New and expected mothers are navigating a nonsense of science and medicine, while trying to mitigate the risks of COVID-19 for themselves and their children.
Why does it matter: Pregnancy can be difficult during normal times, but there is an additional layer of uncertainty during the pandemic, as COVID-19 presents unique risks for pregnant women.
News management: NIAID Director Anthony Fauci said on Wednesday that about 20,000 pregnant women had been vaccinated in the United States so far and no complications had been seen.
- But “it takes us a long time to follow the woman and her fetus and then her baby and see how things go,” Geeta Swamy, an associate professor at OB / GYN and an associate vice president for research at Duke, he points out.
- Pfizer BioNTech and Moderna vaccines authorized for use in the United States do not use live or attenuated viruses, and studies in pregnant animals suggest they are safe, experts say. However, pregnant and lactating women were not included in the initial vaccination studies.
- “No one anticipates that there will be an impact on fetal development or growth,” Swamy told Axios. But some are concerned about the possible side effects of the vaccine, including fever and inflammation, which could stress the fetus.
- “We have good theoretical data and these risks are not high, but in the end individuals have to make that choice and it’s hard,” says Naima Joseph, who specializes in internal maternal medicine at Emory University School of Medicine.
Between the lines: This allows pregnant women to weigh the risks. The CDC does not take a stand, saying: “People who are pregnant and part of a group recommended to receive the COVID-19 vaccine may choose to be vaccinated.”
On the one hand: The data show that pregnant women 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, need intensive care, seek ECMO, be ventilated and die, unfortunately,” said Denise Jamieson, Emory Healthcare JAMA webcast on Monday.
On the other hand: Clinical trials, including those for COVID-19 vaccines, do not usually include pregnant or breastfeeding people, leaving a gap in the knowledge of the effect of one of the most important tools to combat the pandemic.
- Catherine Spong, head of the Division of Maternal-Fetal Medicine and vice president of the OB / GYN department at UT Southwestern, said for webcasting that many experts are “absolutely” disappointed, pregnant women or people who are breastfeeding were not included in the phase studies. III.
- A working group of the Congress met for years and came up with recommendations and an implementation plan on how to include these two groups and “yet, again, they were not included in anything in which they were clearly with a higher risk, ”said Spong, who co-authored a play in JAMA this week about COVID-19 vaccination for pregnant and lactating people.
An open question is if a child is protected if his pregnant mother is vaccinated.
- Pregnant women are advised to receive flu and Tdap vaccines because the newborn will have some immunity in the first few months, Swamy said.
- A handful of recent studies, including one by Joseph, have found that COVID-19 antibodies in the infection cross the placenta.
- But the antibodies were not transferred at a rate as high as “we know it can make the placenta” from studies of other pathogens, says Joseph. “We don’t know yet what that means for vaccines,” but he is now conducting studies.
Other pressing questions …
- Can a mother’s infection affect the fetus? “We think the infection may occur, but it’s quite rare,” says Joseph. “After a year of data and deliveries, there does not appear to be an increased risk of birth defects or anything other than premature birth,” especially in people with severe illness.
- Can caregivers like grandparents help safely? Jamieson and Spong advise caregivers to get vaccinated and wait two weeks after the second shot (for mRNA vaccines). He should wear masks and practice good hygiene.
- Breastfeeding women can receive the vaccine safely, Swamy says, which is supported by the Academy of Medicine for breastfeeding.
What to look for: Pfizer and J&J, which have approved the emergency use of the COVID-19 vaccine, plan to begin clinical trials for pregnant women, and the CDC is monitoring all vaccinated people through its V-safe program.
- Before, Joseph says, “the highest priorities are maternal inclusion in studies of adaptive immunity, because this is the only way to design rational vaccines for this population.”