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Can Pregnant Women Have The Vaccine?

can pregnant women have the vaccine? Today I’m talking about COVID-19 vaccine in pregnancy and breastfeeding.

 Is it safe? Do we know anything? And also a little bit about how the vaccine itself works.

This information is up to date to the best of my knowledge and ability as of November 30th, 2020. Things could change. We will definitely be getting more information, but this is what we know now.

The ones I’m talking about today are the mRNA vaccines that are currently under review and expect it to be approved by the FDA sometime in the coming weeks.

mRNA vaccines are really interesting to me because instead of taking a whole live virus vaccine, like the MMR vaccine or a whole dead virus vaccine, like the influenza shot, we have taken a tiny piece of messenger RNA or mRNA from a dead virus of SARS-CoV-2 and use that for the vaccine. So how does mRNA work in the vaccine? I want to specify I am an OB-GYN.

 I am not an epidemiologist or an immunologist, but I’ll explain it to you to the best of my understanding in a way that hopefully you can understand too because I actually think it’s really cool. mRNA is messenger RNA.

And what that mRNA does in SARS-CoV-2 is create the spike protein. The spike protein is basically the key that SARS-CoV-2 uses to get into your body.

 A protein on the outside of the virus that allows a virus to gain entry into your respiratory system.

When we take that piece of mRNA out and put it in a vaccine your body starts making that protein. It’s kind of like if you sent a message to your printer to print out a, I don’t know, a picture and that’s what your printer would do.

So basically the mRNA is the message that you’re sending to your body to make some of the spike protein, which is the key the virus uses to get into your respiratory system.

Even though your body’s making it, your body recognizes it as not being the typical thing that should be in your body. So immediately your immune system kicks into gear and starts making antibodies that fight that protein off.

Your body is actually doing all the work here. So once your body starts making those spike proteins and then starts making the antibodies, your body has an ability to recognize that spike protein if it ever interacts with it again, out in the wild.

So when you go out and you’re exposed to SARS-CoV-2, if you’ve had this mRNA vaccine, when that virus gets close to your respiratory system your body goes, oh, we know that key.

That’s a key we don’t want SARS-CoV-2 using to get into our body. So it protects against that spike protein being able to be used as the key to get into your body.

And then if the virus does get into your body you’re better able to fight it off because your body and your immune system already recognize it. I hope that that made sense. That’s the way that my brain understands it. And I hope that it helps you understand a little bit of how the vaccine works as well.

And again, there’s a couple of different types of vaccines that they’re developing. These are the mRNA vaccines that are currently under review.

1. CAN PREGNANT WOMEN HAVE THE VACCINE?

IT IS SAFE EFFECTIVE IN PREGNANCY

So unfortunately, despite many OB-GYNs like myself yelling about this for a long time, people who are pregnant were excluded from every vaccine trial and people who are breastfeeding were excluded from most vaccine trials.

This is really unfortunate because it puts us in a very difficult place as far as counseling what you should do.

SO, SHOULD YOU GET IT IF PREGNANT

First off, I want to say this article should not supplement medical advice that your doctor gives you.

You should talk to your own OB-GYN and make this decision in conjunction with them. That being said, I do want to give you some information, so that you have some talking points to bring up with your doctor.

We can kind of extrapolate a little bit of information from other vaccines. However, since we’ve never had an mRNA vaccine, we can’t predict super accurately how it will behave in your body.

We can use biologic plausibility and history to give us a little information.

This vaccine being a portion of a dead virus will most likely react most similarly to other dead virus vaccines because it’s more similar to take a dead piece of virus and compare it to a dead virus than it would be to take a dead piece of virus and compare it to a live virus.

Does that make sense? So we should look at what vaccines have been traditionally contraindicated or recommended against in pregnancy.

And most of those are going to be things that either can wait safely until you’re not pregnant, like HPV vaccine or they’re going to be live virus vaccines, like the MMR vaccine.

Most dead virus vaccines, like influenza shot and Tdap shot are safe to use in pregnancy.

 We would expect based on that, that hopefully this one will be safe in pregnancy, but again, I don’t have any data at this point to base that on.

So why have live vaccines been traditionally not given in pregnancy? This is because people who are pregnant tend to react more strongly to these and have worse side effects. And so we choose not to give those because of that.

There are things like the HPV vaccine, which can safely wait until after pregnancy.

So we just recommend that you wait until you’re not pregnant anymore to get that one as well. Over the next six or 12 months, we will start to get a little bit of data on this from post-licensure data and any post-licensure scientific studies that are done, but they probably won’t be randomized controlled trials because once a vaccine is approved it’s really hard to do a randomized control trial.

Most people aren’t going to want to be randomized once we have the data for them to make that decision.

 If that makes sense. So probably what we’re going to have is post-licensure data, where people who are currently pregnant and opt to get the vaccine are followed to see if they have any bad outcomes or side effects that might be related to the vaccine itself. We will continue to follow these post-licensure events in all people who get the vaccine for a long period of time. But specifically, I’m hoping that in the next six to 12 months, we do have information on people who chose to get the vaccine while they were pregnant.

2. CAN YOU HELP ME WEIGHT RISK/BENEFIT?

We know that COVID in pregnancy might be more dangerous than COVID outside of pregnancy.

And we do know that there are some associated poor fetal outcomes that are looking more and more likely to be associated with COVID-19 infection in pregnancy. I have a article on this.

 I need to do an update. That’s kind of the general understanding is that although pregnant people don’t seem more likely to get infected.

 They might have a higher likelihood of being admitted to the ICU and they might have a higher likelihood of having pregnancy complications, like preterm labor, miscarriage, stillbirth, preterm delivery, and things like that.

That would mean that if someone has weighed, you know, we don’t have any information on the risks, but we know the benefit of it being very effective against preventing COVID-19.

And if you get the vaccine and you still get COVID it seems like your COVID is much less severe.

So that would make us lean towards, okay, well, if COVID in pregnancy can be dangerous and have pregnancy complications associated with it and the vaccine based on biologic plausibility and history, seems like it should be safe and effective.

 Then some people may choose to get the vaccine without that data. I think it’s really important to acknowledge if there are people who choose not to get the vaccine because they don’t want to be, you know, getting it before the data’s there.

 I really think that is completely reasonable. When I evaluate it in my head if I were the person who was pregnant, I think I would probably choose to get the vaccine. Knowing my own risk, benefit analysis and my own risk aversion.

That’s what I would choose. But, I think this is a situation where it’s really, really reasonable to get this information and choose whichever way you think is best for you.

Breastfeeding has been excluded in most of the vaccine trials. Although there are a couple out there that have a little bit of information on it.

We don’t have any evidence to suggest that, I don’t think any vaccine, I can’t think of any vaccine that is completely contraindicated in someone who is breastfeeding.

And we know that there’s probably some conferred immunity from getting the vaccine either while pregnant and those antibodies go through the placenta and help protect the baby when the baby’s born and in creating antibodies that go through the breast milk to the baby. So there probably is a benefit there.

The risk is likely to be minimal, but again, we don’t have that data yet. And hopefully we’ll have more in the next six to 12 months.

 I want to one more time say I think a reasonable decision is whichever one sounds the best for you after hearing this information and talking with your own doctor or midwife.

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