Dr. Jeff Storey

Dr. Jeff Storey

So you’re pregnant. Congratulations! This should be one of the most exciting times of your life – planning, preparing and dreaming of all the possibilities that a pregnancy brings. There are numerous things to think about and decisions to be made.

Unfortunately, the proverb proclaiming “may you live in interesting times” doesn’t come close to explaining what the world is like today. We are now entering our third year of a pandemic with seemingly no end in sight. How do you make choices in this world, especially when pregnant? How do you filter what information is correct when there is so much disinformation?

To begin, COVID-19 is an insidious, vicious disease. It shows no favoritism and is “no holds barred” in how it moves through our communities, region and country. Pregnancy-related data collected over the last 18 months show just how bad it can be when a pregnant woman comes down with COVID-19:

If you are pregnant, you are more likely to get severely ill from COVID-19. One report states that pregnant women are less likely to show the typical symptoms of COVID-19 and are more likely to need hospitalization, require intensive care treatment and be placed on a ventilator.

The risks are even greater for pregnant women with a history of obesity and gestational diabetes. Getting COVID-19 increases the risk of preterm birth, stillbirth and other complications during pregnancy.

What about the COVID-19 vaccines?

The vaccines do not cause COVID-19. The vaccines are not live virus vaccines. Pfizer and Moderna are mRNA vaccines and produce a mimic of the spike protein, causing the body to develop a defense against the real virus.

The Johnson & Johnson vaccine is an adenovirus type 26 vaccine, which creates the same spike protein and triggers an immune response in the body to protect it from COVID-19. Like the other two, is not a live virus vaccine.

A recent study from two academic centers shows that vaccinated, pregnant and lactating women produced a comparable immune response as nonpregnant individuals after receiving the vaccine, and that they produced higher antibody titers (the body’s defense) when infected with COVID-19. They also found antibodies to COVID-19 in the umbilical cord blood and in breastmilk, which transfer defense to a mother’s fetus or newborn children.

Side effects of receiving any of the vaccines are similar and typically mild. These include fever, injection site reaction (swelling and tenderness), fatigue, headaches, and muscle and joint pain. These side effects usually wear off quickly and are very mild, especially compared to the symptoms that women experience when infected with COVID-19. Anaphylaxis is rare, with about five to seven cases per million doses given.

It is important to consider side effects when deciding when to get vaccinated because, while they reflect your body’s building of its immunity to COVID-19, they are bothersome while experiencing them.

There are concerns about the Johnson & Johnson vaccine related to thrombosis with thrombocytopenia syndrome. This represents blood clots within the blood vessels. This complication has been reported only with the Johnson & Johnson vaccine and occurs only in very rare instances. Overall, the incidence is 8.9 out of every million doses of the Johnson & Johnson vaccine. Given that it is more common in reproductive-aged women, it would make sense to talk with your provider about receiving the mRNA vaccines, which do not have the same risk.

There also is a slight risk of myocarditis, or inflammation around the heart, with COVID-19 vaccines. This risk is about the same at 10 per 1 million and occurs more commonly in young males and, in almost all cases, the problem has resolved without treatment.

What does this mean for you?

If pregnant and on medication such as blood thinners, Johnson & Johnson can still be utilized, but there are alternatives that have a reduced risk of blood clots.

If you have heart conditions and are pregnant, most of the cases of temporary myocarditis are in younger males, and the vaccine is still recommended.

Another factor to consider is that the COVID-19 vaccines have been looked at extensively by Developmental and Reproductive Toxicity (DART) studies. To this point, there has been no evidence of a direct or indirect harmful effect on the pregnancy, embryo/fetal development, delivery or early childhood development. V-safe, the vaccines’ health checker, has no recorded safety issues noted in the over 170,000 pregnancies reported to the survey. It also appears that the rate of miscarriage is identical to that of those who are not vaccinated. In other words, the vaccines do not cause miscarriages.

For those of you who are trying to get pregnant, the American College of OB/Gyn, the American Society for Reproductive Medicine and the Society for Maternal-Fetal Medicine all recommend getting the vaccine. As a group, they released the following statement: “As experts in reproductive health, we continue to recommend that the vaccine be available to pregnant individuals. We also assure patients that there is no evidence that the vaccine can lead to loss of fertility.”

It is ultimately your decision on whether and when you get vaccinated. It is also your choice whether you remain susceptible to COVID-19 by not getting vaccinated. But please consider that getting vaccinated is recommended by all the national governing bodies for women’s health, whether you are pregnant, planning a pregnancy or breastfeeding. A vaccine may well help keep your pregnancy safe and your newborn healthy. And all the vaccines have been shown to be safe and very effective at preventing hospital admissions, preventing the need for intensive care treatment and preventing the need for a ventilator for breathing support should you get COVID-19.

Please talk to a women’s health care expert about the recommendations made by the national governing bodies for women’s health care. And may you have a happy, healthy and safe pregnancy and delivery ahead of you!

Dr. Jeff Storey is a fellow of the American College of Obstetrics and Gynecology and assistant chief medical officer at Cheyenne Regional Medical Center.

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