The rationale for including pregnant and lactating women in early CDC-guided COVID-19 vaccination efforts in the United States was outlined in an opinion editorial, published Jan. 26 in the Annals of Internal Medicine, by Dr. Laura Riley, chair of the Department of Obstetrics and Gynecology at Weill Cornell Medicine and obstetrician and gynecologist-in-chief at NewYork-Presbyterian/Weill Cornell Medical Center, and Dr. Denise Jamieson, chair of the Department of Gynecology and Obstetrics and obstetrician at Emory School of Medicine and chief of gynecology and obstetrics at Emory Healthcare.
The Advisory Committee on Immunization Practices (ACIP), the independent committee that develops recommendations for the U.S. Centers for Disease Control and Prevention on who should receive the COVID-19 vaccine and in what priority, has recommended that eligible pregnant and lactating women may choose to be vaccinated and that a conversation with their healthcare provider may be helpful in making an informed decision. The American College of Obstetricians and Gynecologists (ACOG) recommended that the vaccine not be withheld from pregnant individuals and that it should be offered to lactating women. Dr. Riley, who is also the Given Foundation Professor in Clinical Obstetrics and Gynecology at Weill Cornell Medicine, and Dr. Jamieson, are members of ACOG’s COVID-19 expert group. Both organizations also recognized that safety and effectiveness data for the Pfizer-BioNTech mRNA vaccine and the Moderna mRNA-1273 vaccine in pregnant or lactating women are limited, since they were not included in clinical trials, Drs. Jamieson and Riley noted in the article.
Evidence shows that pregnant women with COVID-19 have a higher risk for severe illness and death, with those risks rising higher for those with high blood pressure, diabetes and obesity. Pregnant women with COVID-19 also have an increased risk for preterm births and cesarean deliveries, the authors wrote. Taken together, the evidence suggests that pregnant women with COVID-19 have higher risk than similar nonpregnant persons for poor health outcomes and that risks may also be higher for their babies, they wrote. Thus, it is critical that pregnant persons have the opportunity to be vaccinated if they would otherwise meet the criteria for vaccination, they said.
The two approved COVID-19 mRNA vaccines contain no live virus or other components that could affect a developing fetus or pass into breast milk. The vaccines work by stimulating the production of antibodies against SARS-CoV-2 in the mother’s lymph nodes. The flu vaccine and the tetanus, diphtheria, and pertussis vaccine are already given during pregnancy and have excellent safety profiles, Drs. Riley and Jamieson wrote.
On the basis of what we know about the mRNA COVID-19 vaccines, as well as broader principles of how vaccines work and the safety of other vaccines during pregnancy and breastfeeding, it seems that pregnant and lactating women can be safely included in vaccination efforts, they concluded. Preventing serious illness in women who are pregnant or breastfeeding necessitates prompt discussions about vaccination between patients and their obstetricians. “In the case of COVID-19, time is of the essence, they noted.
Author: Dr. Laura Riley