As the Centers for Disease Control and Prevention expands its guidance for pregnant women surrounding the coronavirus vaccine, what should women who are pregnant or are planning to become pregnant know about getting vaccinated?
As the Centers for Disease Control and Prevention issues its strongest guidance to date urging pregnant women to be vaccinated against COVID-19, what should those who are pregnant or planning to be pregnant know about the vaccines available?
Here's the latest guidance from health officials, doctors and other experts surrounding pregnancy and the COVID vaccines:
Is it Recommended That Pregnant Women Receive the COVID Vaccine?
The CDC on Wednesday issued an alert recommending "urgent action" to increase vaccinations among "people who are pregnant, recently pregnant (including those who are lactating), who are trying to become pregnant now, or who might become pregnant in the future."
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"CDC strongly recommends COVID-19 vaccination either before or during pregnancy because the benefits of vaccination outweigh known or potential risks," the alert stated.
Pregnant women are at risk for pregnancy complications from the coronavirus, with some evidence indicating the virus might increase the chances of stillbirth. They also face a higher chance of requiring intensive care or mechanical ventilation, according to data from the CDC.
"I think most people who are pregnant are generally young and generally healthy, so they don’t really expect that if they were to get this infection, that they could be as sick as we are seeing," said Dr. Brenna Hughes, vice chair of obstetrics and quality in the department of obstetrics and gynecology at Duke University. “It’s surprising to me how few people realize it can happen to them until it does.”
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New guidance from the American College of Obstetricians and Gynecologists (ACOG) says pregnant women can and should get vaccinated against coronavirus.
"We’ve been able to have experience now with the vaccine in pregnancy. We also have more evidence of the benefits of the vaccine as far as antibody transfer to baby," Dr. Linda Eckert, ACOG’s liaison on the Advisory Committee on Immunization Practices said in August.
Chicago's top doctor recently addressed misinformation surrounding the vaccine and pregnancy and fertility, saying data has shown protection can possibly transfer from mom to baby.
"Early studies from the CDC even show mothers can pass some immunity to their children if they are vaccinated," Chicago Department of Public Health Commissioner Dr. Allison Arwady said.
In late April, the CDC announced it was recommending shots for pregnant women after preliminary data showed that Pfizer's and Moderna's vaccines were safe for women as well as their babies. The guidance indicated studies found "no obvious safety signals" surrounding vaccination in pregnant women.
"Women who are pregnant and get COVID have worse experiences with the infection than do non-pregnant women," CDC Principal Deputy Director Dr. Anne Schuchat said at a U.S. Senate hearing in mid-May. "More time in the intensive care unit, more risk of severe outcomes including those rare deaths..."
What Data is Available on the Vaccine in Pregnant Women?
In data released last week, the CDC said a recent study found COVID vaccination does not increase the risk of miscarriage or birth defects.
The agency tracked 1,613 pregnant women who received a COVID-19 vaccine, 30% of whom were vaccinated in the second trimester, while the remaining 70% received their inoculations in the third trimester, Dr. Christine Olson, a CDC medical officer, told the agency's Advisory Committee on Immunization Practices on Wednesday.
Those participants gave birth to 1,634 infants, including 42 twins.
"We reviewed the currently available registry data and found no evidence of an increase in spontaneous abortion rates, and no evidence of any disproportionate negative infant birth outcomes," Olson said.
The 1,613 participants were part of the CDC's v-safe pregnancy registry, which had 5,096 enrollees as of Sept. 13. The CDC reported that 79.4% of the registry's enrollees were white, 8.4% were Asian, 8.1% were Hispanic and 1.4% were Black. Approximately 65% were between the ages of 25 and 34, while 33% were 35 to 44 years old.
Olson cited a CDC study on COVID vaccine-related miscarriages conducted from Dec. 14 through July 19. The report factored into its findings a 12.8% risk of miscarriage by the 20th week of gestation among 2,456 participants who received Pfizer's or Moderna's vaccines while pregnant, which is the normal risk of miscarriage after adjusting for the mom's age.
In addition, the CDC reports "studies in animals receiving a Moderna, Pfizer-BioNTech, or Johnson & Johnson (J&J)/Janssen COVID-19 vaccine before or during pregnancy found no safety concerns in pregnant animals or their babies."
One recent study, published Sept. 8 as a research letter in JAMA, looked at the records of more than 105,000 pregnancies and found no difference between miscarriage rates for those who got a vaccine and those who didn't.
At the same time, the recent guidance comes as more than a quarter million cases of COVID in pregnant women have been reported, 22,000 of whom were hospitalized, according to the CDC.
