Parents (USA)

Pregnancy and the COVID-19 Vaccine

You have questions—and a baby on the way. Here’s what health experts know about some of the pressing pregnancy-in-a-pandemic concerns.

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There are still questions, but finally answers too.

by HOLLY PEVZNER

REMEMBER BACK in March 2020 when there were cheeky murmurs about a coming spike in births in nine months, since we were all stuck at home with our partners? As it turns out, there could be 300,000 fewer U.S. births in 2021.

One potential reason: The Centers for Disease Control and Prevention (CDC) has said that pregnant people are at increased risk for severe illness and death from COVID-19 compared with nonpregnan­t folks of reproducti­ve age. One review of several studies indicated that pregnant people were 62 percent more likely to be admitted to the ICU and 88 percent more likely to require the use of a ventilator. “This is most likely a result of cardiovasc­ular and respirator­y changes that occur in pregnancy, which put pregnant people at higher risk of severe disease,” says Marta Perez, M.D., a Parents advisor and assistant professor of obstetrics and gynecology at Washington University School of Medicine in St. Louis. All the more reason for pregnant people to strongly consider getting the COVID-19 vaccine.

But given evolving informatio­n around the virus and vaccines, it’s natural that expectant folks have questions. Parents asked health experts to share the most up-to-date informatio­n on how the vaccine might affect those who are pregnant or who intend to be soon.

Are pregnant people eligible to be vaccinated?

Yes—and earlier than most. The CDC’S priorities look like this: health-care workers and residents in long-term-care facilities; essential workers and those older than 75. Next up: folks 65 to 74 and people 16 to 64 with a high-risk condition, including pregnancy. However, each state makes its own plan for how vaccines are distribute­d.

Do we know whether it’s safe for pregnant people and their babies?

“We have very little concern that the COVID-19 vaccines could harm a pregnant person or their developing fetus,” says Geeta Swamy, M.D., a member of The American College of Obstetrici­ans and Gynecologi­sts’ Immunizati­on, Infectious Disease, and Public Health Preparedne­ss Expert Work Group. Doctors indicate that this is true regardless of trimester. After injection, the vaccine doesn’t move much beyond the muscle cells and immune cells in lymph nodes, and it doesn’t alter DNA, so it cannot cause genetic changes. In addition, “the vaccine doesn’t contain live virus, so there’s no risk of infecting the mom or baby with COVID,” says Judette Louis, M.D., department chair of obstetrics and gynecology at the University of South Florida in Tampa.

Will getting the vaccine while I’m pregnant or nursing help protect my baby from COVID-19?

“We don’t know for sure, but we think that it’s highly probable,” Dr. Swamy says. This hypothesis is based on the fact that when the influenza and Tdap vaccines are given during pregnancy, babies are protected for a few months. Similarly, “some types of antibodies cross into breast milk,” says Dr. Perez, who got her own COVID-19 vaccine two weeks postpartum while nursing.

But is it recommende­d that I get vaccinated if I’m expecting?

At press time, the CDC can’t officially recommend the vaccine because pregnant people weren’t included in the trials, but there’s no reason to believe it’s not safe, says Dr. Swamy, who notes that the vaccine’s potential effects on pregnant people are being studied. President Joe Biden’s chief medical advisor, Anthony Fauci, M.D., said in early February that the more than 10,000 pregnant people who’d been vaccinated had not experience­d any unusual effects. It’s also worth noting that while the World Health

Organizati­on initially said there wasn’t enough data to recommend vaccinatin­g while pregnant, it now recommends vaccinatio­n for pregnant people who have a high risk of exposure or a high-risk medical condition. The bottom line: Most scientists studying the question believe that the risk of not getting the vaccine while pregnant far outweighs any risks associated with the vaccine itself.

Can my newborn be vaccinated?

No. As of press time, the vaccines are approved only for young adults 16 and older. While there are vaccine trials underway that include kids ages 12 to 16, vaccines for babies will probably be the last to be approved. But COVID-19 infections in newborns are very uncommon, and severe illness appears to be rare, according to the CDC. However, preterm babies and those with underlying conditions may be at an elevated risk of severe COVID-19 illness.

If I forgo the vaccine, what risks might I face if I develop COVID-19 while pregnant?

No increased risk of miscarriag­e or birth defects has been associated with COVID-19. But there appears to be a two- to threefold increased risk of preterm delivery, because if the mother has severe COVID-19 disease, delivery may be performed in hopes of optimizing her care, Dr. Louis says. Keep in mind: If you’re Covid-positive when you give birth and your baby is admitted to the NICU, you may not be permitted to visit for ten to 20 days.

If I get the vaccine, could I still get COVID-19?

Yes. No vaccine has an efficacy of 100 percent. But the two-dose Pfizer and Moderna vaccines are about 95 percent effective. And with 66 percent overall efficacy, the one-dose Johnson & Johnson vaccine is also considered a huge achievemen­t by health experts. All of these vaccinatio­ns are 100 percent effective in protecting against severe COVID-19, but health experts do not yet know whether they prevent asymptomat­ic COVID-19. And while there is emerging evidence that the vaccines reduce the spread, some unknowns remain. “That means that, yes, you should still wear masks and continue to socially distance even after you’re vaccinated,” Dr. Louis says. And even if you’ve already had COVID-19, you should still get vaccinated, to be on the safe side.

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