What to know about pregnancy and COVID-19
During a recent public event, Pennsylvania’s acting Health Secretary Keara Klinepeter shared the news that she was pregnant and had received her booster shot against COVID-19.
“I want my story to help other women across Pennsylvania make an informed decision,” she said.
When the COVID-19 vaccines first became available in December 2020, their safety hadn’t yet been tested in pregnant and breastfeeding women. Understandably, that made many women wary of getting the vaccine while pregnant or trying to conceive.
Now, more than a year later, the evidence is clear that the vaccines are not only safe during pregnancy but also that unvaccinated women who get sick with COVID-19 are more likely to experience severe complications during pregnancy.
“As the pandemic has unfolded, it’s become increasingly clear that COVID-19 is not an infection that you want to get while you’re pregnant,” said Dr. Richard Beigi, president of UPMC Magee-Womens Hospital and professor of reproductive sciences at Pitt. As part of a multicenter study that includes UPMC, Dr. Beigi has been studying the COVID-19 vaccines in hundreds of pregnant and postpartum women.
Only 42% of pregnant individuals in the United States are fully vaccinated, according to the Centers for Disease Control and Prevention, with less than 19% receiving their full vaccine course during pregnancy. Vaccination among pregnant individuals has been steadily increasing over the past year, but it’s still well below the 67% national vaccination rate among those who are eligible for the vaccine.
A study published in Nature Medicine this month underscores the importance of getting vaccinated during pregnancy. The study, which included nearly 88,000 pregnant women in Scotland, found that 98% with COVID19 during pregnancy who were admitted to critical care were unvaccinated.
It also found that those who got COVID-19 toward the end of their pregnancies were far more likely than the general pregnant population to have a stillborn infant or one that died in the first month of life. The death rate was 23 per 1,000 births, compared with a baseline rate of 6 per 1,000 births in Scotland. In all of the babies’ deaths, the mothers were unvaccinated at the time of infection.
That indicates that vaccination is valuable not only for adults, but also it is potentially lifesaving for infants.
Following are local experts’ answers to frequently asked questions about the risks of COVID-19 and the safety of the vaccines during pregnancy.
Why is COVID-19 so risky during pregnancy?
Doctors think pregnancy increases the risk of COVID-19 complications in part because the immune system is weakened during pregnancy, which affects your body’s ability to fight off infection. During pregnancy, your immune system adjusts to prevent your body from rejecting the fetus.
“This is the same for the flu and other common illnesses. Pregnant women are considered high risk when it comes to getting sick,” said Dr. Michelle Harvison, chair of obstetrics and gynecology at St. Clair Health. “That’s simply because of the physiologic changes of pregnancy that affect their immune system.”
Pregnancy can also cause decreased lung capacity because of the pressure that the womb puts on the diaphragm. That means respiratory illnesses like COVID-19 can be exacerbated in pregnant women, according to Dr. Harvison.
Will the vaccine affect my fertility?
There’s no evidence that the vaccine causes infertility despite misinformation that has stated otherwise. Some social media posts have falsely claimed that the vaccines contain a protein called syncytin-1, which is vital for the development of the placenta and a successful pregnancy. The posts claim the vaccine would generate antibodies against the placenta, damaging it and causing miscarriage or infertility.
But syncytin-1 shares only a tiny piece of genetic code with the coronavirus spike protein, which is made in the body by the COVID-19 vaccines. They are two distinct proteins, and it’s not possible for the antibodies created by the vaccines to recognize and attack the placenta.
Researchers at Northwestern University confirmed that the vaccine does not harm this organ in a May 2021 study in the journal Obstetrics & Gynecology. After examining the placentas of 84 vaccinated patients and 116 unvaccinated patients, they found that the placentas of vaccinated women were not injured in any way. However, the placentas of those who tested positive for COVID-19 while pregnant showed evidence of abnormal blood flow.
A new study by researchers at Boston University found that fertility rates among women who received at least one dose of the Pfizer-BioNTech, Moderna or Johnson & Johnson vaccine were nearly identical to unvaccinated women. The study included 2,126 women in the United States and Canada while they were trying to conceive and followed them through six months after delivery. The findings were published this month in the American Journal of Epidemiology.
When is the best time to get the vaccine?
Dr. Grace Ferguson, an obstetrician and gynecologist at AHN West Penn Hospital, said: “You can get the COVID-19 vaccine anytime in your pregnancy.” Health care or other frontline workers who are at high risk of exposure and infection should get the vaccine as soon as possible, she said.
There’s no association between getting the vaccine and miscarriage, and in fact, infection with COVID-19 actually increases the possibility of miscarriage. But many pregnant patients understandably worry about miscarriage early on in their pregnancy. Up to one in five pregnancies end in miscarriage, most often during the first trimester of pregnancy.
“If you’re having any anxiety, I would recommend that you double mask, really limit your exposure, and then when you feel more comfortable about getting out of that first trimester and the pregnancy being well settled and established, then let’s get you your COVID-19 vaccine as soon as your comfort allows,” Dr. Ferguson said.
The last thing she wants is for a patient to attribute a pregnancy loss to the vaccine and potentially refuse future vaccines, including ones for children. “I don’t want a patient to have this bad association with the vaccine because pregnancies end so often in miscarriage,” she said.
How will the vaccine affect my baby?
There’s nothing in the vaccine that could harm a developing baby, although the CDC has been closely monitoring for any adverse effects to mothers and their babies. In a study of 40,000 pregnant women, researchers found that COVID-19 vaccination during pregnancy was not associated with preterm birth or low birth weight. The findings were published in the CDC’s Morbidity & Mortality Weekly Report earlier this month.
Several studies have also found that the number of women who had miscarriages after vaccination is not higher than the miscarriage rate in the general population.
In fact, as the Scottish study showed, the vaccine offers protective benefits for both mother and baby. Vaccination elicits antibodies to SARS-COV-2, the virus that causes COVID-19. These antibodies are able to cross into the placenta and circulate in a baby’s blood after delivery. Neutralizing antibodies have also been found in the breast milk of vaccinated lactating women, another avenue of potential protection against the virus.
“Children under 5 are not able to get the vaccines yet,” Dr. Beigi said. “But the vaccine can provide protection before the baby is able to get their own vaccine.”
What side effects can I expect in pregnancy?
A June 2021 study published in the New England Journal of Medicine found that pregnant women reported more pain at their injection site than women who weren’t pregnant, but they also reported fewer symptoms of chills, fever, headache and muscle aches, which are all common with the COVID-19 vaccines.
Are other vaccines safe in pregnancy?
Vaccines for chickenpox and measles, mumps and rubella, or MMR, are not recommended during pregnancy because they’ re live virus vaccines. That means they’ re made using a living but weakened version of the pathogen. For people with weakened immune systems, live virus vaccines carry a small risk of infection.
“With a live vaccine, there is a theoretical risk that you could actually get the disease,” Dr. Ferguson said. “There are certain infections, like measles, that we would really strongly prefer women avoid in pregnancy because the infection can harm the pregnancy.”
The Moderna and PfizerBioNTech vaccines contain no live virus, while the Johnson & Johnson vaccine uses a modified version of a different virus — one known to be harmless to people — to deliver instructions to our cells.
The flu vaccine and tetanus, diphtheria and pertussis, or Tdap, vaccine are also safe and recommended during pregnancy because they contain no live virus. Both vaccines provide protection for mothers, as well as their babies.