As the COVID-19 vaccination programs roll out, pregnant women, women contemplating pregnancy, and breastfeeding women have questions about whether they should get the vaccine.
While early data suggested that pregnant women may be protected from severe illness from a COVID-19 infection, we now know that not to be the case, and that pregnant women are actually at a higher risk of severe COVID. Pregnant patients with COVID-19 infection are at higher risk of hospitalization and admission to the ICU than non pregnant patients of the same age with COVID infection. A systematic review and meta analysis of data just published in the CMAJ last week also showed that infection with the coronavirus in pregnancy was associated with a 33% higher risk of preeclampsia, 82% higher risk of preterm birth, and 2.1 times higher risk of stillbirth, compared to no COVID in pregnancy.
Canada’s National Advisory Committee on Immunization (NACI) recommends that COVID-19 vaccination may be offered to pregnant women in the authorized age group, if a risk assessment deems that the benefits outweigh the potential risks for the woman and the fetus. In Alberta, where I practice, pregnant women are considered to be a high risk group and are therefore being prioritized for vaccination (Albertans, see Phase 2B).
For any woman making this decision, it is important to understand that:
- There are currently no data on safety nor effectiveness of the COVID vaccine in pregnancy or during breastfeeding.
- Expert opinion suggests that mRNA vaccines are unlikely to pose any risk, because they are not live vaccines, nor are they genetic therapy.
- Animal data have not shown any reproductive safety concerns.
- There is a biologically plausible BENEFIT to breastfeeding after vaccination, as mom’s antibodies could transfer to the breastmilk, potentially providing some immunity to baby against COVID-19.
Points to consider:
- What is the risk of getting COVID-19 in your life?
- What is the local status of virus activity/outbreaks?
- Do you have other health conditions that put you at higher risk of severe COVID infection?
- Gestational age at the time of vaccination (organ development of baby happens mostly in the first trimester)
- If you are planning pregnancy but not yet pregnant, complete both doses of vaccination before pregnancy.
BOTTOM LINE: The decision of whether or not to vaccinate for COVID-19 in pregnancy is a discussion to have with your healthcare provider. While we do not have data to guide us, it is unlikely that the vaccine would pose a risk. What we DO now know are the health risks to mom and baby of getting a COVID-19 infection while pregnant.
This blog DOES NOT serve as individual medical guidance – be sure to talk to your health care provider. Also remember that the data, knowledge, and guidance on COVID-19 vaccination is changing rapidly – watch the NACI Recommendations page for updates.
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