After an astonishingly fast effort to develop a safe and effective vaccine against COVID-19, the United States is on the precipice of having multiple options. Pfizer has sent out the first shipments of its vaccine nationwide, and they will be first rolled out to health care workers and nursing home residents.
But what about pregnant women? Should they get vaccinated against the coronavirus — and should they be prioritized?
Here’s what we know, and don’t know, so far:
The American College of Obstetricians and Gynecologists says pregnant women should not be excluded from vaccination.
This week, the American College of Obstetricians and Gynecologists offered people who are expecting, and their care providers, the first piece of official guidance on COVID-19 vaccination and pregnancy: The organization said COVID-19 vaccines should not be withheld from those who are pregnant who otherwise qualify to receive initial supplies based on current prioritization standards.
That’s true for people who are breastfeeding as well.
So for now, that really means pregnant or breastfeeding individuals who are health care workers should be able to get the vaccine, ACOG says.
But so far, pregnant people have NOT been included in trials.
Yes, ACOG is recommending that pregnant and breastfeeding individuals who qualify to receive the COVID-19 vaccine should be able to — but that does not mean the vaccines have been tested in pregnant women. They have not, which means there is no safety data specific to use during pregnancy.
“When the vaccines do become widely available, unfortunately, we have no data on the safety of the vaccine in pregnant and lactating individuals because they were excluded from Phase 2 and Phase 3 clinical trials for all of the COVID-19 vaccines in development,” Dr. Christopher Zahn, ACOG’s vice president of practice activities, told HuffPost. (Again, COVID-19 vaccination is really only available to health care professionals and residents in nursing homes, but this will change in the coming months.)
Despite a decadeslong push to include expectant mothers as subjects in clinical research, it’s actually not uncommon to exclude pregnant women from the early stages of vaccine development, when researchers are really testing for safety. For example, pregnant women weren’t included in initial trials for the H1N1 vaccine. So while they were identified as a high-risk population, there wasn’t readily available data about what kind of dosing they should receive.
“Certainly the lack of safety and efficacy data will need to be part of the conversation that patients who are pregnant or considering pregnancy will need to have with their obstetrician-gynecologist or other health care professional,” Zahn said about receiving a COVID-19 vaccine.
ACOG says pregnant women should have access to all of the data that is currently available about vaccine safety and efficacy, but does not believe that talking to a health care provider beforehand should be required. That could create unnecessary barriers to access, the group says.
One critical note: The lack of information so far on how the vaccine might impact pregnant women does not necessarily indicate that researchers and doctors are particularly concerned that it would be harmful to them. Women get vaccinated for other illnesses during pregnancy all the time, including whooping cough and the flu. And some of the antibodies they develop pass through the placenta (or breast milk, for breastfeeding moms), which offers their baby some protection.
“There is no suspicion that the vaccine should be bad for pregnant women,” Dr. Jane Minkin, clinical professor of obstetrics, gynecology and reproductive sciences at Yale University School of Medicine, told HuffPost. “But we just do not have the information.”
Pregnant women do seem to face higher risks with COVID-19.
Unlike with the H1N1 virus, which posed a grave risk to pregnant women, the impact of the coronavirus has been less clear. But based on data collected over the past few months, the Centers for Disease Control and Prevention and ACOG say that pregnant women are at slightly higher risk of becoming seriously ill with COVID-19. They also have a higher risk of dying from the virus than their non-pregnant counterparts.
Scientists aren’t sure yet whether the virus can cross the placenta, though one preliminary study of 31 women did find evidence of it in women’s umbilical cord blood, placenta and breast milk. However, the good news is that the CDC says it’s “uncommon” for newborns whose mothers have COVID-19 to have the virus themselves, and among those who do, it’s not clear whether they contracted the virus before, during or after delivery.
The old public health standbys remain particularly important for moms-to-be.
Because pregnant women appear to be at higher risk of severe illness, experts say it’s especially crucial that those women be diligent about the preventive measures we know protect against the virus.
And those who are pregnant and breastfeeding who qualify for the vaccine based on current national prioritization can work with their doctors or health care providers to determine what the risks and benefits may be.
“What do I advise pregnant women? To practice what we all should be doing: mask-wearing, hand-washing, social distancing. And please get flu shots if you haven’t had them yet ― that’s one thing we can easily do,” Minkin said. “Be careful and stay tuned.”
This post has been updated with additional information released about pregnancy, breastfeeding and the vaccine.
Experts are still learning about COVID-19. The information in this story is what was known or available as of publication, but guidance can change as scientists discover more about the virus. Please check the Centers for Disease Control and Prevention for the most updated recommendations.