The COVID Vaccine Rollout Is Leaving Pregnant People Hanging
Without clear guidance, the vax-or-wait decision is weighing heavily on would-be parents.
Early on in the pandemic, quarantine baby-boom rumors seemed about as ubiquitous as hand sanitizer — as if a raging virus and Great Depression-levels of economic uncertainty would be just the thing to get everyone in the mood. There were even cute names for the would-be micro-generation, like "quaranteenies" and "pandemials."
But in my group text with other moms, the chatter revolved around keeping our heads above water. Few of the women I spoke with seemed ready to add another child to the work-from-home/homeschool/childcare chaos. Meanwhile, hospitals were overcrowding, and women feared having to give birth alone. No one seemed to be eagerly flagging down the stork. As one friend deadpanned: 'Those are all going to be first babies. Anyone who is parenting through the pandemic right now isn't voluntarily hopping on the pregnancy train.'
But more than 10 months into America's chaotic response to the coronavirus crisis, many people who put off pregnancy plans at the start of it are weighing whether to try now — and a big variable in their decision is the vaccine, which has begun its rocky rollout to essential workers and the elderly across the nation. Pregnant people are at increased risk for severe illness if they contract COVID-19, according to the Centers for Disease Control and Prevention, but data is limited about the safety of the vaccines for those who are pregnant and for their developing fetuses.
As a group, pregnant and lactating people weren't part of the Pfizer-BioNTech and Moderna clinical trials. This is typical: Pregnant people often aren't included in the clinical trials for vaccines and drugs precisely because of safety and ethics concerns of exposing fetuses to unknown risks. As a result, instead of straightforward guidance from the CDC to get a COVID vaccine as soon as they're eligible — which is the advice for most everyone else — pregnant people are left to decide for themselves between a potentially bad case of the virus, or an unforeseen reaction to the vaccine. As if navigating pregnancy during the pandemic weren't stressful enough (hint: it is).
"They just want their doctor to tell them what is safe." — Emily Oster, PhD
Being pregnant has always meant a slew of extra decisions — Can I please have sushi? Is a glass of wine okay? Do I want that epidural? During the pandemic, pregnant people also must choose the one person who will accompany them into the delivery room, and which mask they'll wear during labor. To vaccinate ASAP or not is one more monumental-feeling decision. But, economist Emily Oster, PhD, tells InStyle, "a lot of pregnant people have expressed to me that they don't want that decision to be on them. They just want their doctor to tell them what is safe." Without hard evidence, doctors are left with something more like 'it's most likely fine.'
Oster, a professor at Brown University and the author of forthcoming book The Family Firm, writes about pregnancy and parenting through a data lens in the hopes of helping people through the "decision fatigue" they can face under even normal circumstances. The level of stress brought on by COVID-19 is in a category all its own (consider the hubbub about schools, visiting family, and untold other public-safety calls made by moms these last 10 months). Determining your own comfort level with a vaccine in pregnancy takes it up a notch. "The uncertainty is very extreme because we just don't know," she explains. "Nevertheless, there is no default. You have to make a decision, and that's something [many people] are struggling with."
Fortunately, the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine have issued their own guidance — and it stipulates that the vaccine shouldn't be withheld from pregnant or lactating people who otherwise meet the health and safety requirements, especially if they're frontline workers. But, ACOG says, "pregnant patients who decline vaccination should be supported in their decision."
[Ed. note: On January 28, 2021, the World Health Organization released new guidelines recommending against the vaccines for pregnant people unless they are at a particularly high risk for COVID-19 infection, due to co-morbidities or being a frontline worker. There is still no research of the vaccines' efficacy and safety in pregnancy.]
A lack of research means there's also no data suggesting the vaccine isn't safe in pregnancy, and many experts believe both COVID inoculations available now are unlikely to harm pregnant people or fetuses. Both are mRNA vaccines, which don't contain a live virus and don't interact with a person's DNA, so "they are unlikely to pose a specific risk for people who are pregnant," according to the CDC. And while the COVID-19 vaccine is new, mRNA vaccines have been developed over the past decade, which is why Diane Horvath, MD, MPH, an OBGYN at Whole Women's Health in Baltimore, is happy to encourage her patients to get them, just as she would traditional vaccines like TDAP or the flu shot — another example of an illness that would be worse for a pregnant person than the vaccine is likely to be.
"We know that pregnant people are a higher-risk group for bad outcomes when they get COVID, so I'm very comfortable saying that I would encourage pregnant people to consider getting the vaccine as soon as they're eligible," Dr. Horvath tells InStyle.
'Getting vaccinated was an easy decision.'
