If you’re pregnant, you likely have a lot of questions about whether it’s safe for you and your baby to receive a vaccine against COVID-19. In this Q&A, Jill Berkin, MD, Assistant Professor of Obstetrics, Gynecology, and Reproductive Science at the Icahn School of Medicine at Mount Sinai, draws on her vast experience as a high-risk obstetrician—as well as her own pregnancy—to offer her perspectives on side effects, vaccines and breastfeeding, and how to decide if vaccination feels right for you.
“Pregnant women should weigh their personal risks of coronavirus exposure against their tolerance of the unknown regarding vaccination,” says Dr. Berkin, who received two COVID-19 vaccine shots during her second trimester of pregnancy. “Right now our information is limited, but all the information we do have suggests that COVID-19 vaccines are safe in pregnancy.” She suggests those with specific questions about their own situation consult with their health care providers.
Why did you get the COVID-19 vaccine?
As a high-risk obstetrician I saw firsthand how pregnant women were affected by COVID-19. I also thought about my day-to-day exposure to the coronavirus through my work. I was more concerned about the known risks of infection than the unknown risks of vaccination, so my decision was easy.
Jill Berkin, MD
In general, do you think other pregnant women should get the vaccine and why?
It’s really important for pregnant women to realize that we don’t have data saying the vaccine is unsafe during pregnancy. Even though our data are limited, all of it points to the fact that vaccination is safe, and we don’t see any side effects specifically impacting the pregnancy itself. We haven’t seen any harm among women who were pregnant after receiving the vaccine in clinical trials.
In addition, each individual pregnant woman has to evaluate her own potential risk for exposure just like I did for myself. As a health care worker my exposures were great, so they outweighed any fears of the unknown with the vaccine. And of course, people who are pregnant may want to consult their own physicians for advice as well.
What are the risks and complications of COVID-19 and pregnancy?
Most pregnant women infected with the coronavirus will have symptoms similar to those who are not pregnant. The vast majority of pregnant women affected are asymptomatic. A large portion of the population has symptoms similar to a cold or flu, including muscle aches and fever. Then there’s a small portion of the population that has more severe disease that might require hospitalization. The data we have now comparing pregnant individuals to non-pregnant individuals shows that symptomatic pregnant women do have a slightly higher risk of a hospital admission, ICU admission, and even mechanical ventilation, but there’s no increased risk of mortality.
Would you say then that pregnant women are at higher risk of developing severe COVID-19?
While it’s hard to fully analyze, the data suggests that pregnant women are at increased risk for developing severe complications of COVID-19. But we have to remind ourselves that in general, pregnant women who become ill are more likely to present to their physicians than women of the same age who are not pregnant, and that’s because you see a doctor more often when you’re expecting. Doctors will also be biased towards admitting women who are pregnant and keeping a closer eye on them because there are two patients at stake.
For those getting the COVID-19 vaccine, what are some side effects to be expected?
The most common side effect that people report is soreness in the arm, similar to a lot of other vaccines. Afterwards some patients might experience mild cold- or flu-like symptoms for about 24 hours. This seems to happen more frequently with the second dose, which is three or four weeks after the first dose. Pregnant women, along with the rest of the population, can take pain relievers such as Tylenol after their vaccine shots to help alleviate some of those symptoms.
Do you think there’s an optimal time for receiving the vaccine during pregnancy?
We don’t have any research to suggest that there is an unsafe time to vaccinate during pregnancy. However, pregnant women might consider not receiving the vaccine during the first trimester. This is only because in general we avoid medical interventions in the first trimester, which is the period of “organogenesis” when the baby’s organs are forming. We don’t have data suggesting there are any negative effects of the vaccine on organ systems. But because we are dealing with a lack of information regarding COVID-19 vaccines and pregnancy—and out of an abundance of caution—perhaps delaying vaccination until the second or third trimester, if possible, could be beneficial.
What do you recommend about vaccination during breastfeeding?
The vaccine certainly has no risks, and only potential benefits. We know that one of the most wonderful things about breastfeeding is that women pass antibodies through their breast milk to their babies. We don’t have much information specifically about antibodies created from COVID-19 vaccination being passed through breast milk. But we do have encouraging data about women who were infected with coronavirus itself forming antibodies and passing those antibodies along through the placenta and through breast milk. So the benefit of being able to protect children against coronavirus when a vaccine is not currently available to children is a remarkable thing and a unique advantage of being a lactating mom.
Luciana Vieira, MD, who conducted the Q&A, is an assistant Clinical Prof of OB/Gyn and Reproductive Science at ISMMS and the Blavatnik Family Women’s Health Research Institute Scholar for 2020-2021. Dr. Vieira has been integral in creating a perinatal database to collect/analyze data on maternal + neonatal outcomes within Mount Sinai Health to improve care.