There is so much yet so little information out there on the COVID vaccine. There is even less for women that are trying to conceive, pregnant, and/or nursing. I am 100% for each person making the decision that is best for them. That is why I decided to do some digging myself. I am not trying to conceive or pregnant, but I am nursing. I figured if I was doing research, there were probably more women out there looking for reassurance as well. Read along to see what a few women’s health Doctor Moms have to say, what I learned, and what I have decided on the vaccine.
Let’s do a little breakdown of the actual vaccine.
The vaccine has a live strand of messenger RNA, or mRNA. The SARS-CoV-2 (COVID) virus has a gnarly spike protein. The mRNA acts as a set of instructions that informs cells on how to make part of that protein. Once the protein is present, the immune system creates antibodies and activates T-cells to combat what it thinks is an infection. These antibodies are now primed for the SARS-CoV-2 virus. This means the immune system is ready to protect against future infection of COVID.
It is also important to note that the mRNA does not enter the cell’s nucleus or alter genetic material. The technology is new but not unknown. It has been studied for well over a decade now. Also, the vaccine doesn’t contain a live virus, therefore it does not carry risk of disease to the vaccinated person. One thing we don’t know yet, though, is how long vaccine-induced immunity lasts.
Let’s hear from the experts.
I know, I know. We know how it works, but what about trying to conceive, being pregnant, or breastfeeding? There is less information available on the vaccine for women in these categories. A few things are known, though. COVID in pregnancy presents a higher risk of severe illness and death versus those that are not pregnant. There is also possible increased risk of pre-term birth with COVID. Now, let’s turn to the experts for advice on the vaccine.
First, I talked to Sukhkamal Campbell, MD, Reproductive Endocrinology and Infertility at UAB Hospital, to learn more about the vaccine while trying to conceive.
Dr. Campbell, you specialize in infertility. What do your patients that are trying to conceive most often ask when considering vaccination? What is your response?
“Most patients want to know one of two things. Many ask about deferring versus continuing to try and conceive while getting or waiting for the vaccine. It is not a live vaccine, nor does it contain inactivated COVID virus. Therefore, it is safe and carries no chance for the patient getting COVID from the vaccine. Since it is not a live vaccine, there is no reason to defer trying to conceive before completing the series. In fact, some women in initial trials of the vaccine did conceive spontaneously during dose one and two. The recommendation was to continue with the series.”
Other questions center around possible side effects that could be detrimental in pregnancy.
The main risk that is important to know about in pregnancy is the risk of fever. Fever is present in 16% of individuals after the second dose. Fever can be scary for pregnant women, understandably. Tylenol is safe in pregnancy and safe with the vaccine, though. I recommend Tylenol for fever prevention and/or fever reduction for patients who get a fever after dose number two. Additionally, the risk of congenital anomalies due to high fever can be worrisome in pregnancy. However, this risk is unwarranted for women who take standard folic acid supplementation (standard prenatal vitamin dosages of folic acid) in the pregnancy. This negates the risk of congenital anomaly related to fever (such as neural tube defects). Other side effects noted include body aches (myalgias), fatigue, and bone pain. These side effects, while bothersome, are not harmful to pregnancy.
My recommendations are based on the American Society for Reproductive Medicine, the American College of Obstetrics and Gynecology, and the Society for Maternal-Fetal Medicine. All recommend we offer vaccination to women at risk for COVID (those working in healthcare, retail, and with certain comorbidities) regardless of pregnancy or trying to conceive status. Therefore, I always respect patient autonomy in making decisions, but even more so now regarding the COVID vaccine and paucity of human data.”
You are currently nursing. I am too. Can you tell me why you’d recommend others receive the vaccine while nursing?
“Nursing mamas fall into the same category in my opinion as pregnant mamas. The goal is to immunize ourselves to not only protect ourselves but to allow for passive immunity for our littles as best that we can. This vaccine does not contain inactivated COVID virus and is not a live vaccine (that may not be safe in pregnancy such as the varicella vaccine). There is therefore no risk of my child getting COVID from the vaccine and no known risk of harm to my child of getting passive immunity from me getting this mRNA vaccine. It’s a way to protect my loved ones and myself. I trust the science and safety for both myself and my breastfed baby. Since he can’t get the vaccine himself, this is the best alternative in my mind.”
