Poppy Insights: Should Pregnant & Postpartum Womxn Get the COVID-19 Vaccine?
Please note: Since this article was published on January 21st, The World Health Organization (WHO) has adjusted its guidelines and dropped opposition to administering this vaccine to pregnant and lactating womxn.
Keep watching this URL for all of the latest guidelines.
Pregnancy can be the most incredible journey, but with the fear and anxiety that comes with a global pandemic it can be intimidating. As COVID-19 vaccine research developed quickly, pregnant and postpartum womxn were not included in any of the studies, causing backlash in the medical community about the ethics of excluding the pregnant population from this important research. As a result, individual womxn and their medical providers are left to decide whether or not to receive the vaccine when it becomes available to them, weighing the risks of exposure against possible side effects, which aren’t fully known yet.
Should pregnant and postpartum womxn get the vaccine? How about pregnant and lactating frontline healthcare workers, whose work puts them at a higher risk for exposure? Is there any one right answer or formula to decide?
Often, pregnant womxn are disproportionately impacted by emerging medical research. In 1974, Congress passed the National Research Act, officially deeming pregnant womxn a “vulnerable population,” and excluding them from many treatment and medication trials, to avoid the risk of harm to fetuses. While medical ethics have evolved since then to allow for more inclusion of the pregnant population in research, many companies simply avoid testing on pregnant people because of the potential legal risk.
Consequently, there have increasingly been calls from the medical community to include pregnant people in vaccine trials. But until that happens, many birthing professionals are left frustrated, grappling with making medical recommendations around a new vaccine without knowing the risks involved.
In fact, in its latest report, last updated on January 8, 2021, The World Health Organization (WHO) announced that due to insufficient data it didn’t recommend the vaccination for pregnant and lactating womxn at this time, unless they are part of a group who has an unavoidable risk of exposure (a health worker, for instance).
Not only is COVID-19 leaving pregnant people anxious, but it’s also leaving them isolated. Many of our members who have been pregnant during the pandemic have had to go alone to important medical appointments, and they’ve lost the ability to have the support of a partner or family member at sonograms, check-ups, and even in labor and delivery.
Dr. Irina Burd, M.D., Ph.D., the Director of Integrated Research for Maternal Fetal Medicine at Johns Hopkins, whose clinical focus is caring for expectant mothers and their babies, has seen many of her colleagues at Johns Hopkins who are pregnant, opt to be vaccinated. For many of them, she says, the potential risk of contracting the virus, outweighs the risks of side effects from the vaccine. For many other women, however, that decision isn’t as clear-cut.
Last week, Dr. Burd and two of her colleagues, Sabra L. Klein, and Patrick S. Creisher, published a piece in The Journal of Clinical Investigation entitled “COVID-19 vaccine testing in pregnant females is necessary.” In it, they covered the background of testing for both the Pfizer-BioNTech and Moderna vaccines, the history of trial enrollment for pregnant womxn, and appealed to organizations developing vaccines to include this population in continued testing. “It is not ethical to ask pregnant women and their medical providers to make decisions about the COVID-19 vaccine in pregnancy and the implications for the health of the pregnancies, and fetal and neonatal development, with little to no empirical evidence upon which to base such decisions.”
Given that the vaccine is not live, Dr. Burd believes it should have been considered for clinical studies in pregnancy. “Other than live virus vaccines, there is no ethical reason to not include pregnant womxn in Phase III trials of the COVID-19 vaccines, especially if preclinical safety and toxicology data were available in animal models. Greater consideration of women’s health in vaccine studies is encouraged,” the group said in their closing remarks.
Dr. Kristin DiGregorio, DO FACOG, a board certified Ob-Gyn who works in a private practice on the Upper East Side of Manhattan, acknowledges that scientists were put in a tough spot regarding whether or not to include the pregnant population in the first round of COVID-19 vaccine testing. However, now that more is known about the vaccine compositions, and as medical trials go forward, she feels that this population should be included, if there are pregnant people willing to take part.
Dr. DiGregorio urged pregnant womxn to think about their risk/benefit situation. “Be honest with yourself about the amount of quarantining you’re doing. If you’re really not going anywhere, could it be less important for you to get the vaccine compared to someone who works in a COVID ICU? Maybe. But be honest about how much you’re really risking exposure based on your daily activity,” she said.
She also pointed out the impact of comorbidities, like diabetes or being overweight. “Especially if you fall into one of those categories of comorbidities, it’s a good idea to really consider getting the vaccine when it becomes available to you,” she added.
The bottom line: most likely, the benefits of receiving the vaccine and lowering your risk for COVID-19 exposure, will outweigh the risks of side effects.
As far as keeping safe beyond masking up and practicing social distancing, Dr. DiGregorio recommended; “Don’t put yourself in situations that you don’t need to be in, for example you don’t need to be going to a birthday party with people you do not normally see. Especially during pregnancy and postpartum periods, minimize the number of gatherings you’re going to, and the amount of travel you’re doing. You can control what you’re doing, but you don’t know what others are doing.”
So, what happens if you’re pregnant and a frontline worker? Allison France, who works in occupational medicine and is currently four-months pregnant, was left to decide whether to vaccinate or not.
Initially, she said, she didn’t want to get the vaccine, knowing it had not been tested on pregnant people. In doing her own research, though, she learned that the mRNA technology posed little risk to an unborn fetus, and because she and her husband work in healthcare and are at a higher risk for exposure, she decided to “opt in” to receive the vaccine.
“For other pregnant womxn, I would 100% recommend getting the vaccine (after, of course, consulting with your OB). While we do both work in healthcare, I was more concerned about my exposure outside of work. I have a child in daycare, and although they are great with preventing exposures, you never know what your kid will bring home. I also did a lot of research from trusted sources. I needed to see the data for myself to feel confident in my choice,” she said.
Whether or not you decide to get vaccinated while you’re pregnant or lactating, Poppy Seed Health is available for support. We’re committed to providing access to real-time emotional and mental health support from doulas, midwives and nurses. Learn more about us today.