New and expectant mothers are looking for science and medicine as they try to reduce the risks of COVID-19 for themselves and their babies.
Why it matters: Pregnancy can be difficult during normal times, but there is an extra degree of uncertainty during the pandemic, as COVID-19 poses unique risks to pregnant people.
Send the news: Anthony Fauci, director of the NIAID, said on Wednesday that so far about 20,000 pregnant people have been vaccinated in the US, and no complications have been seen.
- But “it takes us quite a while to follow the woman and her fetus and then her baby and see how things turn out,” said Geeta Swamy, associate professor in OB / GYN and a co-vice president for research at Duke, points out.
- The experts say the Pfizer BioNTech and Moderna vaccines that are approved in the US do not use live or attenuated viruses, and according to studies of pregnant animals, it is safe. However, pregnant and lactating people were not included in the initial vaccination trials.
- “No one expects there to be an impact on the development or growth of the fetus,” Swamy tells Axios. But some are worried about possible side effects of the vaccine, including fever and inflammation, which could stress the fetus.
- “We have good theoretical data and the risks are not great, but ultimately individuals have to make the choice and it is difficult,” says Naima Joseph, who specializes in internal maternal medicine at Emory University’s School of Medicine.
Between the lines: This allows pregnant people to weigh the risks. The CDC does not take a stand, saying: “People who are pregnant and part of a group that is recommended to receive the COVID-19 vaccine may choose to be vaccinated.”
On the one hand: Data show that pregnant people are at a higher risk of developing severe COVID-19 compared to women of the same age who are not pregnant, and there appears to be a risk of premature birth.
- Pregnant people are “more likely to be hospitalized, require intensive care, need ECMO, be ventilated and die unhappily,” Emise Healthcare’s Denise Jamieson told a JAMA webcast Monday.
On the other side: Clinical trials, including those for COVID-19 vaccines, usually do not include pregnant or lactating people, leaving a gap in the effect of one of the most important pandemic control tools.
- Catherine Spong, Head of the Division of Material-Fetal Medicine and Vice-Chair of the OB / GYN Division at UT Southwestern, told the webcast that many experts were “absolutely” disappointed that pregnant or lactating people were not included in Phase III trials. not.
- A congressional task force met years ago and came up with recommendations and an implementation plan on how to include these two groups, and ‘yet they are not yet included in something where they are clearly at higher risk’, Spong said. co-author of a piece in JAMA this week about COVID-19 vaccination for pregnant and lactating people.
An open question is whether a baby is protected when their pregnant mother is vaccinated.
- Pregnant people are advised to take flu and Tdap vaccines because the newborn will have immunity for the first few months, Swamy said.
- A handful of recent studies, including one by Joseph, found that COVID-19 antibodies of infection cross the placenta.
- But antibodies are not transmitted as quickly as we know the placenta can do from studies of other pathogens, Joseph says. “We do not yet know what this means for vaccines,” but are now doing studies.
Other urgent questions …
- Can a mother’s infection affect the fetus? “We think infection can occur, but it’s pretty rare,” Joseph says. “With more than a year’s of data and deliveries, there does not appear to be an increased risk of congenital anomalies or anything other than premature birth, mostly in people with serious illnesses.
- Can caregivers like grandparents help out safely? Jamieson and Spong recommend that caregivers be vaccinated and wait two weeks after the second admission (for the mRNA vaccines). They must wear masks and practice good hygiene.
- Breastfeeding women can safely get the vaccine, Swamy says, supported by the Academy of Breastfeeding Medicine.
What to look for: Pfizer and J&J, which have applied for the use of the COVID-19 emergency vaccine, plan to launch clinical trials for pregnant women, and the CDC monitors all vaccines through its v-safe program.
- To continue, Joseph says, “the highest priority is to include mothers in studies looking at adaptive immunity, because that is the only way to design rational vaccines for this population.”