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Maggie Anthony didn’t have much time to deliberate before receiving her COVID-19 vaccine. A labor and delivery nurse at Cambridge Hospital in Massachusetts, she suddenly learned from her manager that injections would be available the next day. But with an 8 month old nursing baby at home, she wasn’t sure if she would. Pregnant and breastfeeding women have not been included in clinical trials for COVID vaccines, so there is no vaccine safety data for these groups.
At first, Anthony thought she would refuse. She knew that in the UK, the National Health Service had said that pregnant and breastfeeding people should not be vaccinated. The Food and Drug Administration simply advises, “If you are pregnant or breastfeeding, discuss your options with your health care provider.” But Anthony had another factor to consider: she regularly cares for women who are COVID-positive. “During labor, in the operating room, in their faces – there is no distance,” she says. “So I know I’m definitely exposed.”
When the day came, she was vaccinated. What helped her make up her mind, Anthony said, was to consider pregnancy and breastfeeding separately. In her opinion, it was “somehow impossible to imagine a way” by which the fragile mRNA from the vaccine could reach or affect her nursing baby. If she was still pregnant, with a baby sharing her blood through her placenta, she would have felt more nervous. “It’s definitely a completely different scenario in my mind,” she said.
Government guidelines and news headlines have brought together breastfeeding women and those who are pregnant to talk about the safety of the COVID vaccine. But as people try to make their own decisions without safety data, it might help to recognize that getting vaccinated during pregnancy and breastfeeding comes with different theoretical risks – and potential benefits.
Christina Chambers, perinatal epidemiologist and professor of pediatrics at the University of California, San Diego, said it was never a good idea to group pregnancy and breastfeeding together to ask if something is harmful. Some drugs that are risky during pregnancy are also avoided by people who are breastfeeding, even though they are perfectly safe for a nursing baby.
READ MORE: Does Breastfeeding Prevent Heart Disease and Stroke in Mothers?
Chambers said vaccines in general, especially those like COVID vaccines that do not contain a live virus, are unlikely to harm the fetus or a nursing baby. “But they raise different issues” in pregnant and breastfeeding women, she added.
Some of these problems relate to how vaccines work in general – by eliciting an immune response. Could triggering an immune response during the first weeks of pregnancy increase the risk of miscarriage? If they have an anaphylactic reaction or a high fever in response to the injection, could this affect the baby in any way? These are the kinds of questions researchers will try to answer in future clinical trials.
Yet with breastfeeding, these concerns do not apply. The main question is whether a dangerous amount of a substance is filtered into breast milk. For most drugs, Chambers said, “There is so little that happens to the baby that there is really very little theoretical risk.”
Even if a drug or vaccine ends up in breast milk, its journey into the baby is not over. “Anything that passes through breast milk also has to pass through an intestine,” said Helen Hare, a young doctor in acute medicine in Edinburgh, Scotland. Hare co-authored a BMJ opinion piece titled “Breastfeeding healthcare workers should be offered the COVID-19 vaccine.” The delicate mRNA molecules from Pfizer or Moderna vaccines, if found in milk, would then land in a baby’s stomach acid.
“If this vaccine worked orally, we wouldn’t have injections,” Hare said.
The Academy of Breastfeeding Medicine made the same point in a Dec. 14 statement. “During breastfeeding, the lipids from the vaccine are unlikely to enter the bloodstream and reach breast tissue,” the authors wrote. “If so, it is even less likely that the intact nanoparticle or mRNA will be transferred into milk. In the unlikely event that mRNA is present in milk, it would have to be digested by the infant and it is unlikely to have any biological effects. “
In the absence of clinical trial data on the matter, it is impossible for any organization or expert to say with absolute certainty that there is no risk.
But even the World Health Organization suggests a less careful approach to breastfeeding than pregnancy. For pregnant women, the WHO recommends against receiving the Pfizer vaccine “unless the benefit of immunizing a pregnant woman outweighs the potential risks of the vaccine”, as for high-risk health workers. risk of exposure. But because the vaccine is “biologically and clinically unlikely to pose a risk to the nursing child,” breastfeeding women should be offered their vaccines like anyone else.
While the Academy of Breastfeeding Medicine says vaccines pose “an implausible risk” to a nursing child, it also says there is a “biologically plausible benefit”.
Once the vaccine prompts the mother’s immune system to make antibodies against SARS-CoV-2, the virus that causes COVID-19, these molecules can pass into breast milk. Babies regularly receive temporary protection from their mother’s illness in this way. Researchers have already found COVID antibodies in the breast milk of previously infected women, although they do not yet know what protection these antibodies give to babies.
READ MORE: People with type 1 diabetes have a higher risk of dying from COVID-19. Why are they lower on the CDC’s priority vaccine list?
At UCSD, Chambers is working on studies of how COVID infection and vaccines affect mothers and babies during pregnancy and beyond. The women also provide milk samples that the researchers will test for antibodies. (In an earlier article, Chambers and his coauthors did not find any viruses living in the breast milk of infected women.) Antibodies can also pass to the fetus of a vaccinated person during pregnancy, Chambers said.
During the first round of COVID vaccinations in the UK, women did not have the chance to weigh these factors for themselves. If they were pregnant, breastfeeding, or planning to become pregnant, they could not get the vaccine.
In their opinion piece, Hare and co-author Kate Womersley, a University Doctor in Edinburgh and research associate at the George Institute for Global Health, wrote that “no plausible biological mechanism to explain how an inactivated, recombinant vaccine would cause damage to a nursing baby has been suggested. Yet British policy forced frontline health workers to an impossible choice: they could forgo immunizations, wean their children before they were ready, or lie.
Then on December 30, government press releases on the authorization of a second vaccine in the UK mentioned – almost in passing – that the guidelines had changed. Those who were breastfeeding or pregnant were no longer ineligible for a vaccine.
Womersley said it was “disappointing” that there had not been a clearer announcement regarding the new guidelines. She and Hare have heard anecdotally that women have been denied vaccines even after the switchover. Unclear communication about vaccines is doing women a disservice, Womersley said, undermining public trust.
Hare agreed there should be better communication about vaccines, including recognizing that pregnancy and breastfeeding are two different things. “I think it helps build confidence in the guidelines that the real situation is taken into account,” she said.
Pregnant and breastfeeding women also need to consider different risk factors for COVID itself, Womersley added – COVID is believed to be particularly risky during pregnancy. “We need to tailor the conversation differently for breastfeeding and pregnancy because the benefits and risks are different,” she said.
“I don’t think it helps the two groups to lump them together like that,” Womersley said. “The only thing that really unifies these two groups is that they are systematically discriminated against and excluded from trials.”
This article is reprinted with permission from STAT. It was first published on January 19, 2021. Find the original story here.
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