San Antonio, Texas-based nephrologist Meghana Chalasani, MD, got vaccinated in the first trimester of her pregnancy. After giving birth to her son in June, Dr. Chalasani found out she was unexpectedly pregnant with her second child around Thanksgiving. She says she saw five patients with COVID-19 on the Monday after the holiday, and three of them were dead by Wednesday. She and her husband, an ICU doctor, know how dangerous the virus is and worried about exposing their son.
But when Dr. Chalasani, 33, got to the box on her hospital's pre-vaccination questionnaire asking whether she was pregnant, she checked "prefer not to answer." She didn't want to risk any of her providers trying to change her mind. (The FDA fact sheets on the Pfizer and Moderna vaccines specifically say to mention if you're pregnant or breastfeeding, though there's no further info as to why.) "I went to my vaccine appointment, and they asked me again, and I said, 'Just check no.' So I lied and they gave it to me." To be clear: There is no reason to think she would've been denied the shot — and hiding pregnancy from your healthcare providers isn't advisable.
"I felt it was more important to protect myself," Dr. Chalasani explains. "It was an easy decision for me because I'm high-risk and I'm a physician, so I know a little bit more than the general population about infectious diseases and COVID. And I've seen what COVID does to pregnant women." In addition to the risk of more severe illness, the coronavirus can also increase the risk of preterm birth, according to the CDC.
As for the risk of the vaccine in pregnancy: Clinical trials of mRNA vaccines in pregnant animals haven't affected pregnancy or fertility, which is all there is for now. Dr. Chalasani is doing her part to add to the human data by signing up for V-Safe, the CDC's after-vaccination health tracker. After receiving her second dose last week, she says she feels great — and hopes sharing her experience will "help one pregnant person make a decision either way."
What about the vaccine and breastfeeding?
Not all pregnant healthcare workers are jumping at their first shot at the shots. Judith Meer, DPT, is an orthopedic and pelvic physical therapist in Hoboken, New Jersey, who's due with her second child in late-January. She is eligible to receive the vaccine now, but she has chosen to wait until after giving birth, partly in the hopes of passing on antibodies to her new baby when she breastfeeds.
Meer, 34, lauds the "brilliant people" who developed vaccines so swiftly, but underscores the lack of research in pregnancy, and feels she's close enough to the finish line to wait. "I'm hopeful in taking it postpartum that the antibodies or the T-cells that the vaccine stimulates could potentially transfer into milk and provide some immunity or some protection to my newborn," she says.
Breast milk does contain antibodies that provide infants with passive immunity, and scientists believe people who receive the COVID vaccine and then breastfeed would pass those antibodies onto their babies.
And Meer is leading a pretty low-risk lifestyle these days. She shut down her clinic in December and will be on maternity leave for several months. Living on a boat also makes social distancing easy: "We can take the house out for a spin, and everyone is still at home," she laughs.
What if you aren't pregnant yet?
Baby-boom jokes aside, trying to conceive mid-pandemic isn't as simple as Netflix-and-chilling until it happens. One family may wait to get pregnant until after they can get vaccinated, while others rush to continue fertility plans that are already years in the making. "I cannot wait to get the vaccine to get pregnant," says Amy Switzer, 37. She is going through in-vitro fertilization (IVF) in the hopes of having a second child before she has BRCA1-related preventative surgeries to remove her ovaries and fallopian tubes, which she spoke with InStyle about in October.
"Going through IVF, nothing is predictable and there are no guarantees you will be successful. I feel my time is running out to get pregnant and move forward with my preventive surgeries," Switzer says, after COVID delayed her fertility treatments in 2020. "The vaccine is just a second layer of something I have to think about right now."
If she becomes pregnant, Switzer, who lives in Dallas, plans to discuss getting a vaccine with her doctors. "[The vaccines] are so new, and I have worked so hard to have a healthy child," she says, admitting she's nervous.
That's totally natural, Dr. Horvath says. "It's a really normal, good thing to feel cautious about vaccines and medications, but I think that that caution needs to be informed by the best available scientific evidence and opinion," she explains. "Every decision needs to be made by the individual pregnant person, involving their physician or their midwife if they want, and I think having a discussion about this is a great place to start."
But what if you're not pregnant yet, and thinking about where the vaccine should fit into your fertility plans? "If you have the ability to get the vaccine series and then to attempt pregnancy afterwards, that would be great. I think that would take away some of the perceived risk," Dr. Horvath says. But, she adds, planning your family is a deeply personal choice, and if you're ready to jump in, there is little risk in getting the vaccine while pregnant. The data-minded Oster advises people to break down the decision and "articulate what you really see as the choice." When will you be eligible for the vaccine where you live? Does the type of work you do mean you're exposed to a lot of people, or is it easy to stay home and socially distance? Then, ultimately, what will waiting mean for your plans? If putting off trying to conceive six months doesn't matter, and getting the vaccine beforehand will give you peace of mind, do it. On the other hand, if you're eager to not miss your shot, well, you'd be in good company there, too.