As Oregon continues to expand vaccine eligibility in the fight against COVID-19, pregnant people age 16 and older became eligible for vaccination this week.
The Centers for Disease Control and Prevention defines pregnancy as an underlying health condition when it comes to the coronavirus. Pregnant people are at increased risk of severe illness from COVID-19, and those risks can affect not only them, but also their babies.
Meanwhile, limited early data on how COVID-19 vaccines affect pregnant people — due to their exclusion from initial vaccine trials — led to some uncertainty and the spread of some misinformation about the vaccines’ safety for pregnant people.
Dr. Amy Hermesch, of Oregon Health and Science University
Courtesy of OHSU / Courtesy of OHSU
But a new study provides reassuring evidence. Research just published in the American Journal of Obstetrics and Gynecology found that both the Pfizer and Moderna vaccines — mRNA vaccines — are highly effective for pregnant and lactating people, and could even pass protection to fetuses and newborns. The research also showed no evidence of harm to babies, and almost no difference in vaccine side effects between pregnant and non-pregnant participants. The latest study comes after neither animal-based studies of all three vaccines available in the United States nor the experiences of a growing number of pregnant people who have been vaccinated since the initial trials showed any evidence that vaccines were not safe for pregnant and lactating people.
The American College of Obstetricians and Gynecologists recommends that “COVID-19 vaccines should not be withheld from pregnant individuals who choose to be vaccinated.” Joining in that recommendation is Oregon Health and Science University’s Dr. Amy Hermesch, an obstetrician who specializes in high-risk pregnancies. She said she and others in her field feel strongly that pregnant people “should be given the opportunity to make an informed decision.”
As Oregon was still ramping up towards expanding vaccinate eligibility to pregnant Oregonians, Hermesch joined OPB to answer questions about pregnancy, the pandemic and how expectant and new parents can make informed decisions to keep themselves and their families safe.
Jenn Chávez: Pregnant people are considered a high-risk group for COVID-19. In fact, pregnancy is defined as an underlying health condition by the CDC. Why? What are the risks?
Dr. Amy Hermesch: Pregnant women are considered [at] high risk of complications from COVID-19, when you compare them to other women who are the same age, with the same risk factors. They are at a higher risk of intensive-care-unit admission, needing ventilation support and they’re even at a small increased risk of death. These complications obviously also affect the baby and can result in pregnancy complications like preterm birth, and even stillbirth in some cases.
Chávez: We’re talking about the physical effects of the pandemic on pregnant folks, but I’ve heard more and more people who’ve been pregnant or parented a newborn during the pandemic describe it as an incredibly isolating experience. And I think a part of that might relate to how healthcare has had to change because of the pandemic. What has your experience been as an OBGYN doctor who’s been providing care to patients during this time?
Hermesch: Well, one of the things that’s been different is that we’ve added a virtual component to prenatal care. As an example, we may alternate in-person visits with virtual visits for patients to reduce the number of times they need to come into the clinic and be around other people, which could potentially increase risk of exposure to COVID-19. This has actually been a positive change for some families because it adds flexibility to the type of care you’re able to provide, and many patients think that virtual visits reduce barriers to regular prenatal care visits, such as difficulty with transportation or finding child care. However, it’s really important that patients understand that we want them to come to these visits, either virtually or in-person. So, it’s important to not skip visits, because we want to stay connected, make sure we detect any complications or issues that may come up as soon as possible.
Chávez: When vaccines for COVID-19 were first introduced, there was some uncertainty around how they would affect pregnant or breastfeeding people, not because of any evidence of harm per se, but simply because those people weren’t included, on purpose, at least in initial vaccine trials. So before we look closer at this, first of all, why weren’t those people included in trials? Is that unusual?
Hermesch: No, it’s not unusual. You’re right, clinical trials for the COVID-19 vaccine did not initially include pregnant women, but there’s no scientific reason to suspect that these vaccines — the mRNA vaccine or the adenovirus vector vaccine, which is the Johnson & Johnson — would not be safe in pregnancy. There are several women that did become pregnant shortly before or after receiving the vaccine in the trials, and there haven’t been any adverse outcomes reported in these pregnancies, which is very reassuring.
Chávez: What else have we learned so far about the safety of COVID-19 vaccines for people who are pregnant or breastfeeding? Now that we’ve had not only these trials, but a fair number of people in the US vaccinated at this point?
Hermesch: First of all, there are three vaccines available now in the US: the Moderna, the Pfizer and then the Johnson & Johnson vaccine. There’s been animal reproduction studies in all three of these vaccines that have been reassuring. In addition, that adenovirus vector vaccine — which is the Johnson & Johnson vaccine — there are other similar vaccines that were given, for example, to prevent Ebola virus that have been administered to pregnant women. And in those clinical studies, there haven’t been any safety issues identified with pregnant or lactating women, so that also is very good. Also, we want to assure patients that there’s no evidence that the vaccine can lead to loss of fertility. Loss of fertility because of the vaccine is very scientifically unlikely, and it’s not something that’s been reported in the, now, hundreds of thousands of women that have received a vaccine.
Chávez: So in your opinion then, given all of this, what do you think people going through pregnancy during the pandemic should be weighing or considering in terms of their safety right now?
Hermesch: Well, medical experts and national women’s health organizations, doctors [and] nurses who are experts in reproductive health recommend that the COVID-19 vaccine should not be withheld from pregnant or breastfeeding women. We feel strongly that pregnant women should be given the opportunity to make an informed decision.
They have to consider the prevalence of the virus in their community, their risk of exposure, not only to themselves, but the risk of exposure to their new baby and their family members. You have to think about, what are the risks of not getting the vaccination? So if you don’t get the vaccine and you get COVID during pregnancy, we talked about the increased risk of complications. But also, if you have COVID, it may complicate the care that you’re able to receive, as far as visitors or labor support you’re allowed to have. And then also, getting support and help after you go home and worrying about exposing your family, your mom, your dad.
Chávez: What [has been] the greatest joy for you in your work over the last year? What’s kept you hopeful?
Hermesch: I think that it’s been really a learning experience. I have really enjoyed working very hard to continue to provide care for patients. Because, as you mentioned earlier, babies will continue to be born. Women will continue to need health care. We have worked very hard to be there for them when they needed us, and I have been very fortunate to be part of the team that has been strategizing to think: How can we continue to provide care and keep everyone safe? It’s been very rewarding and I’m really appreciative of all of the team at OHSU, as well as the patients who have continued to trust us with their care.