What you need to know about the COVID-19 vaccine and pregnancy

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Content below originally published December, 2020

We recommend that patients who are pregnant or trying to get pregnant discuss the COVID-19 vaccination with their doctor and give consideration to receiving the vaccine.

Important considerations and frequently asked questions include:

• Level of activity of the virus in your community.
• How effective is the COVID-19 vaccine?
• What are the risks and potential severity of COVID-19 while pregnant?
• Is the COVID-19 vaccine safe for pregnant women and parents-to-be?
• Should I get the COVID-19 vaccine if I am pregnant or thinking about it?
• What are potential risks for pregnant women getting the vaccine?
• Will the COVID vaccine make me infertile or miscarry?
• What if I can’t get access to the vaccine?
• Can the coronavirus be transmitted through IVF or to or from embryos?

Read on for more information about these COVID-19 vaccine FAQs.

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Level of coronavirus activity

Here in Dallas and throughout north Texas the virus activity is high.

How effective is the COVID-19 vaccine?

On December 11, 2020, the U.S. Food and Drug Administration (FDA) issued an Emergency Use Authorization (EUA) for the Pfizer-BioNtech mRNA vaccine for use against the virus that is causing the illness known as COVID-19. The Pfizer vaccine is a 2-dose regimen; the second dose is given three weeks after the first. About a week after receiving the second dose, the vaccine has been 95% effective in large-scale clinical trials and has already been approved for use in five other countries.

Another vaccine for the prevention of COVID-19, from manufacturer Moderna called mRNA-1273, received EUA approval on December 18. Its efficacy rate is reported to be 94%.

What are the risks and potential severity of COVID-19 while pregnant?

Symptomatic pregnant patients with COVD-19 are at increased risk of more severe illness compared with non-pregnant peers including ICU admissions, need for mechanical ventilation and ventilatory support (EMCO), and death. Pregnant women with comorbidities such as obesity and diabetes or who are considered racial and ethnic minority groups are at even greater risk.

Is the COVID-19 vaccine safe for pregnant women and parents-to-be?

The CDC experts say that, based on how mRNA vaccines work, “they are unlikely to pose a risk for people who are pregnant.” This is because mRNA vaccines do not contain the live virus that causes COVID-19, so the shot cannot give a pregnant woman the disease. But the CDC says that the potential risks of the COVID-19 vaccine to a pregnant woman and her fetus are not yet fully known.

While a June CDC study found that pregnant people are at an increased risk of severe COVID-19 illness including hospitalization and need for mechanical ventilatory support, this segment of the population was not included in COVID-19 vaccine trials. Since pregnant women were not included in vaccine trials, we do not have any definitive information on their safety for mom or baby.

However the vaccine is an mRNA vaccine and does not include live virus, so you and your baby can’t get infected from the vaccine. This vaccine does not enter the nucleus and does not alter human DNA in vaccine recipients, so it cannot cause any genetic changes.

The American College of Obstetricians and Gynecologists’ (ACOG’s) COVID-19 working group reports that while pregnant women are typically excluded from most clinical trials, they have been vaccinated for decades with few complications. One ACOG working group doctor, Denise J. Jamieson, MD, MPH, said that because the COVID-19 vaccine uses messenger RNA technology and not a live dose of the actual virus, she anticipates the vaccine should be very safe in pregnancy.

Pfizer reported that about two dozen women became pregnant during the clinical trials, and so far, no evidence exists that the vaccine affects gestation or fertility.

American College of Obstetricians and Gynecologists (ACOG) recommends:

• Vaccination strongly encouraged for non-pregnant individuals within the Advisory Committee on Immunization Practices (ACIP) prioritization group(s).
• Vaccines for those trying to conceive or contemplating pregnancy and meeting ACIP prioritization recommendations.
• Delay of pregnancy after completing vaccination is NOT necessary.
• Vaccination in pregnancy for those in the ACIP prioritization group(s).
• Obtain second dose if conceived between doses.

Should I get the COVID-19 vaccine if I am pregnant or thinking about it?

If you have an underlying health condition or are one of the estimated 330,000 healthcare workers who are pregnant or breastfeeding during the initial months of the vaccine’s release, then it is imperative that you speak to your doctor about inoculation.

Even if you don’t fall into the above categories and you are pregnant or thinking about getting pregnant, it’s best to speak with your doctor. Review the potential risks of vaccines in general, the science behind mRNA vaccines and your timing to determine whether getting vaccinated is the right choice for you.

