Pregnant People Haven’t Been Part Of Vaccine Trials. Should They Get The Vaccine?

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Health care workers will be among the first to receive a coronavirus vaccine when they become available. But the vaccines have not been tested on pregnant people, raising questions about whether pregnant and lactating health care workers should get the shot.

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Ruth Faden, founder of Johns Hopkins University’s bioethics institute, says it’s not an ideal situation – rolling out a vaccine that hasn’t been tested on pregnant people. «We’re in a situation right now where we have to go forward with the information that we absolutely do not have. It’s understandable that we don’t have data from pregnant women yet, but it would be nicer if we did, she told NPR’s Weekend Edition.

The American College of Obstetricians and Gynecologists has urged the CDC’s Advisory Committee on Immunization Practices not to exclude pregnant and lactating people from the high-priority populations for COVID-19 vaccine allocation. ACOG notes that pregnant people are at high risk from the coronavirus for multiple reasons: «In addition to being an identified at-risk group by themselves, upwards of half of pregnant women also fall into another priority category, including frontline workers and those with underlying conditions.

In Britain, regulators have advised against offering the Pfizer/BioNtech vaccine to pregnant people or those who are breastfeeding. They also warn that «women of childbearing age should be advised to avoid pregnancy for at least 2 months after their second dose.

Jamieson says that Canada’s approach is better than the U.K.’s. «The Pfizer instructions in Canada specify that pregnant women should talk to their health care provider, she explains. «It’s listed under one of the things that ‘if you have this condition, discuss with your health care provider’, but they do not list it as a contraindication, and pregnant women are being vaccinated with the Pfizer vaccine in Canada.

What about breastfeeding?

In the U.S., the Society for Maternal-Fetal Medicine has stated that «there is no biological plausibility for the exclusion of lactating women from these trials.

«For some reason, that does not make any sense to me, lactating and pregnant women are always lumped into one group, Jamieson says. «They’re actually two very different groups, and there’s even less theoretical reason to be concerned about lactating women. We give live viral vaccines — measles, mumps and rubella vaccine — routinely to lactating women. And that’s a live viral vaccine.

Dr. Laura Riley, chair of the department of obstetrics and gynecology at Weill Cornell Medicine and the chair of ACOG’s immunization committee, agrees.

«The thought that this mRNA vaccine is going to get into breast milk — really? We want to stop people from dying, and get the vaccine. I would hate to see a woman who is breastfeeding stop so that they could get the vaccine, she says.

Considerations for getting the vaccine while pregnant

Jamieson is hopeful, based on the public comments of the FDA, that the agency will do what ACOG has advocated for: If a pregnant woman would otherwise be offered the opportunity to be vaccinated, she should have the opportunity to talk to her health care provider and potentially be vaccinated.

The FDA could decide that pregnant people should not take the vaccine. But more likely, Faden says, it will be up to pregnant people and their doctors to decide what’s best.

So assuming they get the option, how should pregnant people decide whether to get vaccinated for the coronavirus?

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Faden recommends they assess their individual risk: their risk of becoming infected in the first place, and the risk of becoming seriously ill if you’re infected with the virus.

«A disproportionate amount of burden of disease in pregnancy seems to be hitting women who are low-income, women who are from communities of color, women who are otherwise disadvantaged, she notes. «There’s nothing about pregnancy that is protective.

In consultation with their health care provider, Jamieson says, the pregnant person can then put that risk assessment together with what’s known about mRNA vaccines, what’s known about other vaccines during pregnancy, and decide what makes sense.

Riley says she is currently getting flooded with calls from pregnant health care workers, asking what they should do: «I work in an ICU, I work in a COVID unit – should I get the vaccine? Should I wait to get pregnant? they ask her.

«It’s easy to say it’s handwringing, but they’re the front-line workers – whether they’re a nurse, or a doc, or sitting at the front desk, Riley says. «I worry about the ladies at the grocery store every single day. At least if you’re in a hospital, you’ve got PPE. But if you work in a grocery store, and you’re riding the train to work — a lot of those people are pregnant or thinking of getting pregnant.

In the absence of vaccine trial data on pregnant people, the call on whether to get vaccinated will likely come down to that conversation between the pregnant person and the health care provider.

«People who are pregnant have a lot to worry about, and we don’t need to add to people’s stress, Faden says. «Unfortunately, this is a stressful circumstance. Take a deep breath, and if you’re given the choice, it may make good sense to have this vaccine. It may not.