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Since the start of the pandemic, pregnant women have faced a difficult choice: to vaccinate or not to vaccinate.
The risk of serious illness or even death from COVID-19 – although low – is higher during pregnancy. More than 82,000 coronavirus infections in pregnant women and 90 maternal deaths from the disease were reported in the United States last month.
But there is very little data on the safety and effectiveness of COVID-19 vaccines during pregnancy, as people who are pregnant or breastfeeding were not included in the initial clinical trials. (Pfizer recently started a new trial with 4,000 pregnant women.)
Now, researchers are starting to provide answers. A recent study published in The American Journal of Obstetrics and Gynecology shows that vaccines are not only safe and effective for pregnant and breastfeeding women, they may also provide some protection for their babies.
“This is a very important study,” says Dr. Judette Louis, an obstetrician who until recently was president of the Society for Maternal Fetal Medicine. “People have tried to put together as much information as possible and this study says, okay, there is a benefit.”
Although small – with a sample size of 131 – the study is the largest to date on the subject. Lead author Dr. Kathryn Gray, a specialist in maternal fetal medicine at Brigham and Women’s Hospital in Boston, said people were eager to participate.
“People just volunteered to give us any kind of sample they could to try to help generate data,” Gray says.
All 131 participants had been vaccinated with the Pfizer or Moderna vaccine; 84 were pregnant, 31 were breastfeeding and 16 were non-pregnant women aged 18 to 45. The study involved patients and researchers from Brigham and Women’s Hospital, Massachusetts General Hospital, and the Ragon Institute.
Blood samples were taken at the time of the first and second vaccine doses, and again after six weeks.
“The antibody levels, which we look for in response to vaccination, were similar between the groups,” says Gray.
And when the researchers compared the antibody levels to those of women who had been infected with COVID-19 during pregnancy, the levels of antibodies in response to the vaccine were higher.
This finding “suggests that even if you’ve had a COVID infection, getting the vaccine will lead to a more robust antibody response,” Gray says.
Side effects from the vaccinations were mild and similar to those who were not pregnant, including pain at the injection site after the first dose and muscle pain, headache, fever and chills after the second dose. Gray said.
But perhaps the most exciting discovery: Antibodies have also been found in umbilical cord blood and breast milk.
“If these antibodies are produced during pregnancy and while breastfeeding, the baby is clearly getting some of them,” says Dr. Laura Riley, OB-GYN at New York-Presbyterian Hospital who heads the Obstetrics and Gynecology Department. Weill Cornell Medicine. .
Riley likes the process to that of the flu vaccine: given during pregnancy, it produces antibodies that cross the placenta and are “protective for the baby during the first months of life,” she says.
The hope is that the COVID vaccine will be similar, although Riley warns that it is not yet clear whether it will protect the baby from the disease or how long that protection will last. “But it’s certainly nice to see that there is protection,” she said.
NewYork-Presbyterian has also launched a study on the effectiveness of the vaccine during pregnancy, says Riley, who is also a member of the COVID-19 expert working group for the American College of Obstetricans and Gynecologists. Among the questions she asks herself is an optimal quarter to get the COVID vaccine to maximize its benefits.
And as it becomes more available, the Johnson & Johnson vaccine should be included in future studies.
So while the current results are very encouraging, Riley says more research is needed.
As for people who are trying to decide whether to get the vaccine now, Dr. Judette Louis tells her patients to weigh the benefits against the risks.
“We haven’t seen any safety issues with the vaccine, but we’re definitely seeing worse results if you get COVID,” says Louis, who is also president of obstetrics and gynecology at the University of South Florida.
“If you’re pregnant you’re more likely to end up in the intensive care unit, you’re more likely to end up on a ventilator. And a little more want to die, ”says Louis.
Compare that to if you get the vaccine: “It doesn’t just protect you against severe COVID and going back to the hospital. It seems to pass antibodies to your baby.”
Louis and other obstetricians are encouraging their pregnant patients to participate in the CDC’s V-safe program, which attempts to collect as much data as possible to help others make informed decisions about COVID-19 vaccination.
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