Covid-19 vaccines put pregnant women in a dilemma

“What is the risk to my child if I get the vaccine? That empty 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 University of Pennsylvania hospital due to appear on March 21.

The dilemma faced by expectant mothers like Dr. Lewey, who decided to skip vaccination for the time being and to rely on masking and other precautions, highlights a flaw in screening Covid-19 vaccines during their hasty development: they were not tested at pregnant women.

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The companies behind two Covid-19 vaccines approved in the US have not enrolled pregnant women in the late studies to assess whether the injections are working safely.

In the absence of 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 that pregnant people should make the decision for themselves and encourage conversations with doctors.

Referring to insufficient data, the World Health Organization, meanwhile, has generally discouraged shots during pregnancy, except for those at high risk, such as health workers or those with certain health conditions. But on Friday, the WHO also said on its website that “we have no specific reason to believe there will be specific risks outweighing 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.

Mothers-to-be are more likely to have a serious case of Covid-19 than women who aren’t pregnant, and are more likely to have a premature birth if they get the disease, said Dr. Elovitz. The vaccine can help reduce the risks. Also, some vaccines have been shown to be safe for other infections during pregnancy and to provide protection for mother and child, she said.

Most experts say they don’t expect problems based on how mRNA vaccines work. Still, 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 during pregnancy, they say. The Pfizer and Moderna vaccines use a gene-based technology called messenger RNA, which was never approved for use until the pandemic.

The uncertainty makes the choice to vaccinate very challenging, expect mothers say.

“It was a tough decision,” said Brenda Manning, 37, who is currently a candidate for the vaccine in Dallas, where she lives.

Mrs. Manning has limited exposure to Covid-19 because she is a stay-at-home mother whose husband works from home. But her pregnancy and hypertension put her at higher risk for a serious case of Covid-19 should she get it.

After weighing up her options, Ms. Manning decided to sign up for the vaccine, although she was not given a date for her first dose. She thinks she can make one last call if she gets an appointment before her due date of February 14.

‘If I get a call earlier [the baby] I’ll make a decision about the race time, ”she said. “And if I don’t get the chance to get the vaccine for that, there is my answer.”

The way doctors handle the matter can vary depending on expectant mothers. Many said their doctors showed them through the risks and benefits before leaving the decision to them. Other women said their doctors encouraged vaccination after those talks.

About 39% of pregnant women surveyed by the University of California, San Diego, and the pregnancy advisory group MotherToBaby said they would not receive a Covid-19 vaccine if it became available to them, while 25% said they would not receive a vaccine while breastfeeding.

Thirteen percent said they wouldn’t get the vaccine anyway, according to the survey, which began in October and continues to this day.

Christina Chambers, a professor of pediatrics at the University of California, San Diego, who helps lead the survey as part of studies examining the impact of Covid-19 and the vaccines on pregnancy and breastfeeding, said the women are hesitant because of the lack of information.

Dr. Chambers said she expects more pregnant women will feel comfortable with vaccinations as the rollout continues.

The delay in establishing the safety of Covid-19 vaccines in pregnant women and fetuses is due in part to delays in animal testing, said Ruth Faden, founder of the Johns Hopkins Berman Institute of Bioethics who develop the PREVENT- project that advocates the inclusion of pregnant women. in the development of vaccines during pandemics.

The U.S. Food and Drug Administration recommends animal studies before researchers test vaccines in pregnant women.

Moderna says when tested in rats, it didn’t find his vaccine had any adverse effects on reproduction or development. The company plans to set up a registry to monitor the status of mothers who received the vaccine during pregnancy and their babies.

Pfizer says it has completed an animal study and submitted the data to the FDA. The European Medicines Agency said animal studies showed that Pfizer’s vaccine had no harmful effects on reproduction or development. Pfizer says it will start a vaccine study in mothers in the first half of 2021.

Pfizer and Moderna say they are monitoring what happens to those who became pregnant after vaccination, as well as any pregnant people who went through pre-vaccination screening during the trials.

The UK initially did not include women who were pregnant or soon to become pregnant in the vaccine rollout in December. Public Health England updated its guidelines in January, but says vaccination may be especially important for those who are highly exposed to the virus or have certain underlying high-risk health conditions. In those cases, women may choose to receive the vaccine after speaking with their doctor or nurse, the agency said.

In January, the Israeli Health Ministry updated its guidelines to recommend the vaccine for pregnant women, especially those with pre-existing medical conditions and those exposed to a lot of public exposure.

Write to Sarah Toy at [email protected] and Laura Cooper at [email protected]