Should You Get the COVID-19 Vaccine if You are Pregnant or Trying To Conceive?

As soon as COVID-19 vaccines arrived, conspiracy theories about harmful effects began spreading. Perhaps shrewdly, several of these conspiracy theories target reproductive age women, claiming falsely, for example, that the vaccines will impair fertility or, if they are already pregnant, harm their baby’s placenta.

This is partly the fault of the Moderna and Pfizer, the producers of these vaccines, who excluded pregnant women from their clinical trials, despite leading maternal health organizations like the American College of Obstetricians and Gynecologists all but begging them to test their vaccines in pregnant women. Naturally, the antivax movement was more than happy to step into the resulting data void.

So here’s what I think pregnant women should know, if they have the chance to get one of these vaccines: Get the vaccine. Get it as soon as it is offered to you.

Here’s why:

The latest data suggest pregnant women have an elevated risk of severe COVID-19. They are more likely than other women their age to be admitted to the hospital, to need help breathing, and to die from the disease. The absolute rate of these outcomes is still low, as pregnant women are relatively young, but it is a real risk.

As Yuri Edelsen, a Health Minister in Israel, where they recently began vaccinating pregnant women, recently told the Jerusalem Post, “I would say, not being a medical doctor, that when I look at these terrible cases of a number of pregnant women who are in serious condition with the coronavirus, I say to myself, probably it is worse to take the little risk of taking the vaccine instead of finding yourself in a terrible situation in the hospital.”

There is also the mental health aspect. Even if you do not wind up in the hospital, just having a bad cold while pregnant is a horrible experience (no Nyquil for you) and that’s without the added existential dread of wondering for days if you will recover or take a sudden turn for the worse, as can happen in severe cases.

And then there’s what we know about vaccine safety in pregnancy from other vaccines. The Centers for Disease Control recommends two vaccines during pregnancy: The flu vaccine, because pregnant women are at higher risk of severe illness from the flu; and the tetanus, diphtheria and pertussis (Tdap) vaccine, because pregnant women can pass on antibodies protective against pertussis (whooping cough) to their fetus, providing crucial protection when they are newborns.

Both the Pfizer and Moderna vaccines rely on mRNA (messenger RNA). The mRNA enters your cells, which copy them into a viral protein that primes your immune system to recognize the virus if you later become infected. Neither vaccine contains live virus, so they cannot cause an infection. mRNA does not enter the cell nucleus, which contains the cell’s DNA, so it cannot cause genetic changes. “Based on how mRNA vaccines work, experts believe they are unlikely to pose a specific risk for people who are pregnant,” according to the Centers for Disease Control, (CDC).

Finally, getting vaccinated may help protect your baby. The good news is that unlike the Zika or Rubella, SARS-COV-2, does not appear to transfer from a pregnant woman to her fetus or to cause birth defects.

But the virus can still affect your baby’s health. SARS-COV-2 does appear to infect the outer portion of the placenta. A recent study found a high rate of placenta abnormalities after maternal infection, including poor blood flow and inflammation. Pregnant women with COVID-19 also have an elevated risk of premature birth, or delivery before 37 weeks, and preterm birth can affect your baby’s health.

And on the plus side, infected women do seem to pass protective antibodies against SARS-COV-2 to their fetus, so, as with the Tdap vaccine, getting the vaccine during pregnancy could help protect your baby from COVID-19.

Given all these potential benefits, why are the Centers for Disease Control and the American College of Obstetricians and Gynecologists not outright calling for vaccinating pregnant women? Instead, they state that the vaccine “should not be withheld” from pregnant women, and emphasize that it is a pregnant woman’s “personal choice”.

I was not part of the committees that came up with these recommendations, but I suspect the wishy-washy advice comes down to what these medical organizations feel culpable for and what they do not.

I am not accusing them of CYA exactly, but ultimately, medical organizations feel more responsible if they recommend something and it turns out not to be safe than they do if the current-bad-status quo continues, and that fact — understandably — biases them towards extreme caution. But their bias need not be yours. Get the vaccine.

Originally published at https://expectingscience.com on February 3, 2021.