, lactating and/or contemplating pregnancy.
Some places to get the vaccine:
CVS Pharmacy: https://www.cvs.com/immunizations/covid-19-vaccine
Walgreens Pharmacy: https://www.walgreens.com/topic/promotion/covid-vaccine.jsp
Rite Aid Pharmacy: https://www.walgreens.com/topic/promotion/covid-vaccine.jsp
Safeway Pharmacy: https://www.mhealthappointments.com/covidappt