Maggie Anthony did not have much time to consult before getting her COVID-19 vaccine. She is a nurse at Cambridge Hospital in Massachusetts and suddenly heard from her manager that shots would be available the next day. But with a baby who was 8 months old at home, she was not sure if she would accept it. Those who are pregnant and lactating have not been included in clinical trials for the COVID vaccines, so there are no data on the safety of the vaccines for these groups.
At first, Anthony thought she would take off. She knew that the National Health Service in the UK had said that people who were pregnant and breastfeeding should not be vaccinated. The Food and Drug Administration simply recommends, “If you are pregnant or breastfeeding, discuss options with your healthcare provider.” But Anthony has another factor to consider: she regularly cares for COVID-positive women. “During labor, in the operating room, in their faces – there is no distance,” she said. “So I know I’m definitely being exposed.”
When the day dawns, she gets her chance. What helped her decide, Anthony said, is to consider pregnancy and breastfeeding separately. According to her, it was ‘quite impossible to suggest a way’ in which the fragile mRNA in the vaccine could reach or influence her nursing baby. If she was still pregnant, with a baby sharing her blood through her placenta, she would have felt more nervous. “It’s definitely a very different scenario in my mind,” she said.
Government guidelines and news headlines have brought together those who are breastfeeding and pregnant when talking about COVID vaccine safety. But when people try to make their own decisions without safety data, it can help to recognize that vaccination during pregnancy and lactation carries different theoretical risks and potential benefits.
Christina Chambers, a perinatal epidemiologist and professor of pediatrics at the University of California, San Diego, said it is never a good idea to combine pregnancy and breastfeeding if they ask if something is harmful. Some drugs that are risky during pregnancy are also avoided by people who are breastfeeding, even if they are completely safe for a baby who is breastfeeding.
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Chambers said vaccines in general, especially those like the COVID vaccines that do not contain any live virus, are unlikely to harm a fetus or a baby who is breastfeeding. “But it brings up a kind of different problems” in pregnant or breastfeeding women, she added.
Some of these problems are related to the action of vaccines in general – by causing an immune response. Can the risk of miscarriage increase due to an immune response during the first weeks of pregnancy? If it has an anaphylactic reaction or high fever due to the shot, can it affect the baby in any way? These are the kinds of questions that researchers will try to answer in future clinical trials.
But with breastfeeding, these problems do not apply. The most important question is whether a dangerous amount of substance is filtered in breast milk. For most drugs, Chambers said, “The baby gets so little that the theoretical risk is really small.”
Even if a drug or vaccine does end up in breast milk, the journey to the baby is not completed. “Anything that goes through breast milk must also go through the intestines,” said Helen Hare, a junior doctor in acute medicine in Edinburgh, Scotland. Hare co-authored a BMJ opinion piece entitled ‘Breastfeeding Healthcare Workers to Offer the COVID-19 Vaccine.’ The delicate mRNA molecules in the Pfizer or Moderna vaccines would then end up in the stomach acid of a baby if they made it into the milk.
“If this vaccine works orally, we will not do injections,” Hare said.
The Academy of Breastfeeding Medicine made the same point in a statement on December 14th. “During lactation, the vaccine lipid is unlikely to enter the bloodstream and reach breast tissue,” the authors wrote. “If this does happen, it is even less likely that the intact nanoparticle or mRNA will be transferred into milk. In the unlikely event that mRNA is present in milk, the child is expected to digest and is likely to have no biological effects. ”
With no clinical trial data on the issue, it is impossible for any organization or expert to say with absolute certainty that there are no risks.
But even the World Health Organization suggests a less cautious approach to breastfeeding than during pregnancy. For pregnant people, the WHO recommends not getting the Pfizer vaccine “unless the benefit of vaccinating a pregnant woman outweighs the potential vaccine risks”, as for health workers with a high exposure risk. But because the vaccine is’ biologically and clinically unlikely to pose a risk to the breast-feeding child’s, those who are lactating should be offered their shots just like anyone else.
While the Academy of Breastfeeding Medicine says that the vaccines pose a ‘small probable risk’ for a child who is nursing, there is also a ‘biologically acceptable benefit’.
After the vaccine causes the mother’s immune system to make antibodies against SARS-CoV-2, the virus that causes COVID-19, the molecules can pass into breast milk. Babies regularly receive their babies temporary disease protection. Researchers have already found COVID antibodies in the breast milk of previously infected women, even though they do not yet know how much protection these antibodies offer to babies.
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At UCSD, Chambers is working on studies of how COVID infection and vaccines affect mothers and babies during and after pregnancy. Women also produce milk samples that researchers will test for antibodies. (In an earlier article, Chambers and co-authors found no live virus in the breast milk of infected women.) Antibodies can also be transmitted to the fetus of a person who was vaccinated while pregnant, Chambers said.
During the first round of COVID vaccinations in the UK, women did not have the opportunity to weigh these factors for themselves. If they were pregnant, breastfeeding or planning to get pregnant, they could not get the chance.
In their opinion piece, Hare and co-author Kate Womersley, an academic junior doctor in Edinburgh and research fellow at the George Institute for Global Health, write that ‘no plausible biological mechanism for how an inactivated, recombinant vaccine can cause harm to breastfeeding. baby was suggested. Yet British policy forced frontline health workers into an impossible choice: they could give up vaccination, wean their children before they were ready, or lie.
On 30 December, the government’s press releases on the authorization of a second vaccine in the UK – almost incidentally – mentioned that the guidelines had changed. Those who were breastfeeding or pregnant were no longer eligible for a shot.
Womersley said it was disappointing that there was no clearer announcement of the new guidelines. She and Hare have heard anecdotally of women being denied vaccinations even after the change. Womersley has vaguely hampered communication about the vaccines by undermining public confidence.
Hare agreed that there should be better communication about the vaccines, among other things to recognize that pregnancy and breastfeeding are two different things. “I think it helps to give confidence in the guidelines on which the real situation is considered,” she said.
Those who are pregnant and breastfeeding also have different risk factors than COVID to consider, Womersley added. COVID is thought to be particularly risky during pregnancy. “We need to adjust the conversation differently for breastfeeding and pregnancy because the benefits and risks differ,” she said.
“I don’t think it helps one of the groups to put them together like that,” Womersley said. “The only thing that really unites those two groups is that they are regularly discriminated against and excluded from hearings.”
This article is reproduced with permission from STAT. It was first published on January 19, 2021. Find the original story here.