The COVID vaccine and pregnancy

Dear Dr. Roach: What are your thoughts on the COVID19 vaccine during pregnancy? I have read that it is safe. Could you explain how? — H.B.

Dear H.B.: Pregnant women do not seem to be more likely to get COVID-19, but they are more likely to have complications from it. Preterm birth rates and the need for Caesarian section both are increased in a pregnancy that is affected by COVID-19. Fortunately, over 90% of infected pregnant women will recover before delivery. Still, protection should be top of mind.

There are not robust safety data on the use of the vaccine in pregnancy; however, expert opinion is generally on the side of recommending the vaccine. The mRNA vaccines made by Moderna and Pfizer do not contain any live virus. The mRNA last for only a short time in the body and cannot become part of a person’s cells because mRNA is destroyed by the body’s own mechanisms shortly after the cells have made the spike protein. Long after the spike proteins made post-vaccination by the muscle cells are destroyed, the B cells and T cells remember how to mount a fast response to destroy any virus before it can cause illness. Neither the mRNA nor the spike protein poses a danger to the fetus.

Because the risks for pregnant women are greater than those of nonpregnant women, the vaccine is probably more important to give to pregnant women. The threat from COVID-19 in the population now is so great that the benefits outweigh the risks. Every pregnant woman should get counseling and an explanation of the risks and benefits before making her decision for herself and her baby.

The same arguments and conclusions apply for women who are breastfeeding.

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