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What you should know about getting the COVID-19 vaccine while pregnant

Early research shows it might protect both you and your baby. We talked to an expert about the benefits and risks.

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Pregnant people are often left out of medical studies, so when vaccines became available to protect against COVID-19, pregnant people looking for answers largely came up empty-handed. While the COVID-19 pandemic has shined some light on pregnant and breastfeeding women's age-old status as "vulnerable," the lack of data collected about pregnancy in all three of the US's available vaccines' clinical trials may have left you sifting through conflicting advice on how to best protect you and your child. 

The Centers for Disease Control and Prevention says that those who are pregnant can get a COVID-19 vaccine, but it stops short of a full recommendation because of the lack of clinical data. (There are studies underway right now, as well as information available through the Vaccine Adverse Event Reporting System and v-safe pregnancy registry). Additionally, agencies that serve pregnant people, including the American College of Obstetrics and Gynecology, back the CDC's guidance that vaccines should be available to pregnant and breastfeeding people because of their high risk of COVID-19 complications, which can also affect the fetus and lead to preterm deliveries.

Given the constant swirl of clashing advice and misinformation about COVID-19 vaccines, fertility and pregnancy, you may be in a tough spot trying to make the best choice for you and your growing family. To help clear some of it up, we talked to an expert and looked at a few studies about the benefits and risks of getting vaccinated while pregnant. 

I'm pregnant. Should I get the COVID-19 vaccine? 

Dr. Ella Speichinger, an OB-GYN at University of Missouri Health Care, says she recommends it to patients, because the known risks of COVID-19 are greater than the unknown risks of COVID-19 vaccination during pregnancy. 

"That's true of almost all vaccines, but it's especially true for COVID, even though there is the emergency exemption waiver on it, and it was not studied in pregnant women," Speichinger says. 

However, Speichinger says she values concerns patients have about the vaccine, because there is a lot doctors don't know, simply because it hasn't been studied. "I think it's important to underscore that that is a true thing, and to validate that for women," she says. "And at the same time point out that there are real known risks for COVID." Speichinger says a pregnant person considering vaccination should talk to their doctor about potential risks and benefits.

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Preliminary data on about 35,000 pregnant women who got vaccinated and volunteered information through the v-safe program shows that pregnant women have the same vaccine side effects as non-pregnant women -- temporary injection pain in the arm, fatigue, headache, muscle aches and fever.  

It's important to note that fever from any cause has been associated with adverse pregnancy outcomes, and the CDC recommends pregnant people who experience fever after vaccination take acetaminophen to lower their body temperature.

I'm skeptical of the vaccine. What are the risks of getting COVID-19 while pregnant? 

Pregnant and recently pregnant people are at higher risk of severe illness from COVID-19, including death, according to the CDC, and they're also at increased risk for preterm delivery (birth before 37 weeks) and other adverse pregnancy outcomes. 

Although there is information available now about how risky COVID-19 can be for pregnant people, that wasn't necessarily the case at the beginning of the pandemic, and pregnant people were not highlighted specifically as "high risk." Speichinger says that is likely because people who get pregnant are usually generally healthy and under age 40. Recent research, however, gives cause for concern. A study published by the American Journal of Obstetrics and Gynecology found that pregnant women were three times more likely to be hospitalized with COVID-19 and 13 times more likely to die than similarly aged individuals who were not pregnant when infected with COVID-19. 

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Pregnant people who receive a COVID-19 vaccine should monitor themselves for fever, a common side effect after vaccination, and take acetaminophen if necessary. Fever during pregnancy has been associated with adverse outcomes, according to the CDC. 

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Why are pregnant people at such a higher risk? 

Speichinger says it isn't known, but that it may be because pregnant people's immune systems are naturally depressed so their bodies don't reject the growing fetus, or because pregnancy could alter the body's way of mounting an immune response to COVID-19. 

"I've had many patients who have had COVID while they were pregnant, and they've been just fine," she says. "But there have definitely been severe cases where patients had to get delivered early because they could no longer oxygenate their fetus." 

