With the recent opening of eligibility of the COVID-19 vaccine to everyone age 16 and older, Keck Medicine of USC obstetrician-gynecologist Marc H. Incerpi, MD, offers information on the safety of the vaccine for people who are pregnant or are planning to become pregnant.
Is it safe for people who are pregnant to get the vaccine?
I am asked that question by patients routinely and we do feel that it is safe for pregnant women to get the vaccine. Although pregnant women were excluded from the initial clinical trials for the three currently approved vaccines, there is no reason to think that these types of vaccines would in any way be harmful to the patient, fetus or newborn. In fact, there is some data that has been gathered that has found that there hasn’t been a difference in the side effects in women who are pregnant versus individuals who are not pregnant. And, after looking at adverse outcomes like miscarriage, stillbirth, pregnancy complications, maternal ICU admissions, birth defects and infant hospitalizations, there is no increased risk of those complications in women that have received the COVID vaccine. While the numbers are admittedly small, this is still encouraging data.
Are there risks associated with not getting the vaccine?
Pregnancy is an independent risk factor for COVID-19 disease severity and is considered a high-risk medical condition as outlined by the CDC. Although rare, we do know that when patients who are pregnant get COVID-19, they are at a threefold increased risk for ICU admissions, need for mechanical ventilation and ventilatory support and a 1.7-fold increased risk of death compared to women who are not pregnant. In addition to these maternal complications, there is also a slightly increased risk of pre-term delivery as well as stillbirth in women who get COVID while pregnant. These risks are further magnified in pregnant women who have other complications such as diabetes and obesity. And, similar to individuals who are not pregnant, risks are greater for certain racial and ethnic populations. So when you balance the risks of getting COVID while pregnant versus the potential harms of the vaccine, I believe the evidence favors getting the vaccine. I strongly recommend that women who are pregnant get the vaccine.
What should patients ask their OB/GYN before getting a COVID vaccine?
I think it’s very important for women to talk to their doctor about getting the vaccine. Women should talk through the potential risks of not getting the vaccine, and what side effects they should be prepared for if they do get the vaccine. As OB/GYNs, we receive guidance from the American College of Obstetricians and Gynecologists and from the Society for Maternal-Fetal Medicine, and most obstetricians are recommending that patients get the vaccine. While we don’t yet have hard, robust data to say there is definitely no harm, the recommendation is that there are more benefits to getting the vaccine than not.
One of the things that’s important to realize in pregnancy is that there are other vaccines that women can get when they’re pregnant, such as the flu vaccine or Tdap, and it’s important to wait about 14 days from the time they get their COVID vaccine to get those other vaccines.
When should a person who is pregnant or wants to become pregnant get a COVID vaccine?
This is a hot topic right now. The current recommendation from the CDC and FDA is that a patient can get the vaccine any time during pregnancy. There is some exciting data that is coming out that the antibodies that mom produces will actually transfer to the fetus, so when the newborn is delivered, the baby will have passive immunity and be protected from COVID as well. Although this has been primarily shown in women who have received the vaccine in the third trimester and data is lacking for women who receive the vaccine in the first trimester, I encourage women to get the vaccine as quickly as possible, because the longer one stays unvaccinated, the more likely one will be exposed to COVID and the greater the likelihood of getting infected.
Is there a preferred COVID vaccine for pregnant people to get?
I encourage my patients to get any of the COVID vaccines available to them. The studies mentioned previously that show passive immunity among infants were conducted with women who received the mRNA vaccines, Pfizer or Moderna. However, I don’t think there is a preferred vaccine to be given to pregnant women. The efficacy rates for all three of these vaccines are quite high and all have been demonstrated to produce an adequate antibody response. There has been a great deal of press recently regarding the Johnson and Johnson vaccine specifically related to the extremely rare complication of cerebral venous sinus thrombosis. The risk of this complication was approximately one in a million (6 out of 6.8 million doses administered). None of these 6 women who developed these blood clots in the brain were pregnant or postpartum. After a brief pause, the Johnson and Johnson vaccine is now back on the market.
What symptoms should prompt a pregnant woman to consult a doctor after vaccination?
Minor side effects such as fever, pain at the vaccination site, and fatigue are relatively common. Acetaminophen is recommended especially if fever occurs. However, the side effects that should cause a woman to consult her doctor would be extreme shortness of breath, possibly indicating anaphylaxis (a severe allergic reaction). If pregnant women receive the Johnson and Johnson vaccine, they should consult a doctor immediately if they experience any of the following within 21 days of receiving the vaccine: severe headache, abdominal pain, leg pain or swelling, shortness of breath, new neurologic symptoms, or new or easy bruising.
Will the vaccines lead to infertility?
There is no scientific evidence to prove that at all. That’s a myth that I’ve had patients and their family members ask me about, but the scientific evidence has disproved concerns about infertility as it relates to the COVID vaccines.
Any other thoughts?
Even though individuals, including pregnant women, are getting vaccinated, it’s important to recommend that we continue with social distancing, hand washing and mask wearing until we get further information before we start relaxing those types of guidelines. Lastly, I encourage all pregnant women who receive the vaccine to enroll in a CDC registry so that we can obtain more valuable data to benefit the pregnant community.