What pregnant women face during COVID-19

New mothers and expectant mothers navigate a swamp of science and medicine as they attempt to mitigate the risks of COVID-19 for themselves and their babies.

Why is this important: Pregnancy can be difficult under normal circumstances, but there is an additional layer of uncertainty during the pandemic as COVID-19 presents unique risks to pregnant women.

Driving the news: NIAID Director Anthony Fauci said on Wednesday that about 20,000 pregnant women have been vaccinated in the United States so far and no complications have been seen.

• But “we need a little time to follow the woman and her fetus and then her baby and see how things are going”, Geeta Swamy, associate professor in OB / GYN and an associate vice president for research at Duke, points out.
• The Pfizer BioNTech and Moderna vaccines licensed in the US do not use live or attenuated viruses and studies in pregnant animals suggest they are safe, experts say. However, pregnant and lactating women were not included in the initial vaccine trials.
• “No one predicts that there will be an impact on the development or growth of the fetus,” Swamy tells Axios. But some worry that the potential side effects of the vaccine, including fever and inflammation, could stress the fetus.
• “We have good theoretical data and these risks are not high, but at the end of the day, individuals have to make that choice and it is difficult,” says Naima Joseph, a specialist in maternal internal medicine at the Faculty of Medicine of the ‘Emory University.

Between the lines: This leaves pregnant women to weigh the risks. The CDC takes no position, saying: “People who are pregnant and in a group recommended to receive the COVID-19 vaccine may choose to be vaccinated.”

On the one hand: Data shows that pregnant women 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 women are “more likely to be hospitalized, to require intensive care, to require ECMO, to be ventilated and to die, unfortunately,” said Denise Jamieson of Emory Healthcare. JAMA Monday webcast.

On the other hand: Clinical trials, including those for COVID-19 vaccines, generally do not include pregnant or breastfeeding women, leaving a knowledge gap on the effect of one of the most popular pandemic tools. important.

• Catherine Spong, chief of the maternal and fetal medicine division and vice president of the OB / GYN department at UT Southwestern, said during the webcast that many experts are “absolutely” disappointed that pregnant or breastfeeding women do not ‘were not included in the phase III trials.
• A congressional working group has met for years and made recommendations and an implementation plan on how to include these two groups, and “yet again they were not included. into something where they were clearly more at risk, “said Spong, who co-wrote an article in JAMA this week on COVID-19 vaccination for pregnant and lactating women.

An open question is whether a baby is protected if its pregnant mother is vaccinated.

• Pregnant women are recommended to get the flu and Tdap shots because the newborn will have some immunity for the first few months, Swamy said.
• A handful of recent studies, including one from Joseph, found that COVID-19 antibodies from an infection crossed the placenta.
• But the antibodies weren’t transferred at as high a rate as “we know the placenta can do it” from studies of other pathogens, Joseph says. “We don’t yet know what that means for vaccines,” but are currently conducting studies.

Other urgent matters …

• Can infection from a mother affect the fetus? “We think infection can happen, but it’s pretty rare,” Joseph says. “Over a year of data and deliveries, there does not appear to be an increased risk of birth defects or anything other than preterm delivery,” primarily in people with severe illness.
• Can caregivers like grandparents help safely? Jamieson and Spong recommend that caregivers get vaccinated and wait two weeks after the second shot (for mRNA vaccines). They must wear masks and practice good hygiene.
• It is safe for women who are breastfeeding to receive the vaccine. Swamy says, which is supported by the Academy of Breastfeeding Medicine.

What to watch: Pfizer and J&J, who have applied for an emergency use authorization for its COVID-19 vaccine, plan to begin clinical trials for pregnant women, and the CDC is monitoring all those vaccinated through its v-safe program .

• Moving forward, Joseph says, “The highest priorities are maternal inclusion in studies that examine adaptive immunity because it is the only way to design rational vaccines for this population.”