Should pregnant people get COVID-19 vaccine? With little data, experts have no easy answers

To vaccinate or not to vaccinate — that is the question pregnant women are asking themselves as COVID-19 shots roll out across the country.

Like so many things involving the pandemic, there are no easy answers. The two vaccines that have received emergency use authorization from the Food and Drug Administration were not tested for safety or efficacy in pregnant women, so there’s no hard data to go on.

The American College of Obstetricians and Gynecologists says the vaccines “should not be withheld from pregnant individuals who meet criteria for vaccination,” such as the health care workers who received priority access. The medical group also says that “pregnant patients who decline vaccination should be supported in their decision.”

The Centers for Disease Control and Prevention are in agreement that if pregnant women are eligible for a COVID-19 vaccine, “they may choose to be vaccinated.” But the agency stops short of saying they should.

With as many as 300,000 pregnant women in the nation’s health care workforce, it’s a predicament neither patients nor their doctors can afford to ignore. And as vaccine access expands to include people with medical conditions that make them more vulnerable to a severe case of COVID-19, even more women will face the same dilemma.

Both the CDC and ACOG suggest that pregnant women weigh the benefits of a vaccine against the possible risks, noting that the pros and cons may be different for each person. A consultation with a doctor may be helpful, but it should not be required, both organizations say.

The picture is also unclear for women who are trying to become pregnant and for mothers who are breastfeeding. Both ACOG and the CDC agree that COVID-19 vaccines should be available to women in both groups.

Vaccines are routinely given to pregnant women to protect them and their developing babies from diseases like influenza and whooping cough, a pair of obstetricians and gynecologists noted this week in Annals of Internal Medicine. And “few if any vaccines” are considered unsafe for nursing mothers, including the one for measles, mumps and rubella that contains live but weakened viruses.

In the midst of a pandemic that has killed at least 3,000 American women of childbearing age, adding a COVID-19 vaccine to the mix is certainly sensible, wrote Dr. Laura Riley of Weill Cornell Medicine and Dr. Denise Jamieson of Emory University School of Medicine.

The clinical trials conducted by Pfizer and Moderna may offer some reassurance to pregnant women who are leaning toward vaccination.

Both vaccine makers gave pregnancy tests to women of childbearing age so they could be excluded from their Phase 3 trials. Nevertheless, three dozen pregnant women got in — either their pregnancies were too early to trigger a positive test result, or they conceived shortly after receiving their first dose.

The Pfizer clinical trial included 12 pregnant women who received the vaccine and 11 who got the placebo. At least one of the volunteers in the placebo group had a miscarriage, according to a report by FDA scientists who reviewed Pfizer’s clinical trial data. No miscarriages or other pregnancy-related problems were reported by volunteers who got the vaccine.

Another 13 pregnant women were enrolled in Moderna’s clinical trial; six of them got the vaccine and seven got the placebo. Among the women in the placebo group, one had a miscarriage and another had an elective abortion, FDA scientists reported. None of the women in the vaccine group reported any problems related to their pregnancies.