With news of not one, but two coronavirus vaccines on track for emergency use authorization by the end of the year, there’s a light at the end of the dark tunnel that was 2020. Both Pfizer and Moderna’s trials showed their jabs are around 95% effective at protecting against COVID after two doses. But these vaccines are unique in that they use a new technology, called mRNA, to trigger your body’s immune response. And that technology hasn’t ever been tested in pregnant people. So what does that mean for people who are kinda sorta thinking about being pregnant when these vaccines start to roll out?
“There’s isn’t a simple answer [to this question], especially, since no vaccine is currently approved,” Dr. Christopher Zahn, MD, vice president of practice activities at the American College of Obstetricians and Gynecologists, tells Bustle.
Despite plenty of data vouching for the safety of well-studied vaccines, Dr. Alisa Kachikis, MD, MSc, an expert in obstetric pharmacology and maternal-fetal medicine at the University of Washington, explains that there’s a lingering stigma around vaccines and pregnancy. This concern, she says, is often rooted in not wanting to expose their fetus to a foreign substance. But that’s not a helpful way of looking at them, she says. “Vaccines in general are safe during pregnancy and we recommend them.”
Vaccines & Pregnancy
Pregnant people are encouraged to get vaccinated against things like the flu, to confer immunity to both the parent and the fetus once born. The flu shot, like many other vaccines, is made with inactivated viruses to trigger your body’s immune response. Vaccines made with live viruses, for things like measles, mumps, and rubella (MMR), should not be given to pregnant people because they can theoretically harm a developing fetus, per the Centers for Disease Control & Prevention (CDC), but they’re completely safe for anyone who’s not pregnant. mRNA vaccines are a different category altogether; instead of putting a piece of virus into your body to trigger immunity, they use molecules that can teach the body’s cells how to produce the proteins that create antibodies.
Again, though, mRNA vaccines are such a new technology that they haven’t yet been studied in pregnant people. The FDA recommends pregnant people be included in all Phase 3 drug trials — and specifically encouraged it for the COVID vaccine — but cannot force pharmaceutical companies to do so. Neither Pfizer nor Moderna’s trial included pregnant people. Though public health experts have called for pregnant women to be included in studies as soon as possible, it’s still unclear at what point pregnant people will be allowed into these clinical trials.
In a statement, Pfizer tells Bustle, “We are working on a potential pathway to build a maternal indication into our program. Pfizer is following guidance provided by the Food and Drug Administration (FDA) for development and licensure of vaccines to help prevent COVID-19, including the important consideration of use in pregnant women and women of childbearing potential.” Moderna did not return a request for comment.
Kachikis notes that there’s no reason to assume that the safety data for pregnant people getting these kinds of vaccines would look very different from the data for non-pregnant people. In Moderna’s trial, most “adverse events” were mild or moderate, though almost 10% of participants reported a “severe” event — fatigue — after the second dose. Likewise, Pfizer’s most severe self-reported side effects were temporary fatigue or headaches.
What To Do About The COVID Vaccine If You’re Pregnant Or Want To Be
In October, the majority of a working group commissioned by the Advisory Committee on Immunization Practices (ACIP) at the CDC recommended that for people who are set to get the vaccine early — healthcare workers, for example — pregnancy should be “a precaution, but not a contraindication” for getting it, meaning it shouldn’t stop people from getting vaccinated. A majority of the group also recommended that if someone learns they’re pregnant after receiving the first dose of the vaccine, they should go ahead and get the second scheduled dose.
That’s because COVID-19 is a really awful disease for anyone, and being pregnant puts you at greater risk for a severe case. “We do know that there is an increased risk for adverse effects with pregnant women who have COVID-19 in terms of hospitalization, ICU admittance, even death,” says Kachikis, who is in the early stages of researching COVID immunity in pregnant people and their fetuses.
A Dec. 1 statement from the Society for Maternal Fetal Medicine also recommended that pregnant people get the vaccine after consulting with their healthcare provider, much for the same reasons. “Healthcare professionals should also counsel their patients that the theoretical risk of fetal harm from mRNA vaccines is very low,” the statement notes.
In absence of actual data, Kachikis says that people of reproductive age are going to be left having a “frank conversation with [their] healthcare provider” about risks and benefits of getting the vaccine. Zahn says, “Any decisions made should be based on any available data and recommendations for use in pregnancy, patients’ individual risk factors and the potential benefits, and their unique needs, desires, and values.”
Kachikis adds that these conversations should also go over what additional protective measures pregnant people will need to take — masking, social distancing, etc. — given that the vaccine won’t immediately end the pandemic. Same goes for the logistics of pregnancy in a pandemic — using telemedicine instead of in-person visits to reduce your risk of exposure, for example, and keeping an eye on how hospitals are managing labor and delivery. “I think for someone planning a pregnancy, that is really one of the most important steps to take right now,” Kachikis says.
Vaccine research is ongoing, and scientists will know more about them every day they’re in use. Until pregnant people can be studied, though, Kachikis says people shouldn’t let COVID make them afraid of becoming pregnant. “COVID-19 isn’t necessarily a reason to delay pregnancy, but it’s important to get all the information ahead of time or at the start,” she says.
Dr. Alisa Kachikis, MD, MSc