Doctors discuss COVID-19 vaccine for pregnant women

MILWAUKEE (CBS 58) -- As the vaccine rollout continues, pregnant women have questions about whether or not they should receive the vaccine when it is available to them. 

"Right away, the Society for Maternal Fetal Medicine said explicitly that pregnant and lactating women should have access to the vaccine and that whether or not they decide to use the vaccine was dependent on an individualized conversation with their physician," said Dr. Jennifer McIntosh, a maternal fetal OB specialist at Froedtert and the Medical College of Wisconsin. 

"The reason they came out with that statement is that pregnant women were not included in the vaccine trials, unfortunately. Because of that, there's no direct data on this particular vaccine, or these two particular vaccines, in pregnancy. That being said, the risks of COVID in pregnancy are very high and so they didn't want women, particularly front line workers, excluded from the option of getting the vaccine simply because women hadn't been included in the trials."

McIntosh says there aren't any direct concerns about this vaccine, specifically. 

"We have a long track record of giving vaccines in pregnancy that are safe. This is an MRNA vaccine, we don't have any concerns that this vaccine should negatively impact the pregnancy, but all we have our animal studies as it relates to pregnancy so there's the acknowledgement that there could be risk that we just don't know. By comparison, we do have lots of data from what happens to women who are pregnant who get COVID and the risks of COVID in pregnancy are very high," she said. 

She says it's important for patients to have an individual discussion with a physician. 

"There are some things we don't know about the vaccine in pregnant women, but you have to weigh risks and benefits. Are you in a position where you're exposed to a lot of COVID patients everyday and have a real risk of getting COVID? Because we know what those risks are and yes, there's some theoretical unknowns with the vaccine and so you sort of weigh the risks and benefits of your individual situation," she said. 

She points to a patient analysis tool that was created for what known risks and benefits there are for the vaccine. 

"It's really well done because it states what we know about the vaccines in general, what we know about the animal studies from the vaccines and then it goes into what we know about the risks of COVID in pregnancy, and then it goes into what an individual's own risks and preferences are," she said. " It's that mix of a patient's own risk and preferences that are going to determine whether or not she wants the vaccine."

A number of organizations have come out with recommendations and statements regarding the vaccine. 

The American College of Obstetricians and Gynecologists recommends that COVID-19 vaccines should not be withheld from pregnant individuals who meet criteria for vaccination based on ACIP-recommended priority groups. 

The American Society for Reproductive Medicine says it continues the recommendations of an ASRM COVID Task force saying, "COVID-19 vaccination is recommended for women who are contemplating pregnancy or who are pregnant in order to minimize risk to themselves and their pregnancy."

It also states because COVID-19 mRNA vaccines are not composed of live virus, they are not thought to cause an increased risk of infertility, first or second trimester lost, stillbirth, or congenital anomalies. 

Earlier this week, the World Health Organization said about the Moderna vaccine that "While pregnancy puts women at a higher risk of severe COVID-19, the use of this vaccine in pregnant woman is currently not recommended, unless they are at risk of high exposure."

According to a report in Reuters, the WHO director of immunization said that clinical trials of the Moderna vaccine were needed on pregnant women, but said “There is no reason to think there could be a problem in pregnancy, we are just acknowledging the data is not there at the moment."

"I wish we had more information on the vaccines and pregnancy, we just don’t. The clinical trials that have been put together here in the United States all excluded pregnant women. What we do know is in the Moderna and Pfizer trials, 23 women did become pregnant, and there’s been no reported ill effects to the moms or their fetuses," said William Hartman, the principal investigator for the UW Health AstraZeneca vaccine trial. 

Hartman says there are a lot of ethical concerns in clinical trials that have to be taken into account. 

"One of them is you don’t want to potentially cause harm to anybody, especially a mother and her child, and so these are some things that we take very seriously in clinical trials. That being said, as we move forward here, trials are going to begin to look at these particular vaccines and pregnant women. So starting, I believe next month, there’s going to be actual studies looking at these vaccines in pregnant women who are otherwise healthy to determine whether or not there are any deleterious effects that occur."

But he says there are some simple facts they know now with COVID-19 and pregnant women. 

"Pregnant women who contract COVID-19 do worse clinically than non-pregnant women in the same age group, and there can be some consequences of COVID-19 on the pregnant mom such as early term birth and premature birth."

McIntosh says when patients become eligible for the vaccine, they should have a conversation with their doctor. 

"As women become in those eligible groups, they should absolutely have that open dialogue with their obstetrician."