New and expectant mothers navigate a swamp of science and medicine as they try to reduce the risks of COVID-19 to themselves and their babies.
Why it matters: Pregnancy can be difficult in normal times, but there is an extra layer of uncertainty during the pandemic as COVID-19 poses unique risks for pregnant people.
Driving the news: NIAID director Anthony Fauci said on Wednesday that approximately 20,000 pregnant people in the US have been vaccinated so far and no complications have been seen.
- But “it takes us quite some time to follow the woman and her fetus and then her baby and see how things will turn out,” Geeta Swamy, associate professor of OB / GYN and emphasizes an associate vice president of research at Duke.
- The Pfizer BioNTech and Moderna vaccines approved for use in the US do not use live or attenuated viruses, and studies in pregnant animals suggest they are safe, experts say. However, pregnant and lactating people were not included in the initial vaccine studies.
- “No one expects there will be an impact on the development or growth of the fetus,” Swamy tells Axios. But some are concerned that potential side effects from the vaccine, including fever and inflammation, could stress the fetus.
- “We have good theoretical data and those risks are not high, but ultimately individuals have to make that choice, which is difficult,” said Naima Joseph, who specializes in maternal internal medicine at Emory University’s School of Medicine.
Between the lines: Because of this, pregnant people have to weigh the risks. The CDC does not take a position, saying, “People who are pregnant and are in a group recommended to receive the COVID-19 vaccine may choose to get vaccinated.”
On the one hand: Data show that pregnant people are at higher risk of developing severe COVID-19 compared to women of the same age who are not pregnant, and there appears to be a risk of preterm birth.
- Pregnant people are “more likely to be hospitalized, require intensive care, require ECMO, be ventilated, and sadly die,” Emory Healthcare’s Denise Jamieson told a JAMA webcast Monday.
On the other hand: Clinical studies, including those for COVID-19 vaccines, generally do not include pregnant or lactating people, leaving a gap in knowledge about the effect of one of the most important tools for fighting pandemics.
- Catherine Spong, Chief of Maternal-Fetal Medicine and Vice Chair of UT Southwestern’s OB / GYN Division, said on the webcast that many experts were “absolutely” disappointed that pregnant or breastfeeding people were not in the phase III studies were included.
- A congressional task force met for years and came up with recommendations and an implementation plan on how these two groups could get involved, and “yet, again, they weren’t included in anything where they were clearly at higher risk,” Spong said. who co-authored a piece in JAMA this week about COVID-19 vaccination for pregnant and lactating people.
An open question is whether a baby will be protected if its pregnant mother is vaccinated.
- Pregnant people are recommended to get flu and Tdap vaccines because the newborn will have some immunity for the first few months, Swamy said.
- A handful of recent studies, including one from Joseph, found COVID-19 antibodies from an infection crossing the placenta.
- But antibodies didn’t transfer as quickly as “we know the placenta can” from research into other pathogens, says Joseph. “We don’t know yet what that means for vaccines,” but are now conducting research.
Other pressing questions …
- Can a Mother’s Infection Affect the Fetus? “We think an infection can occur, but it is quite rare,” said Joseph. “Over a year of data and deliveries there does not appear to be an increased risk of birth defects or anything other than preterm birth,” especially in people with serious illness.
- Can caregivers such as grandparents safely help? Jamieson and Spong recommend that caregivers get vaccinated and wait two weeks after the second injection (for the mRNA vaccines). They must wear masks and practice good hygiene.
- Breastfeeding women can receive the vaccine safely, Swamy, who is supported by the Academy of Breastfeeding Medicine.
What to watch: Pfizer and J&J, which have filed for an emergency use for their COVID-19 vaccine, plan to initiate clinical trials for pregnant people, and the CDC monitors all vaccinated people through its v-safe program.
- Looking ahead, says Joseph, “the highest priorities are the inclusion of the mother in studies looking at adaptive immunity, because that is the only way to design rational vaccines for this population.”