SGIM Forum

Perspective

Contemplating the COVID-19 Vaccine in Pregnancy

Dr. Owen (cassedy@uw.edu) is an academic hospitalist fellow and acting clinical instructor at University of Washington in Seattle, WA.

The year 2020 was a lot of firsts for me—first year as a hospitalist, first house, first pregnancy, and first time practicing medicine during a pandemic. With the arrival of 2021, I reflect on the ups and downs of last year’s journey. As a pregnant woman, I noticed that, in general, people seemed disarmed by the humanness of this experience and were suddenly interacting with me in a way that strangers never did in the past. For the most part, it has overall been a positive experience as a young hospitalist at a public safety net hospital.

During my third trimester, a nurse from France whom I’d never met before greeted me by placing her hands on my belly saying “And who is this?” in a very kind and genial way. Patients who are facing difficult diagnoses and scary procedures often smile when they see the bump and enjoy giving me a few parenting tips or stories that seems to temporarily ease their mind from their stressful situation. As a rule, I avoid self-disclosure to remain professional and patient centered unless there is a very high chance that it will strengthen a therapeutic alliance without crossing any boundaries. Being so visibly pregnant somewhat undermines this effort, but I am grateful that on the whole it does not seem to have had a detrimental effect on my practice.

With the recent availability of the COVID-19 vaccine, I encountered some less-than-welcome attention due to my status as a pregnant woman. Unsolicited advice from Facebook friends, coworkers, patients, and loved ones about whether pregnant women should get the vaccine has come pouring in thereby sowing seeds of doubt in my initial resolve to roll up my sleeve and get vaccinated.

Upon seeking guidance from major healthcare organizations at the time, ca. December 2020, I was disappointed that the recommendations were quite vague. The World Health Organization (WHO) went so far as stating pregnant persons should not get the vaccine unless they are in very high-risk jobs (such as frontline healthcare workers, like myself) but failed to specify why aside from citing a lack of data. Although technically I was “okay” to receive the vaccine by the guidelines given my status as a frontline healthcare worker, they were far from comforting and my doubts grew stronger.

After doing some research and discussing the vaccine with my infectious disease colleagues, I found that there are no known toxic materials to fetuses in the vaccine and that based on the physiologic mechanism of how an mRNA vaccine works there is no real theoretical risk to a pregnant mother or fetus. It seems that the only reason societies recommend against the vaccine is that they have not yet studied the pregnant population (as is the case for many medications on the “do-not-use-list” in pregnancy).

As an internal medicine physician, I see the world in gray much more than black and white that reflects the increasingly complex and tailored approach we take to managing medications in chronic disease. After all, each patient has a unique set of pathologies and circumstances. When faced with the decision of whether to obtain the vaccine for COVID-19, perhaps adding some “gray” to the guidelines could be helpful. For example, having a succinct and specific breakdown of what is reassuring about the COVID-19 vaccine for pregnant persons and what specifically causes concern for risk to the fetus could be very helpful as a decision aid.

After weeks of going back and forth, I decided to consult my own obstetrician who made me feel empowered to get the vaccine at 32-weeks pregnant, given my status as a frontline healthcare worker. I received both shots, felt great, and now am the proud mother of a healthy baby boy who does not seem affected by my vaccination status. In fact, the American Journal of Obstetrics and Gynecology (AJOG) published a study in March 2021 showing that both umbilical cord samples and breast milk of vaccinated mothers contain antibodies to COVID-19.1 Emboldened by my good outcome shortly after vaccinating, I felt the urge to share my experience. However, out of a practical need to preserve my energy for my remaining weeks of work and preparation for baby, I opted to forgo the social media “vaccine selfie” route and signed up for a trial that will follow me and baby post-vaccine and help contribute to the safety data instead.

At the end of the day, I think this could be one of the best things a pregnant person who decides to vaccinate can do for other mothers out there. Pregnant women deserve to have protection from COVID-19, too, and deserve better reassurance than what the current recommendations offer. Even though I am officially past my big “year of firsts,” it was fulfilling to start 2021 using my knowledge and resources as a physician and situation as a pregnant person to have the courage to be among the first in the world enrolled in a COVID-19 vaccine trial.

References

  1. Gray KJ, Bordt EA, Atyeo C, et al. COVID-19 vaccine response in pregnant and lactating women: A cohort study. Am J Obstet Gynecol. 2021 Mar 24;S0002-9378(21)00187-3. doi: 10.1016/j.ajog.2021.03.023. Online ahead of print

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