In these cases, Speichinger says the patients usually improved after giving birth, but that it was delayed. It's also impossible to know who will have a bad reaction to COVID-19 while pregnant. 

"It's really unclear who of the healthy pregnant cohorts is going to be the one that gets sick," she says.

During what trimester should I get the vaccine?

Speichinger says she doesn't have enough data to say one way or the other, but most patients she sees hold out during the first trimester. The data available so far also reflects vaccination during the later stages of pregnancy. This may be due to the naturally high rate of miscarriage during the first trimester, and patients being more cautious because of that. Anywhere from 9% to 80% of pregnancies, depending on the patient's age, will end in miscarriage during the first trimester, according to the ACOG

"Most people feel concerned in the first trimester because there's such a high risk of miscarriage in general," Speichinger says. "Conflating the miscarriage with vaccine administration is what leads to vaccine hesitancy in the first trimester." 

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More research is needed earlier in pregnancy, but recent research shows that parents vaccinated during the third trimester of pregnancy may pass antibodies onto their newborns.

What if I'm breastfeeding? 

"If a woman is uncomfortable doing it while pregnant, I absolutely think getting it while she's breastfeeding is a good idea," Speichinger says. "Because all of those antibodies can then cross through to the milk and protect baby while the mom is still producing those antibodies." 

There's not enough data to show how long that protection lasts, but the CDC reports that breastfeeding people who have received an mRNA vaccine produce COVID-19 antibodies in their breast milk. 

Does the vaccine type matter? 

Moderna's and Pfizer's are mRNA vaccines, which use a new technology that delivers instructions to our immune systems on how to make protective proteins. Johnson & Johnson's, the third vaccine available for emergency use in the US, uses viral vector technology by delivering a harmless virus into our bodies that triggers an immune response. Viral vector vaccines, notably the Ebola vaccine, have been studied in pregnant and breastfeeding people with no adverse effects found, according to the CDC

The early research available now shows that mRNA vaccines are safe for pregnant women, and that miscarriage rates among women who received a COVID-19 vaccine are similar to miscarriage rates of women who didn't get vaccinated. In a v-safe survey of 827 pregnant women who got a COVID-19 vaccine, about 14% experienced pregnancy loss -- within the range that is naturally expected. 

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Early data suggests that people who receive a COVID-19 vaccine while breastfeeding or in the third trimester of pregnancy pass antibodies to their newborns. 

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After the FDA lifted the pause that had been placed on Johnson & Johnson after reports of blood clots (the CDC identified 28 cases out of 8.7 million people vaccinated with Johnson & Johnson, the majority of them in women), the CDC issued a statement that women under age 50 should be aware of their increased risk of this still rare, but serious form of blood clots, and consider the other vaccines that don't carry this risk. Given the demographic of the blood clotting risk, Speichinger says her bias would steer her pregnant patients toward a Pfizer or Moderna vaccine. "I still think the risk is exceedingly rare compared to the complications of COVID," she says. "But if you had a choice, I would pick one of the other two."

I want to be pregnant in the future. Will the COVID-19 vaccine make me infertile? 

The fear people have regarding their fertility and vaccination isn't exclusive to the COVID-19 vaccine, but that's a conversation for another time. The specific fear about infertility and COVID-19 vaccines stems from a now-debunked post on Facebook that claimed the vaccine would make pregnant people's bodies attack a protein needed for placenta formation in early pregnancy, because the spike protein in the COVID-19 vaccine is "similar." Experts have disproved this, saying that not only do the two proteins have "almost nothing in common," but even if they did, infection with COVID-19 would have the same outcome. There is no research to suggest people who have had COVID-19 will have a more difficult time getting pregnant, and many have since the beginning of the pandemic. 

Speichinger says she "cannot think of a theoretical reason" COVID-19 vaccines would cause infertility, and many of her pregnant patients have received a vaccine. The only fertility advice she offers is that if you're hesitant about getting a vaccine while pregnant, you should try to get fully vaccinated before you become pregnant. 

"Delaying a cycle is absolutely worth it," Speichinger says. 

The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a physician or other qualified health provider regarding any questions you may have about a medical condition or health objectives.