By Jay Goldberg, MD, MSCP
A professor of obstetrics and gynecology, Dr. Jay Goldberg has authored over one hundred publications and lectured at countless conferences for Symposia Medicus over the last 15 years. Dr. Goldberg gives us his timely take on the topic of COVID-19 vaccination for pregnant women and breastfeeding mothers.
Although the majority of young healthy people have asymptomatic COVID-19 infections, pregnancy has been reported to increase the risk of a more serious course. It has been reported that COVID-19 infection in pregnant women has a significantly higher risk of ICU admission and ventilation requirement compared to non-pregnant women. COVID-19 infection may also increase the risk of preterm delivery. Pregnant women infected with COVID-19 also have higher death rates compared to similarly matched non-pregnant women.
The availability of effective vaccinations against COVID-19 gives hope that we are finally seeing light at the end of the tunnel. Initial studies of the Pfizer-BioNTech mRNA vaccine reduced COVID-19 infection by 95% after two doses. Studies of Moderna’s COVID-19 vaccine was similarly effective in reducing infection. Additional COVID-19 vaccines may also soon be approved for usage. Published trials on the COVID-19 vaccines, however, have not included data on pregnant or breastfeeding women.
On top of misinformation regarding the vaccine on social media, leading health organization have issued conflicting statements regarding whether it should be used in pregnant women. Recently, the World Health Organization (WHO) has recommended withholding COVID-19 vaccination from pregnant women unless they are at high risk for exposure. In response to the WHO recommendation, ACOG and the Society for Maternal Fetal Medicine (SMFM) have jointly issued a statement that COVID-19 vaccination should not be withheld from pregnant women wishing to receive it.
Due to the lack of pregnant and breastfeeding women studied, there is no reliable safety data on these populations. It is reassuring that unpublished developmental and reproductive toxicity (DART) studies on pregnant animal subjects has reportedly shown no teratogenic vaccine-related impact. These mRNA vaccines against COVID-19 neither contain live virus nor use an adjuvant to boost efficacy. Additionally, the vaccines do not enter cell nuclei or affect cell DNA. Based upon the facts known, most experts agree that the benefits of COVID-19 vaccination of pregnant and breastfeeding women far outweigh any potential risks. To gather the needed data, vaccinated pregnant women should be encouraged to sign up for the CDC’s V-SAFE safety monitoring program.
As it is still a relatively new infection, there are still many unknowns about COVID-19 and COVID-19 vaccination. How long will immunity against infection last following vaccination? Will a booster injection be later needed?
Of the initial 1,257 pregnant women accepting testing when admitted to our L&D at Einstein Medical Center Philadelphia, 45 (4%) were positive for SARS-CoV-2. Only 9% of the infected women were symptomatic. Interestingly, 3 (7%) of the 45 women infected at delivery had a prior positive COVID-19 test more than 90 days previously. All three of the reinfected women were asymptomatic at the time of their second positive test. As prior COVID-19 infection in pregnant women may not provide immunity to future infection in some patients, will a similar issue be seen in vaccinated patients?
Given the anti-vaccination mentality of some of our pregnant and breastfeeding patients, it is important for obstetrical providers to be able to intelligently and patiently provide evidence-based information to them. COVID-19 vaccination may be an especially difficult sell to those pregnant women who have declined flu or TDAP vaccinations, both of which have excellent safety records.
To beat COVID-19, vaccination alone may not be enough. It is critical for women’s healthcare providers to actively advocate that patients additionally continue to wear masks, socially distance, avoid crowds, wash their hands, avoid indoor eating with others not from their pod, and follow published guidelines on travel and quarantine after COVID-19 exposure.
Let’s hope that we can turn things around in 2021!
Dr. Goldberg is the Director of the Philadelphia Fibroid Center at Einstein Medical Center. He lives in Philadelphia, Pennsylvania.