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Should pregnant women get a COVID-19 vaccine?

Photo by Markus Spiske on Unsplash
Photo by Markus Spiske on Unsplash

Pregnant women are caught in the middle of differing opinions when it comes to getting vaccinated against the COVID-19 virus. And the opposing opinions about who should or shouldn’t get vaccinated is rooted in fears that further muddy the waters for a vulnerable group during a global pandemic.

A recent recommendation from the World Health Organization (WHO) caused a clash among health experts after stating that only pregnant women in a high-risk category get a COVID-19 vaccine on Jan. 26

“While pregnancy puts women at a higher risk of severe COVID-19, the use of this vaccine in pregnant women is currently not recommended, unless they are at risk of high exposure (e.g. health workers),” reads the recommendation.

When the statement was released, some healthcare industry groups disagreed, in part. In a joint statement, the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) noted they were “aware” of WHO’s statements, and yet remained steadfast in their opinion that FDA-approved COVID-19 vaccines should not be withheld from pregnant women.

WHO clarified its statement just a few days later, recommending pregnant women in the highest risk categories, such as women with comorbidities and healthcare workers, should have priority to get a vaccine. However, as an overall group, pregnant women were not considered to be among the highest risk or priority group for vaccination by WHO.

In contrast, other health experts might advise getting vaccinated due to a higher likelihood adverse outcomes for pregnant women who do contract COVID-19. Though researchers aren’t entirely sure why, pregnant women who are infected with the virus are at an increased risk for severe illness, as well as adverse pregnancy outcomes like preterm birth, compared to non-pregnant women of the same age, according to the Centers for Disease Control and Prevention (CDC).

“This is a scenario where if you deny the vaccine for someone who is high risk for getting the COVID-19 virus infection, you're putting them at a disadvantage,” Judette Louis, MD, immediate past president of SMFM and chair of obstetrics and gynecology at the University of South Florida, told The Whipp. “There is clear data that if you're pregnant and you catch COVID-19, you're more likely to end up critically ill, more likely to end up on a ventilator and more likely to die.”

Exclusive trials

Both the CDC and WHO cited a lack of data about vaccines for pregnant women in their COVID-19 recommendations. That’s because pregnant women were excluded from most clinical trials for COVID-19 vaccines, as well as many treatment options.

ACOG and SMFM have advocated for women to be included in these types of trials, but fears about potential harms and regulations have kept this group on the outs historically.

“Part of it is fear there may be harm to the fetus, fear of litigation, and there are some FDA rules that make it hard to include pregnant women in trials,” explained Louis.

Unfortunately, focus on the potential harm to the fetus may also take away from potential harm to the mother, according to Louis.

In advocating for pregnant women to be considered for inclusion in trials, “we’re framing it as this is an emphasis on the life of the mother too, and not just saying no to the vaccine because of potential harm to the baby,” Louis told The Whipp. “If the mother is critically ill or if the mother dies, then that impacts the baby. So we need a healthy mother too.”

Instead of trials, drugs and vaccines in pregnant women are often studied after-the-fact, when treatments and vaccines are already widely in use. To avoid confusion and delayed safety facts, pregnant women should be included in trials, according to Christopher Zahn, MD, ACOG’s vice president of Practice Activities.

“ACOG strongly advocated for the inclusion of pregnant people in the COVID-19 vaccine trials so that we would currently have the data to support the safety and efficacy of the vaccines in this population,” Zahn told The Whipp in a statement. “But even in the absence of this data, pregnant people should know that the way the vaccines work and early evidence from animal studies gives us reason to believe that there should be no harmful effects to the fetus or female reproduction.”

Even without the clinical trial data, the type of vaccines already approved by the FDA, by Pfizer and Moderna, are well-known and studied.

“The safety of these vaccines were demonstrated in the clinical trials with non-pregnant individuals and it is expected that there will be similar results in pregnant individuals,” Zahn said.

Individual assessment

Healthcare groups across the board agree that all pregnant people should take an individual assessment to determine their own risk when considering getting a vaccine. For instance, for a person who works from home, limits their exposure to others and has a spouse or partner who also works from home, may feel their risk of contracting COVID-19 is relatively low, and therefore hold off getting vaccinated when available, according to Louis. In contrast, a healthcare professional or someone in a setting with high exposure may should likely get vaccinated.

But there’s no doubt that making that individual assessment is more difficult without data. Women in general are also more wary of getting a COVID-19 vaccine, with one recent study finding men were more likely to say they would get vaccinated against the virus compared to women. Plus, a rising anti-vaxx movement and proliferation of misinformation across social media platforms further misconstrue facts about safety and efficacy.

“If we’re completely honest, even when we have data there is still fear of vaccines,” Louis said. “But this makes it even worse in that [pregnant women] were not included. So we get some patients telling us that because there were no pregnant women in those trials, they don’t want to take the chance and take the vaccine.”

Still, patients should have the autonomy to make the decision for themselves, according to both SMFM and ACOG. And that means not withholding options from women.

“It’s not an easy choice for some but we should certainly know more in the months to come, as studies in pregnant women are set to begin soon and data is currently being collected on pregnant individuals who inadvertently and intentionally received the vaccines,” Zahn told The Whipp. “For now, some may decide that the risks outweigh the benefits but ACOG firmly believes that pregnant people deserve autonomy and must be given the choice to be vaccinated in the face of a potentially life-threatening virus and in the absence of credible data that would suggest it would do harm.”

Editor's note: This article has been updated. A previous version misspelled the name of Dr. Judette Louis. We regret the error.

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