Doctors say the answer depends on the woman’s risk of getting Covid-19 and her underlying health issues, but there isn’t enough data yet to make a definitive recommendation. Guidance from health agencies, meanwhile, varies.
“What’s the risk to my child if I get the vaccine? That blank space, that data-free zone of not knowing what the effects would be, is really worrisome,” said Jennifer Lewey, a 40-year-old cardiologist at the Hospital of the University of Pennsylvania who is due March 21.
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The dilemma faced by expectant mothers like Dr. Lewey, who decided to skip vaccination for now and rely on masking and other precautions, highlights a gap in vetting Covid-19 vaccines during their rushed development: They weren’t tested in pregnant women.
the companies behind two Covid-19 vaccines authorized in the U.S., didn’t enroll pregnant women in the late-stage trials evaluating whether the shots work safely.
Absent hard data, the U.S. Centers for Disease Control and Prevention, American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine say pregnant people should make the decision for themselves, encouraging conversations with doctors.
Citing insufficient data, the World Health Organization, meanwhile, has generally advised against the shots in pregnancy, except for high-risk individuals like health-care workers or those with certain health issues. But on Friday, the WHO also said on its website that “we don’t have any specific reason to believe there will be specific risks that would outweigh the benefits of vaccination for pregnant women.”
Michal Elovitz, an obstetrician-gynecologist and director of the maternal and child-health research center at the University of Pennsylvania, said she leaves the choice to her patients after discussing the potential benefits and risks.
Expectant mothers are more likely to have a severe case of Covid-19 than women who aren’t pregnant, and have a higher chance of needing a preterm delivery if they contract the disease, Dr. Elovitz said. The vaccine could help reduce the risks. Also, some vaccines for other infections have been shown to be safe in pregnancy and offer protection to the mother and child, she said.
Most experts say they don’t anticipate any issues, based on how mRNA vaccines work. Yet scientists still don’t know if the mRNA vaccine can cross the placenta, and if it can, scientists don’t know if it would harm the fetus, maternal and fetal health experts say. This type of vaccine has never been used in pregnancy, they say. The Pfizer and Moderna vaccines use a gene-based technology called messenger RNA, which had never been cleared for use until the pandemic.
The uncertainty makes the choice to vaccinate very challenging, expectant mothers say.
“It was a hard decision,” said Brenda Manning, 37, who is currently eligible to receive the vaccine in Dallas, where she lives.
Ms. Manning has limited exposure to Covid-19 because she is a stay-at-home mother whose husband works from home. Yet her pregnancy and hypertension put her at higher risk of having a severe case of Covid-19, should she get it.
After weighing her options, Ms. Manning decided to sign up for the vaccine, though she hasn’t been given a date for her first dose. She figures she can make a final call if she gets an appointment before her Feb. 14 due date.
“If I get called to do it before [the baby] comes, I’ll make a game-time decision,” she said. “And if I don’t get the opportunity to get the vaccine before that, there is my answer.”
How doctors handle the matter can vary, according to expectant mothers. Many said their doctors walked them through the risks and benefits, before leaving the decision up to them. Other women said their doctors encouraged vaccination after those conversations.
Some 39% of pregnant women surveyed by the University of California, San Diego, and pregnancy-counseling group MotherToBaby said they wouldn’t get a Covid-19 vaccine if it became available to them, while 25% said they wouldn’t get a vaccine while breast-feeding.
Thirteen percent said they wouldn’t get the vaccine regardless, according to the survey, which began in October and is continuing.
Christina Chambers, a professor of pediatrics at University of California, San Diego, who is helping lead the survey as part of studies looking at how Covid-19 and the vaccines affect pregnancy and breast-feeding, said the women are hesitant because of the lack of information.
Dr. Chambers said she expects more pregnant women will become comfortable with vaccinations as the rollout continues.
The delay establishing the safety of Covid-19 vaccines in pregnant women and fetuses stems partly from lags conducting tests in animals, said Ruth Faden, founder of the Johns Hopkins Berman Institute of Bioethics who helps lead the PREVENT project, which advocates for including pregnant women in the development of vaccines during pandemics.
The U.S. Food and Drug Administration recommends the animal studies before researchers test vaccines in pregnant women.
Moderna says it didn’t find its vaccine had adverse effects on reproduction or development during testing in rats. The company plans to establish a registry to monitor how mothers who got the vaccine while pregnant and their infants fare.
Pfizer says it has finished an animal study and submitted the data to the FDA. The European Medicines Agency said animal studies found Pfizer’s vaccine didn’t have harmful effects on reproduction or development. Pfizer says it will start a maternal vaccine study in the first half of 2021.
Pfizer and Moderna say they are tracking what happens to those who became pregnant after vaccination, as well as any pregnant people who slipped through pre-vaccination screening during the trials.
The U.K. didn’t initially include women who were pregnant or soon-to-be pregnant in its vaccine rollout in December. Public Health England updated its guidance in January, however, saying vaccination could be particularly important for those who are highly exposed to the virus or have certain underlying high-risk health conditions. In those cases, women may choose whether to get the vaccine after having a discussion with their doctor or nurse, the agency said.
In January, Israel’s Health Ministry updated its guidance to recommend the vaccine for pregnant women, especially in those with pre-existing medical conditions and those who have a lot of exposure to the public.
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