New and expectant mothers are navigating a stupid science and medicine while trying to mitigate the risks of COVID-19 for themselves and their babies.
Why it’s important: Pregnancy can be tough during normal times, but there is an additional layer of uncertainty during the pandemic, as COVID-19 presents unique risks for pregnant women.
Driving the news: NIAID Director Anthony Fauci said Wednesday that approximately 20,000 pregnant women had been vaccinated in the U.S. 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 points out an associate research vice president of Duke.
- Pfizer BioNTech and Moderna vaccines authorized for use in the U.S. do not use live or attenuated viruses and studies on pregnant animals suggest they are safe, according to experts. However, pregnant and lactating people were not included in the initial vaccine trials.
- “No one predicts there will be an impact on fetal development or growth,” Swamy tells Axios. But some are concerned that the possible side effects of the vaccine, including fever and inflammation, could stress the fetus.
- “We have good theoretical data and those risks are not high, but ultimately, people have to make that decision and it’s difficult,” says Naima Joseph, who specializes in internal maternal medicine at Emory University School of Medicine.
Between lines: This makes pregnant people weigh the risks. The CDC does not take any position, stating, “People who are pregnant and who are part of a recommended group to receive the COVID-19 vaccine may choose to get vaccinated.”
On the one hand: The data show that pregnant women have a 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 admitted to the hospital, to require intensive care, to require ECMO, to be ventilated and to die, unfortunately,” she told Denise Jamieson, Emory Healthcare, at JAMA webcast Monday.
On the other hand: Clinical trials, including those for COVID-19 vaccines, typically do not include pregnant or lactating people, leaving a gap in knowledge about the effect of one of the most important tools in combating the pandemic.
- Catherine Spong, head of the Division of Maternal-Fetal Medicine and vice president of the OB / GYN department at UT Southwestern, told the broadcast that many experts are “absolutely” disappointed that pregnant or breastfeeding people are not included in phase III trials.
- A congressional working group met for years and proposed recommendations and an implementation plan on how to include these two groups, and “yet, again, they were not included in something where they were clearly at greater risk. “Spong said he co – authored a piece on JAMA this week on COVID-19 vaccination for pregnant women and infants.
An open question is if a baby is protected if their pregnant mother is vaccinated.
- Pregnant women are advised to get the flu and Tdap vaccine because the newborn will have some immunity for the first few months, Swamy said.
- A handful of recent studies, including one by Joseph, found that COVID-19 antibodies to the infection cross the placenta.
- But the antibodies were not transferred at such a high rate as “we know the placenta can do” from studies of other pathogens, Joseph says. “We still don’t know what that means for vaccines,” but they are now conducting studies.
Other urgent questions …
- Can a mother’s infection affect the fetus? “We think an infection can occur, but it’s pretty weird,” Joseph says. “Over the course of 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 serious illnesses.
- Can janitors like grandparents help safely? Jamieson and Spong recommend that caregivers be vaccinated and wait two weeks after the second shot (for mRNA vaccines). They must wear masks and practice good hygiene.
- Breastfeeding women can get the vaccine safely, Says Swamy, who has the support of the Academy of Breastfeeding Medicine.
What to see: Pfizer and J&J, which have applied for emergency use of their COVID-19 vaccine, plan to begin clinical trials for pregnant women, and the CDC is monitoring all vaccinated people through its program. -safe.
- Going forward, Joseph says, “the top priorities are maternal inclusion in studies that consider adaptive immunity, as this is the only way to design rational vaccines for this population.”