At 30 weeks pregnant, most women would be putting the finishing touches on the nursery, rounding up remaining baby gear, and packing their hospital bag. But Jacqueline Parchem, MD, was faced with an additional task – deciding whether to receive the COVID-19 vaccine despite limited data for pregnant women.
As a maternal-fetal medicine physician with The University of Texas Health Science Center at Houston (UTHealth) on the front lines in labor and delivery at Houston hospitals, she decided the benefits of receiving the vaccine outweighed the risks.
The U.S. Centers for Disease Control and Prevention (CDC) says pregnant women are at an increased risk for severe illness from COVID-19, and if infected, they might have an increased risk of adverse pregnancy outcomes, such as preterm birth.
“For me personally, I’m more worried about getting infected with COVID-19 and becoming really sick,” said Parchem, who is an assistant professor in the Department of Obstetrics, Gynecology and Reproductive Sciences at McGovern Medical School at UTHealth and maternal-fetal medicine specialist with UT Physicians, the school’s clinical practice. “I know that would be bad both for me and for my family, and I would feel guilty if it happened and I had turned down a really effective vaccine. Other people would say that they couldn’t live with themselves if they got the vaccine and there was a problem with the baby – even if that problem wasn’t related to the vaccine. Each person has their own perception of the risks.”
While the mRNA vaccines have shown to be 94%-95% effective at preventing severe illness from COVID-19, the data for pregnant women and their offspring is limited because they were excluded from the clinical trials. However, 23 patients in Pfizer’s trial (12 in the vaccine arm) and 13 in Moderna’s (6 in the vaccine arm) later found out they were pregnant. So far, no adverse outcomes have been reported.
“Those women will be followed for their outcomes, but those numbers are too small to tell us anything definitive about safety. There’s a history of pregnant people being excluded from clinical trials. That means we don’t have the data we’d like to have to make decisions we have to make right now,” said Parchem, who is an attending physician at Harris Health’s Lyndon B. Johnson Hospital and Children’s Memorial Hermann Hospital. “This sounds obvious, but if we want to have safety data in pregnancy, some pregnant women have to be willing to be vaccinated.”
Some are hesitant because the mRNA technology behind the Pfizer and Moderna vaccines is new. However, Parchem said while the science behind the vaccines is novel, the maternal immune response is expected to function the same as when pregnant women receive their universally recommended flu shot.
“The vaccine is going to tell my body to make the coronavirus spike protein that will generate the immune response. I think we can apply the principles we know from other vaccines and say that I will make antibodies that could pass to the baby through the placenta. We vaccinate during pregnancy for the flu and whooping cough because if mom gets vaccinated, baby can be protected in those vulnerable first few months of life. That passive immunity may be important for COVID-19 as well,” Parchem said.
The American College of Obstetricians and Gynecologists, the Society for Maternal-Fetal Medicine, and several other professional groups have said pregnant and lactating women should not be excluded from receiving the vaccine and should speak with their physician about whether it’s right for them.
“People need to think about what their personal risk of exposure is and what that means for themselves and their family members,” Parchem said. “Some people are constantly exposed, due to work or the nature of their household – maybe their spouse is an essential worker. Maybe they have one of the comorbidities we know puts you at a higher risk of severe COVID-19 or they are in the one of the communities that have been disproportionately affected by COVID-19. We know that Black and Latinx communities have higher rates of infection and death.”
Parchem said it all comes down to a risk-benefit analysis, and encourages pregnant women to look at the data for themselves.
“A lot of pregnant women who have COVID-19 are surprised – I’m not sure that anyone is good at knowing what their true risk is. Getting the vaccine is a really a hard decision and we need to respect what each individual decides. What you think you will do when pregnant and what you actually do, think, and feel can be different. Even I was surprised at how much I went back and forth. Now, I feel lucky to have had the chance to receive it. We need to be transparent about what we know and don’t know about this vaccine to build trust moving forward. And we don’t have good reason to believe that the mRNA vaccines are harmful in pregnancy,” Parchem said. “I hope all people who are eligible will strongly consider getting vaccinated because it is one of the best tools we have to protect ourselves and those around us.”
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