I also wanted to hear first-hand from someone who received the vaccine while pregnant, so I reached out to Gretchen McCreless, MD; Gynecology at St. Vincent’s Hospital.
Dr. McCreless, you received the first round of COVID vaccine while 37 weeks pregnant. What led you to that decision?
“Being pregnant during a pandemic was one of the more stressful experiences of my life! So much time was spent worrying and trying to avoid COVID during pregnancy because of the unknown risks to the baby and the risk of more severe illness for me. I couldn’t wait to be vaccinated. I read statements from the American College of Obstetrics and Gynecology, the Society for Maternal-Fetal Medicine, and the American Society for Reproductive Medicine. All three organizations feel that pregnant and breastfeeding patients should not avoid the vaccine, despite the lack of data in these groups. I also read extensively on the mRNA vaccine and felt very encouraged by the science behind it and the overall safety of it.
I reached out to friends who are high-risk OB physicians and all of them encouraged me to get the vaccine without hesitation. On the way to my vaccine appointment, I almost decided to wait until after he was born. My husband said, “What if there are supply chain issues? You never know when you’ll get to schedule it again. Don’t miss your shot!” So I didn’t.
When it comes to my patients, I inform them of data and recommendations from the above referenced groups. Overall, it seems that the shot is safe and should have little effect in pregnant or breastfeeding women. It still has to be a decision that each individual is comfortable in making, though. The risks of COVID in pregnancy seem to be far worse than the risk of the vaccine. How likely you are to be exposed should also weigh into your decision. I was caring for patients directly. Someone working from home may not have the same urgency to receive it as a healthcare worker or teacher, for example.”
You received your second dose of vaccine at two weeks postpartum, while nursing. Was that of any concern to you?
“The general consensus is that overall risk of the vaccine is low in pregnant and breastfeeding women. I hesitated again about the vaccine and unknown risks to my two-week-old. I’ve heard from a few other nursing mothers that their babies had mild effects from the shot including fatigue, fussiness, and fevers. The vast majority of nursing moms who have had it report no side effects in the infant, however. I also spoke to our pediatrician. She agrees that the risks of COVID and the importance of the vaccine are greater than any theoretical side effects he may experience. So I am now fully vaccinated, which is such a relief after all the months of stress and worry!”
Lastly, I contacted Amelia Sutton, MD; Maternal and Fetal Medicine, Medical Genetics, Obstetrics and Gynecology at Novant Health Presbyterian Medical Center in North Carolina (residency and fellowship at UAB).
Dr. Sutton, I am nearing the end of my nursing journey with my youngest. Would you recommend I wait to wean until after the vaccine? Can you also speak about the breastmilk studies you are participating in?
“I definitely recommend continuing to nurse after receiving the vaccine. I am thrilled to have received the vaccine while nursing my three-month-old baby. The mechanism of the vaccine is not expected to cause any problems at all for the baby. In fact, even if the vaccine is excreted into breast milk, the baby’s stomach will break it down. The major benefit of breastfeeding is the potential to pass antibodies to the baby that protect against COVID-19. The Society for Maternal-Fetal Medicine and the American College of Obstetrics and Gynecology recommend that we offer the vaccine to pregnant and lactating patients.
I am participating in two research studies that are investigating the vaccine in pregnancy and lactation. The first one is a registry that tracks outcomes in people who are pregnant, lactating, or contemplating pregnancy. The second study is looking at whether the vaccine mRNA is excreted into breastmilk and for the presence of antibodies in the milk. I am sending several samples of my milk, after getting the vaccine, to Dr. Rebecca Powell at the Icahn School of Medicine at Mount Sinai for study.”
You are a MFM doctor, which means that you are already seeing high-risk pregnant patients. What would you recommend those patients do in regards to getting the vaccine now versus waiting until they deliver?
What did I decide?
After much prayer and research (thanks to these wonderful Doctor Moms), I’ve come to the decision that it is best for me and my family if I get the vaccine. My husband is in an office setting every day. My oldest child is in a public pre-K program and is around many people each day. Although I am a healthy stay-at-home mom, we are in frequent contact with older family members with comorbidities. Since maternal antibodies will be excreted into my milk, thus hopefully providing my youngest with passive humoral immunity, I will also continue my nursing journey until after I receive the vaccine. I am looking forward to becoming a renegade spike-protein-making, COVID-fighting mom. This is my shot! May 2021 be the year that we end this pandemic!
