Updated on Jan. 7.
More than a year ago now, the first cases of covid-19 were reported out of Wuhan, China. Since then, more than 20 million people in the United States alone have been infected with the novel coronavirus. Among these are more than 53,000 pregnant women.
As cases and deaths continue to rise, public health efforts such as social distancing, frequent hand washing and wearing a mask remain central to combating the spread of the virus. But there are now additional tools to prevent infection: the FDA-approved Pfizer-BioNTech and Moderna vaccines. These vaccines are 95 percent and 94 percent effective, respectively, in preventing coronavirus infection, and will dramatically reshape the global response to the pandemic.
For women who are considering becoming pregnant, already pregnant or are breastfeeding, however, many questions remain. Pregnant and lactating women were not included in the trials for the vaccines, tracking with the belief that this protects them and their fetus from risk. Guidance from the Centers for Disease Control and Prevention states that “people who are pregnant and part of a group recommended to receive the COVID-19 vaccine may choose to be vaccinated.”
As an OB/GYN at Brigham and Women’s Hospital in Boston, I am among the essential workers who have been offered the vaccination. I am also 24 weeks pregnant. And I have chosen to get vaccinated.
Like many women who found out they were pregnant during the pandemic, I first glimpsed my baby at an ultrasound appointment, to which I was accompanied by the pixelated image of my husband on my phone. Despite working in the hospital where I get prenatal care, I feel relieved when I see my doctor’s face pop up on my computer, knowing our telemedicine visit is one less hour spent exposed to possible infection.
Meanwhile, I take care of pregnant patients suffering from covid-19 infection every day. I see firsthand how the virus alters everything about childbirth. While working, I carefully monitor our pregnant patients, and not uncommonly I gown up, put on my N95 mask and wheel a patient, whose belly looks remarkably similar to my own, to the intensive care unit for respiratory support. These faces remain with me — I can recount in excruciating detail each patient’s clinical decline requiring intubation, and all the steps that led to delivery by Caesarean section while the mother was sedated on a ventilator, unknowingly experiencing the birth of her first child. With each shift, I watch their vital signs and wonder could this be me, my sister, my friend? I worry for each patient as if they were.
These are the stories that ground my understanding of the countless journal articles and data briefs I read. I am intimately aware of the known risks associated with pregnancy and coronavirus infection. Pregnancy is itself an immunosuppressive state, and symptomatic pregnant patients with the coronavirus are at increased risk for severe illness compared with their nonpregnant peers. Coronavirus infection also increases risk of preterm birth, and we are only just beginning to understand the impact of infection on how the placenta develops and on fetal growth and development. The risk of severe infection associated with pregnancy is compounded by maternal medical conditions such as diabetes, obesity and cardiovascular disease, which are known risk factors for severe infection. This disproportionately impacts Black and Hispanic pregnant women, who are more likely to develop severe coronavirus infections and already experience higher rates of maternal morbidity and mortality associated with pregnancy.
Given all of these risks, when I received an email from my institution regarding the distribution of Pfizer’s coronavirus vaccine, I felt a new wave of pregnancy-fueled, fatigue-induced emotion well up inside of me. I was relieved that so many of those who work tirelessly beside me would now be able to protect themselves and, by reducing their risk of infection, their loved ones at home as well. I felt a deep sense of gratitude toward those responsible for bringing the vaccine to market so quickly. At the same time, I still felt nervous about getting the vaccine while pregnant.
While I am accustomed to counseling patients regarding the safety of many medications used in pregnancy, the lack of data around the new coronavirus vaccine was particularly problematic. Like all pregnant women, I belong to a population at high risk for severe infection and, like many essential workers who are women, have increased exposure based on my role as an OB/GYN. This led me to start a deep dive into the theoretical risks of vaccine exposure.
After learning more, the science and development behind the vaccine reassured me. The Pfizer-BioNTech and Moderna vaccines are a new type of vaccine based on mRNA. The vaccine works by injecting mRNA into the muscle cells of the arm. Your cells then produce the identifying protein of the virus, which is recognized by your immune system and triggers your body’s defense mechanisms. This protects you if you are exposed in the future, because your body will continue to recognize the identifying protein of the virus and attacks it. In this way, the virus is exactly like all other vaccines used during pregnancy.
Because of how this process works, there is no way you could get an infection from the vaccine itself. There is also no way that the mRNA used in the vaccine could alter genetic material in the recipient. Lastly, as with all vaccines given in pregnancy, your immunity is passed to your newborn, which protects them after birth and before they are able to receive vaccines themselves.
To me, the theoretical risks of receiving the vaccine seemed minimal in comparison to the known risks of contracting the coronavirus in pregnancy.
What’s my advice to other pregnant women worried about the vaccine? The American College of Obstetricians and Gynecologists and the Society for Maternal Fetal Medicine recommend that pregnant and lactating women discuss the coronavirus vaccine with their OB/GYNs and be offered the vaccine, but that receiving the vaccine should not require approval of an OB/GYN or be mandated. In other words — share your concerns with your doctor. Consider the level of viral activity in your community, occupational exposure, ability to distance in your living space, the type of transportation you use, work environment and your ability to access personal protective equipment (PPE).
These individual variables also play out in the complex realm of structural factors such as access to care, systemic racism and the historic and continued inequities in the health-care system. These issues affect health outcomes for all patients, but dramatically so for pregnant women. My perspective as a White woman may differ from women of color, who are most impacted by the inequities that continue to underpin dramatically different health outcomes for pregnant women. We have a lot of work to do to build confidence in a health-care system riddled with examples of oppression. Like all decisions we make about our reproductive health, this is a choice that only you can make. Your choice might be different from mine.
If you choose to get the vaccine, you may experience some mild fatigue, chills, muscle pain, joint pain and headache. These are signs that the body’s immune system is recognizing the protein tag on the virus and creating an immune response to it that will protect you in the future. Any symptoms following vaccination should resolve three days after administration, can be managed with acetaminophen (Tylenol) and are far less concerning than a coronavirus infection. If you prefer to wait to get the vaccine until after pregnancy or completing breastfeeding, you should still take standard preventive measures — hand washing, physical distancing and mask-wearing.
Until pregnant and lactating women are included in all phases of vaccine campaigns, each of us must engage in well-informed decision-making while we wait for more information. In the meantime, I will remember the faces, stories and data that ground the clinical course of the patients I care for. I will continue to worry and advocate for my patients to make the best choice for themselves and their families. But perhaps the next time I bring a patient to the ICU with severe covid-19 illness, I will take comfort in the knowledge that my personal decision to get vaccinated was the best choice for my baby and me.
Alice Abernathy is OB/GYN at Brigham and Women’s Hospital.
Editor’s Note: This article has been updated to more clearly reflect CDC guidelines for pregnant people.