Dr. Moune Jabre, Assistant Professor of Clinical Obstetrics & Gynecology at Weill Cornell Medicine-Qatar, says the risk of adverse effects from the vaccine are theoretical while the risk of catching COVID-19 is not
The vaccine rollout has been a source of anxiety for many pregnant and breastfeeding women as they struggle with the decision of whether or not to get vaccinated. The anxiety stems from the fact that clinical trials of the COVID-19 vaccines explicitly excluded pregnant women.
This means there is not enough data to clearly say if the vaccine is as effective for pregnant or breastfeeding women as it is for the rest of the population, and whether it could result in unique side effects for these particular women and their babies. Therefore, most countries have stayed away from issuing definitive guidance on whether pregnant or breastfeeding women should be vaccinated.
“It is very important to understand that this lack of a definite answer is only because of an absence of data; it's not based on any evidence there is a risk,” said Dr. Moune Jabre, Assistant Professor of Clinical Obstetrics & Gynecology at Qatar Foundation partner university Weill Cornell Medicine-Qatar (WCM-Q),
The guideline from the Ministry of Public Health in Qatar is that pregnant and breastfeeding women should discuss their case with their respective OBGYN and follow their advice. This is in line with other national organizations such as the American College of Obstetricians and Gynecologists and The Royal College of Obstetricians and Gynecologists in the UK – both of which recommend that the COVID-19 vaccine not be withheld from pregnant women. And that each person should consider their own potential risk factors and discuss them with their doctor.
“This is an excellent recommendation because every case has to be individualized. There are several factors to be considered to determine whether an individual is high-risk, including their health and environmental factors.”
It is important to clarify that although the actual risk of severe illness and death among pregnant individuals is very low, it is higher when compared to non-pregnant individuals from the same age group
What we know so far is that pregnant women are more likely to get severe COVID-19 than their non-pregnant counterparts, and are slightly more likely to give birth prematurely if they have COVID-19.
“It is important to clarify that although the actual risk of severe illness and death among pregnant individuals is very low, it is higher when compared to non-pregnant individuals from the same age group. Catching COVID-19 while pregnant puts women at increased risk of requiring intensive care, including breathing support,” said Dr. Jabre.
Speaking on how she would recommend a pregnant woman make this decision, Dr. Jabre said: “Here are the two things I'd urge people to consider. First, what's your risk of exposure to COVID-19? Are you a nurse dealing with COVID-19 patients? Is your husband or another member of the household in a profession that puts them at high risk of exposure? Either of these will significantly increase your risk of exposure.
“The second thing to consider is, do you suffer from any underlying medical conditions like chronic lung, kidney or heart problems, diabetes, high blood pressure, or sickle cell disease? All of which could worsen the effects of COVID-19 if contracted.”
The risk of getting infected, and getting seriously ill is much higher than the theoretical risk of adverse effects from the COVID-19 vaccine
In Dr. Jabre’s view, if the answer to either of those questions is a yes then the individual should seriously consider getting the vaccine, as “the risk of getting infected, and getting seriously ill is much higher than the theoretical risk of adverse effects from the COVID-19 vaccine.”
And if on the other hand, a woman is young and healthy, and is self-isolating at home with minimal risk of exposure, then it's debatable whether this individual should get the vaccine now or can wait until there is more data. “In this case, there is not a pressing need for you to take it right now. However, pregnancy does predispose you to a higher risk of severe disease, so you would not be wrong in choosing to take it now,” said Dr. Jabre.
“Theoretically, based on our understanding of how mRNA vaccines work, particularly the fact that they don’t contain live virus and are quickly broken down, the consensus among the medical community is that the vaccine is highly unlikely to have any detrimental effects on the mother or the fetus.”
If antibodies triggered by the vaccine also pass into breast milk, getting vaccinated while you’re breastfeeding may even help to protect your baby
Over the course of the Pfizer clinical trial, 23 of the participants became pregnant. Only one poor outcome was reported among the 23 women, and that person was in the placebo group – meaning she did not receive the Pfizer vaccine at all. While this data is encouraging, the numbers are very small, and hence no concrete conclusions can be drawn from them.
Then would it be true that if breastfeeding mothers choose to take the vaccine, they would therefore be able to protect their babies from COVID-19 as well?
“Yes, potentially. Antibodies against the virus have been detected in the milk of mothers who have been infected with COVID-19. So, if antibodies triggered by the vaccine also pass into breast milk, getting vaccinated while you’re breastfeeding may even help to protect your baby. But, this would depend on when you get vaccinated because it takes time to build immunity, and for the body to produce antibodies in large enough numbers for them to get secreted into breast milk.”
Again, there is not enough data to clearly indicate whether the number of antibodies in breast milk is enough to ensure the baby is protected, but we do know from other vaccines that a protected mom is the best way to protect a baby from infection because there is less chance of mom getting infected and then transmitting it to her baby.
The good news is efforts are underway to fill these information gaps. Numerous studies are planned or have already started to investigate the effects of COVID-19 vaccines on pregnant and breastfeeding women as well their children. Until then, people will have to rely on their OBGYN to help them make this decision.