A total of 161 pregnant women have died of COVID, the CDC said, with 22 deaths in August alone. Yet, less than a third of pregnant women have been vaccinated, the agency reported.
What Should Pregnant Women Consider Before Getting the Vaccine?
The CDC recommends expectant women who may be hesitant to contact their health care provider.
Key considerations to discuss might include:
- The unknown risks of developing a severe allergic reaction
- The benefits of vaccination
The CDC also said all women under the age of 50 "should be aware of the rare risk of TTS [Thrombosis with thrombocytopenia syndrome]" after receiving the Johnson & Johnson vaccine. This risk was no seen with the Moderna of Pfizer mRNA vaccines, officials said.
Pregnant women should also consider their risks of contracting COVID-19 as the potential for severe illness is increased, experts said.
Are Pregnant Women at a Higher Risk for COVID-19 Infections?
The CDC stated that pregnant people who contract COVID-19 "have an increased risk of severe illness," including the risk of an infection that could lead to ICU admission, mechanical ventilation, and possibly death. Pregnant people with COVID-19 could also face an increased risk of adverse pregnancy outcomes, such as preterm birth, the agency added.
According to preliminary findings of a study from the National Institutes of Health, pregnant women who experienced severe symptoms of COVID-19 had a higher risk of complications during and after pregnancy.
"Compared to nonpregnant women who have the same health and age, a COVID-infected woman is about 1.3 to 1.4 times more likely to end up in the hospital when she's pregnant," Dr. Regan Theiler, a Mayo Clinic obstetrician, said in a statement.
Another 2020 report, from the journal BMJ, concluded that compared to those without COVID-19, pregnant women who have the disease are 18 times more likely to end up in the ICU, nearly three times more likely to die from the disease and nearly one and a half times more likely to have a premature delivery.
More than a quarter million cases of COVID in pregnant women have been reported, 22,000 of whom were hospitalized, according to the CDC.
A total of 161 pregnant women have died of COVID, the CDC said, with 22 deaths in August alone. Yet, less than a third of pregnant women have been vaccinated, the agency reported.
What About Vaccine Side Effects?
Pregnant women are not expected to experience different or more severe side effects from the vaccines, experts said.
According to the CDC, some people who receive the vaccine could experience a fever, particularly after their second dose.
"If you experience fever following vaccination you should take acetaminophen (Tylenol) because fever—for any reason—has been associated with adverse pregnancy outcomes," the CDC's website states.
Pregnant people should also talk to their doctors if they have a history of allergic reactions to any other vaccines or injectable therapy.
The CDC also said all women under the age of 50 "should be aware of the rare risk of TTS [Thrombosis with thrombocytopenia syndrome]" after receiving the Johnson & Johnson vaccine. This risk was no seen with the Moderna of Pfizer mRNA vaccines, officials said.
What About Women Who Are Breastfeeding?
The CDC reported there is currently "limited data" for breastfeeding women, but said early reports have shown that antibodies in breastmilk could help protect babies.
According to the CDC, there is limited data on:
- Safety of COVID-19 vaccines in people who are breastfeeding
- Effects of vaccination on the breastfed baby
- Effects on milk production or excretion
"COVID-19 vaccines cannot cause infection in anyone, including the mother or the baby, and the vaccines are effective at preventing COVID-19 in people who are breastfeeding," the CDC's website state. "Recent reports have shown that breastfeeding people who have received mRNA COVID-19 vaccines have antibodies in their breastmilk, which could help protect their babies. More data are needed to determine what protection these antibodies may provide to the baby."
According to the American College of Obstetricians and Gynecologists, "theoretical concerns regarding the safety of vaccinating lactating individuals do not outweigh the potential benefits of receiving the vaccine."
The University of Chicago Medicine said that experts "do not believe that breastfeeding will provide any antibody protection to the baby."
"However, we do not yet have any data on this point and it should be clarified in future studies," the health care group noted.
Does the COVID Vaccine Affect Fertility?
Chicago's top doctor said "it's been studied" and there have been "no impacts on fertility in men, or in women."
Arwady tweeted that "there are still studies underway, but there is currently no evidence that ANY vaccines, including COVID vaccines, cause fertility problems in women or men."
COVID-19 mRNA vaccines are not thought to cause an increased risk of infertility, according to ACOG.
The CDC said those trying to become pregnant now or who want to get pregnant in the future, along with their partners, are encouraged to receive the vaccine.
"Those who are trying to become pregnant do not need to avoid pregnancy after COVID-19 vaccination.," the CDC's website states. "There is currently no evidence that any vaccines, including COVID-19 vaccines, cause fertility problems. Many women have become pregnant after receiving COVID-19 vaccine. However, results from ongoing long-term studies are not yet available."
