Pregnant infectious disease pharmacist talks through decision to get COVID-19 vaccine
CHARLOTTE, N.C. (WBTV) - Charlotte doctors say the current guidance for pregnant women and the COVID-19 vaccine is not black and white.
Additional guidance this week from the World Health Organization about Moderna’s COVID-19 vaccine during pregnancy revealed the agency is not recommending it for women who are pregnant except if they are at high risk of exposure to COVID-19 or have pre-existing conditions.
The agency points to the lack of research to date noting, “The available data on mRNA-1273 vaccination of pregnant women are insufficient to assess vaccine efficacy or vaccine-associated risks in pregnancy.”
However, this risk versus benefits approach to vaccination falls in line with previous guidance about the Pfizer vaccine.
Doctors at Atrium Health in Charlotte say the risk versus benefits approach, is the same approach they are taking based on guidance from the American College of Obstetricians and Gynecologists.
Risk versus benefits
Danya Reynolds is a clinical pharmacist in infectious diseases at Atrium Health and says it was weighing risks against benefits that informed her decision about the vaccine. As a clinical pharmacist, Reynolds studies drugs and treatments to help people fighting infectious diseases like COVID-19.
“It’s a very interesting time to be in my role because there are new drugs coming out all the time with hopeful clinical benefit in patients with COVID,” said Reynolds.
Reynolds is also 34 weeks pregnant. She says when she first learned several weeks ago that a COVID-19 vaccine was on its way, she was anxious to learn more.
“Initially I was very excited that there was going to be a vaccine, and then my next question was - because I am a clinical pharmacist in infectious diseases - my first question was, ‘How many pregnant patients did they include in the clinical trials?’” said Reynolds.
Reynolds adds when she learned there was no data on pregnant women in clinical trials, she turned to her OB, her physician and other colleagues. She says her decision came down to risk versus benefits which is something Atrium’s Interim Chair of OBGYN Dr. Ngina Connors says every pregnant woman should discuss with her doctor.
“We know that pregnant women are at higher risk for severe COVID-19 disease,” said Dr. Connors. “Although most pregnant women are going to do fine with COVID, we do have pregnant women who end up in the ICU, and unfortunately we can’t determine who is going to have severe disease and who isn’t.”
Dr. Connors says right now the American College of Obstetricians and Gynecologists says pregnant women should be able to get the vaccine if they want it. However, because of the lack of research and data, they also have not gone as far as to recommend it. Dr. Connors says things you should consider include:
- Prevalence of the virus in your area
- Underlying medical conditions like hypertension or diabetes
- Risk of exposure to the virus
It is that last consideration which was big for Reynolds who is exposed to COVID-19 patients daily. She ultimately decided to get vaccinated.
“I was reassured that there were about 20 patients in some of the clinical trials that ended up getting pregnant, and so far there haven’t been any issues compared to the patients who got a placebo in that trial,” said Reynolds.
Reynolds had no side effects after her first dose, but says she did develop common side effects like chills and muscle aches after her second dose for about 24 hours.
She says since then, she hasn’t had any further issues, and she is still on the frontlines until baby girl arrives in March.
“I’m excited, once my baby is old enough, to be able to talk to her about this, and to explain to her the historical significance of what was going on as she was developing and all the tough decisions that I had to make,” said Reynolds. “I do think this is a really important time and will be important to shape the course of the future.”
How does the vaccine impact mom and baby?
Because the COVID-19 vaccine is a Messenger RNA vaccine instead of a live vaccine, many have asked about its potential impacts on mom and baby. Dr. Connors echoed guidance from the WHO and the CDC which suggests because of how Messenger RNA works, theoretically any impacts should be low. However, Dr. Connors says because data is limited its full impact is not known.
“Messenger RNA is taken into the cell and is used to make protein. In this case, the spike protein (which is just a portion) of the coronavirus is made. This protein is released and the immune system recognizes it as foreign and makes antibodies against it (like any other vaccine),” said Dr. Connors. “The messenger RNA does not enter the part of the cell where the DNA is housed, so it does not alter DNA. At this point, the vaccine is thought to theoretically have low risk for pregnant women. However, there is no data to prove it is safe since pregnant women were not included in the trials. We do not know if the messenger RNA crosses the placenta because it has not been studied.”
Is the vaccine safe for women who are breastfeeding?
Dr. Connors says according to the American College of Obstetricians and Gynecologists, the vaccine should not be withheld from women who are breastfeeding who fall into similar considerations as women who are pregnant. (Women who are at high-risk of exposure, underlying conditions, etc.)
“So we have not gone as far as recommending it,” said Reynolds. “But once the patient has delivered and she’s breastfeeding, then we should be offering those women the vaccine. That’s a little bit different than pregnancy, and I think people feel a little bit more comfortable when they’re breastfeeding and the baby is outside versus getting vaccinated while pregnant.”
Dr. Connors add women who get the vaccine would not need to discontinue breastfeeding after receiving the vaccine.
“Just by the way the vaccine works it takes time for your body to get that Messenger RNA and synthesize that protein and for your body to build an immune response,” said Dr. Reynolds. “So that’s not an immediate reaction, so I would suggest that you just continue to breastfeed like you would normally unless there’s some recommendation that comes out in the future that you should not do that.”
Planning for a family
Many people have asked if it would be safe to get the vaccine while you are trying to get pregnant. The WHO “does not recommend delaying pregnancy after vaccination.”
However, Dr. Connors says if someone is trying to be extra cautious, they could wait a little bit of time before trying to get pregnant. Connors says given that there is still more research to be done, it would not hurt to wait.
“If people want to be very conservative and very safe, then 6 to 12 weeks before attempting to get pregnant-- they could try to do that, but again there’s no data about that so that doesn’t mean that’s what they should do or shouldn’t do.”
Right now research is ongoing about pregnancy and the COVID-19 vaccine. The CDC says, “limited data are currently available from animal developmental and reproductive toxicity studies. No safety concerns were demonstrated in rats that received Moderna COVID-19 vaccine before or during pregnancy; studies of the Pfizer-BioNTech vaccine are ongoing.”
The CDC says more studies are planned and both vaccine manufacturers are monitoring people in the clinical trials who became pregnant.
If you are looking for more information on COVID-19 and pregnancy:
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