COVID-19 Vaccine Considerations to Discuss with a Doctor During Pregnancy

In the months since the Pfizer-BioNTech and Moderna COVID-19 vaccines received emergency approval, pregnant or lactating people, who are considered immunosuppressed, have received conflicting advice on their eligibility.

In a recent viewpoint article, two Texas researchers argue that clinicians can provide their pregnant and lactating patients with sufficient information to make an informed decision about COVID-19 vaccination by looking at what is already known about other vaccines given during pregnancy.

The lack of either cohesive or decisive guidance has put the onus on clinicians to provide counsel. The researchers outline how doctors can synthesize the limited data available to them—facts about COVID-19 vaccines, the accounts of pregnant and lactating women who have received a COVID-19 vaccine, and studies on the effects of non-COVID-19 vaccines on pregnant and lactating women—to inform their patients on the benefits of the COVID-19 vaccine. The February article was published in the journal JAMA. 

Official Recommendations

The Centers for Disease Control and Prevention (CDC) states that "people who are pregnant and part of a group recommended to receive COVID-19 vaccine, such as healthcare personnel, may choose to be vaccinated. A conversation between pregnant patients and their clinicians may help them decide whether to get vaccinated."

The CDC recommends a few key considerations pregnant patients should discuss with their healthcare provider, which largely overlap with those recommended by the article authors:

• The likelihood of exposure to SARS-CoV-2, the virus that causes COVID-19
• Risks of COVID-19 to them and potential risks to their fetuses
• What is known about the vaccine: how well it works to develop protection in the body, known side effects of the vaccine, and lack of data during pregnancy

Federal agencies, such as the U.S. Food and Drug Administration and the Advisory Committee on Immunization Practices, have avoided making an explicit recommendation on the vaccine one way or another.

On January 26, the World Health Organization (WHO) issued a statement that cautioned pregnant women against receiving the Moderna vaccine for reasons that were not specified, the article's co-author Emily Adhikari, MD, assistant professor of obstetrics and gynecology at the University of Texas Southwestern Medical Center, tells Verywell.

Just three days later, however, the statement was revised to clarify that “pregnant women at high risk of exposure to SARS-CoV-2 (e.g. health workers) or who have comorbidities which add to their risk of severe disease may be vaccinated in consultation with their healthcare provider.”

Precedent for Vaccination in Pregnant and Lactating Women

COVID-19 vaccination wouldn't be the first vaccine offered to pregnant people. Vaccination against influenza and whooping cough can confer lifesaving immunity on pregnant and lactating patients.

In a study of 3,693 pregnant women, influenza immunization during gestation was linked to a 19% reduction in maternal influenza, a 15% reduction in low fetal birth weight, and a 30% reduction in neonatal influenza.

The pertussis vaccine reduced whooping cough, a potentially fatal respiratory illness in infants, by 85 percent compared with waiting until after pregnancy. Since 2012, the CDC has recommended pertussis vaccination for pregnant and lactating women.

COVID-19 Risk While Pregnant

COVID-19 infection can be particularly deadly in pregnant people for both the mother and fetus. Roughly 5% of all infected pregnant women have to be hospitalized for respiratory symptoms, Adhikari says.

In addition, they are also at significantly increased risk for preterm delivery and miscarriage. In a study of infected pregnant women, hospitalization was linked to a 10 to 25% increase in preterm delivery, though increases of as much as 60% were also recorded.

The disparity in symptom severity is a side effect of the unique physiology of pregnancy. In the nine months following conception, hormonal and physical changes put pressure on respiratory organs such as the lungs and diaphragm, oftentimes causing mild shortness of breath or difficulty breathing.

Consequently, pregnant and lactating women are at greater risk for severe respiratory illness, which can threaten the health of both the mother and the baby, and typically considered a priority group during epidemics and pandemics. 

“This means that [pregnant] women who develop severe pneumonia from COVID-19—which we think is about 5% of all [pregnant] women with the infection—have a harder time dealing with the stress from the infection, and may be more likely to have respiratory failure than non-pregnant women of similar age groups,” Adhikari says. This is also true of other respiratory diseases such as influenza, she adds. 

Information and Research Needed

Pregnant and lactating women were excluded from the “development and clinical evaluation” of COVID-19 vaccines and treatments due to liability issues, Adhikari says, so concerns regarding the impact of COVID-19 vaccination on developing fetuses and neonates are purely theoretical—that is, they are not supported by available evidence. 

Those who opt for the vaccine can expect to experience the standard side effects—“arm pain, body aches, low-grade fever, headache, and fatigue,” according to Adhikari—if they experience any at all.

We “do not have any reason to think that experiencing these symptoms puts a woman or her baby at risk,” Adhikari says. 

However, that hasn’t helped soothe vaccine hesitancy.

One reason for the outpouring of skepticism is the fact that the vaccines are mRNA-based. While mRNA vaccine technology has been in development for decades, it has never been used in a “widely available public health tool...in this context before,” Adhikari says. Its relative novelty, in addition to other factors, has fuelled fear and suspicion among certain communities. 

“We are very lucky that this mRNA platform could be utilized to make a vaccine that was highly effective and safe by building on what had already been done," Adhikari says. "If not, imagine where we might be today in this pandemic." At the same time, the public’s lack of familiarity with this platform, she says, “has made COVID vaccinations a particularly challenging public health initiative.” 

Adhikari believes that “data confirming safety and efficacy will be important to gather as more pregnant women are choosing to be vaccinated.” 

Such efforts are already underway. On February 18, Pfizer announced that they had begun a clinical trial in about 4,000 healthy pregnant women between 24 and 34 weeks along following a successful animal study. The trial will monitor the women's infants for six months after birth.

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.