For otherwise healthy people in general, the COVID Task Force of the American Society of Reproductive Medicine does not recommend withholding the vaccine from patients who are planning to conceive, who are currently pregnant, or who are breastfeeding. It does encourage patients undergoing fertility treatment to receive the vaccination based on current eligibility criteria. Because the vaccine is not a live virus, the Task Force says there is no reason to delay pregnancy attempts due to vaccine administration or to defer treatment until receiving the second dose.

At the same time, the ASRM Task Force notes that recent studies suggest that pregnancy poses a higher risk for severe COVID-19 disease along with factors such as race, obesity, hypertension, and diabetes. Therefore, each person should weigh individual risks and benefits with her own doctor before receiving the vaccination.

 

What are potential risks for pregnant women getting the vaccine?

Because there has been no specific research on the COVID-19 vaccine on pregnant women, no known risks have been documented. However, vaccines pose risks to the population at large in general. A known side effect of inoculation is a fever resulting from mounting an immune response. Some studies have shown fever in pregnancy has been associated with an increased risk of neural tube defects; however, this was not seen in women taking more than 400mcg of folic acid daily. If experiencing a fever after vaccination, an antipyretic, like acetaminophen, is recommended.

Another is that, sometimes, ingredients in the vaccine can on rare occasions can cause allergic reactions. Reactions can include anaphylaxis, a severe condition that can cause shock, a rapid pulse rate, difficulty breathing, nausea, and vomiting. Whether pregnant or not, anyone receiving the COVID vaccine should be monitored for 15 to 30 minutes after receiving the shot to mediate any complications

Will the COVID vaccine make me infertile or miscarry?

Currently, there is no data connecting the vaccine and infertility, and social media posts saying otherwise are “inaccurate,” according to Yale University vaccine expert Saad Omer in a Dec. 11, 2020 The New York Times wire story.

The key ingredient in Pfizer’s and Moderna’s vaccine is a genetic material that “teaches” human cells how to produce a protein, called spike, that can fight the coronavirus. No placental proteins or genetic material in the vaccine teaches the body how to make placental proteins.

Instead of delivering a live virus, the Pfizer and Moderna vaccines contain mRNA, a variation of a naturally occurring substance that directs the production of protein in cells throughout the body. The vaccine’s mRNA instructs the body’s immunological system to recognize the actual virus as a foreign invader and resist.

Duke University immunologist and expert in neonatal immunity Stephanie Langel explains in the same The New York Times article that the coronavirus spike and placental proteins have nothing in common, “making the vaccine highly unlikely to trigger a reaction to these delicate tissues.”

Regarding miscarriage, Mary Jane Minkin, MD, of Yale School of Medicine, tells USA Today that there has been no evidence among the 44,000 COVID-19 cases in pregnant women this year that spike protein antibodies attacked any cells in the placenta, which would cause pregnancy complications or miscarriage.

What if I can’t get access to the vaccine?

Regardless of whether you get the COVID-19 vaccine, it is imperative to continue wearing a mask and social distancing. Stay in touch with your doctor to learn when the COVID-19 vaccine will become available in your area.

If you become pregnant during the pandemic, notify your doctor immediately. According to the CDC, of those 44,000 pregnant women in this country tested positive for COVID-19 this year, more than 8,500 had to be hospitalized, and of those, 300 were admitted to intensive care and 57 died.

Can the coronavirus be transmitted through IVF or to or from embryos?

To date, no published scientific research suggests that the coronavirus is transmissible from gametes (reproductive cells such as embryos, eggs, and sperm) to an intended mother or a gestational carrier.

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Conclusion: Precautions are still the best medicine

Organizations such as ACOG are urging the FDA, CDC and state leaders to allow the vaccination of pregnant women against COVID-19. Doing so would not only protect the mother and unborn child, but also the healthcare providers tending to them.

In the meantime, the best medicine for intended parents and pregnant women is to continue following state-mandated orders and CDC recommendations to protect yourself and others from COVID-19.

• Continue to limit your exposure to individuals outside your household.
• Wear a mask.
• Practice good hand and mouth hygiene for the next several months.

If at any time you have questions about COVID-19 symptoms or prevention, contact your healthcare provider.

For more information online, see information on COVID and the vaccine on the website of the American Society for Reproductive Medicine.