I was hoping my doctor would be more helpful.
I’m a journalist who’s spent the last year reporting on the U.S. government’s response to the pandemic. But one thing my job teaches me every day is how little I know. So as a pregnant woman, I thought it would be prudent to follow the advice of the Centers for Disease Control and Prevention and ask my doctor whether I should get a COVID-19 vaccine.
His answer: “It’s a personal choice.”
That wasn’t exactly useful advice, though I understood why he gave it. If you’re like most Americans wondering whether to get a coronavirus vaccine, the medical and scientific experts have one thing to say: “Yes!” We have gold-standard scientific evidence proving the vaccines are safe and effective. But if you’re pregnant, the official answer can be a lot more confusing.
That’s because the initial clinical trials for the coronavirus vaccines excluded anyone pregnant or lactating, following the decades-long norm for new medical treatments. There are many reasons for this: Pregnant women are more complicated physiologically, and scientists must evaluate the health of both mother and fetus. The practice also relates to the history of a drug called thalidomide: Regulators writing rules for clinical trials in the 1970s could look at the recent discovery that the drug many doctors had prescribed for morning sickness caused babies to be born with missing limbs or other birth defects.
Since then, experts have continued to debate how cautious to be when it comes to pregnancy. In January, the World Health Organization recommended pregnant women not get vaccinated for the coronavirus — advice that conflicted with the CDC’s guidance to let individuals decide for themselves. The WHO later updated its stance and now aligns more closely with the CDC.
All this complicates the vaccine choice for pregnant women. How do you go about making an important medical decision without rock-solid clinical trial evidence or clear guidance from experts?
I’m neither a doctor nor a scientist, but as a journalist I get to read widely and question experts directly. Here’s some of what I found and how I went about making this decision.
I started by figuring out my decision-making framework. I suppose I could have flipped a coin. But in the face of unknowns, with my health and my child’s health at stake, it seemed wise to weigh risks and benefits. That’s actually a common tool in medicine: When doctors decide whether to advise you to undergo heart surgery, for example, they consider the risk of complications from the procedure, as well as the risk that, without the surgery, your heart could malfunction.
In addition to weighing risks and benefits, Dr. Denise Jamieson, chair of the Department of Gynecology and Obstetrics at Emory University, says it’s important to understand the rigorous process regulators used to evaluate the vaccines’ safety. After clinical trials involving tens of thousands of participants, including a small number who became pregnant during the trials, independent experts reviewed the vaccines’ safety data for both the Food and Drug Administration and the CDC. Professional societies such as the American College of Obstetrics and Gynecology then wrote their own recommendations, urging health authorities to make the vaccines available to pregnant women. “It’s a multi-step process reviewed by independent scientists all along the way,” Jamieson said. “This isn’t a half-baked idea. The data are carefully reviewed and continue to be reviewed on an ongoing basis.”
Then I examined the evidence about risks from the vaccine. Though we don’t have clinical trial data, we’ve known for months that the vaccines did not harm pregnant lab animals. And the real-world evidence about the vaccines’ safety is getting better and better: Nearly 78,000 people in the U.S. have told the CDC they received the vaccine while pregnant. Thus far, none of those vaccinations has been shown to harm any mothers or babies. “That’s pretty convincing to me that the vaccine is safe,” said Dr. Geeta Swamy, an obstetrician and associate vice president for research at Duke University. The CDC analyzed a small amount of its initial data in March and found that vaccinated pregnant women experienced normal side effects from the shots and were no more likely to experience birth complications than non-vaccinated pregnant women.
Furthermore, scientists say there’s no obvious biological reason the mRNA vaccines (those made by Pfizer and Moderna) or the Johnson & Johnson vaccine would harm a pregnancy. The technology in the Johnson & Johnson vaccine was also used in the Ebola vaccine, shown to be safe during pregnancy. Indeed, pregnant women have safely taken other vaccines for decades. Vaccines containing snippets of “live” virus, such as the chickenpox immunization, aren’t recommended for pregnant women, but the coronavirus vaccines do not contain live virus. Instead, they prompt the body to create coronavirus proteins that then kick a patient’s immune system into gear to develop antibodies.
Given all the good signs so far, experts say the current guidance from organizations such as the CDC and ACOG now seems particularly cautious. More studies on vaccinated pregnant women are due to publish soon. “I think the data will come in the not too distant future,” said Jamieson, “where we’ll be more comfortable recommending the vaccine, just like we recommend the influenza vaccine and TDAP [tetanus, diphtheria and pertussis vaccine] during pregnancy.”
I considered the risk of NOT getting the vaccine. Evidence from multiple studies shows that if I become infected with the coronavirus, pregnancy makes me more likely to become severely ill, meaning I may need to be hospitalized or even put on a ventilator. COVID-19 could also increase my chance of giving birth too early, which could mean health complications for my baby. And though more than 60 million Americans are now fully vaccinated, including most of the vulnerable residents in our nation’s nursing homes, the highly infectious variants of the coronavirus are also now spreading. “The infection rates are still quite high,” Jamieson said. “You don’t want to be the last person shot and killed in a war. You don’t want to get infected just as we have the end of this pandemic in sight.”
I weighed potential benefits on both sides. The biggest potential benefit of avoiding the vaccine while pregnant was steering clear of any possibility of an unforeseen, rare complication. But the benefits of taking the shot seemed more concrete: I would be protected from a severe coronavirus infection. I may be able to pass antibodies to my child, as vaccinated women did in several recent studies. I would help contribute to my community reaching herd immunity, shielding others who can’t be vaccinated due to a history of severe allergic reactions or other reasons. And I would be able to participate in the full reopening of our society with a much lower risk of unknowingly transmitting the virus to vulnerable people.
I considered my personal circumstances. If I wanted to avoid both the unknowns of vaccination and the risk of contracting severe COVID-19, I could have fully quarantined until the pandemic’s end, or until I gave birth. But I knew that wasn’t really possible for my family. And I knew it wouldn’t be good for my spiritual and mental health. And after a year of Zoom celebrations, I also wanted to attend my sister’s upcoming college graduation, as well as my cousin’s wedding.
I decided to get the coronavirus vaccine. I concluded the clear benefits of getting vaccinated outweighed unknown and possibly nonexistent risks. And the proven risks of contracting the coronavirus while pregnant, or unknowingly passing it to others, outweighed the benefits of the “wait and see” approach.
I got the first dose of the Pfizer vaccine on Tuesday. And I signed up for the CDC’s v-safe post-vaccination tracker to help scientists learn more about how the vaccine impacts pregnancy and childbirth.
I hope that tracker’s data — and other forthcoming studies — will mean doctors can soon offer pregnant patients more helpful advice.