Should you get the Covid-19 vaccine if you are pregnant?

Well the authors of a new publication in the American Journal of Obstetrics & Gynecology concluded that not only should pregnant people get the Covid-19 vaccine, they “should be broadly prioritized for Covid-19 vaccine allocation in the U.S.” In other words, in the line waiting for the Covid-19 vaccine right now, those who are pregnant should move closer to the front.

This conclusion was based on their analysis of data from 35 hospitals and clinic systems in the state of Washington. These systems apparently account for 61% of deliveries in the State each year. That’s deliveries of babies and not of Amazon packages or pineapple pizza by the way.

The research team led by Erica M. Lokken, PhD, MS, and Kristina M. Adams Waldorf, MD from the University of Washington identified 240 women who tested positive for the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) via polymerase chain reaction (PCR) tests from March 1 to June 30, 2020. This came out to a rate of 13.9 cases for every 1,000 deliveries. Comparing this to the 7.3 per 1,000 rate among all 20 to 39 year old adults in Washington State meant that those pregnant were 70% more likely to have been infected with the Covid-19 coronavirus. Excluding the 45 cases of patients who didn’t have any symptoms when they screened for SARS-CoV2 dropped the rate to 11.3 Covid-19 coronavirus cases per thousand deliveries. That’s still 30% higher than the rate for 20 to 39 year old adults in general.

Does this mean that the virus selectively infects people who are pregnant, saying, “show me your pregnancy test and I’ll decide whether to infect you?” Or might your body be less able to fend off infection when you are pregnant? After all, lots of things do change when you are pregnant including potentially your immune defenses. Not necessarily. Just because pregnancy was associated with a higher infection rate in the study doesn’t mean that being pregnant somehow led to infection. Remember correlation does not mean causation. Otherwise the rise in global temperatures over the years could somehow be blamed on the decrease in the number of pirates during the same time and the solution to climate change would be training more pirates.

Instead, there may have been other reasons why those pregnant happened to be at greater risk for being exposed to the virus. For example, perhaps pregnancy may have meant on average more visits to health care settings, which during those months could have had more of the virus going around, especially those settings that were not taking proper precautions. Of note, in the study, 70.7% of the 240 pregnant women who tested positive for SARS-CoV-2 were from racial and ethnic minority groups. So what if persons of color were more likely to have visited health care locations that didn’t have the resources to protect against the spread of the virus?

Keep in mind that the virus has to actually reach you in the first place to infect you. That’s why taking recommended precautions can keep the Covid-19 coronavirus away whether you are pregnant or not. One example of a proper precautions is social distancing such as staying at least six feet or one Denzel (because Denzel Washington is about six feet tall) away from others at all times. Another example is washing your hands frequently and thoroughly, making sure that you sing through the first chorus of the Divinyls song, “I Touch Myself,” which is about 20 seconds, while lathering up with soap and water. Oh, and being around people who actually believe in face mask wearing, science, and helping each other can be important too.

Studies have shown that pregnant people may do worse after getting infected with the Covid-19 coronavirus. The Centers for Disease Control and Prevention (CDC) warns on its website that “pregnant people with Covid-19 have an increased risk of severe illness, including illness that results in ICU admission, mechanical ventilation, and death compared with non-pregnant women of reproductive age. Additionally, pregnant people with COVID-19 might be at increased risk of adverse pregnancy outcomes, such as preterm birth, compared with pregnant women without COVID-19.”

So it would make sense to get the Covid-19 vaccine if you are pregnant, right? Well, one thing that may be giving you pause is the limited amount of data on the safety and efficacy of Covid-19 vaccines in pregnant people. For example, during the Phase 3 clinical trial, so far only about couple dozen people have become pregnant after receiving the Pfizer/BioNTech Covid-19 vaccine, based on available reports. None of them to date have had substantial problems with the vaccine, again based on what data has been published. But this isn’t enough people to draw any strong conclusions. This lack of data is why the World Health Organization (WHO) on January 8 of this year did not not recommend the vaccination of pregnant women. Their stance has since changed, but more on that later.

Experiments in other animals such as rats have suggested that the Covid-19 vaccines should be safe in pregnant people. However, you probably aren’t a rat, not physically at least. (If you are indeed physically a rat, congratulations on your ability to read this article.) While rats and people may be similar to a certain degree, they are still different in many ways. For example, rats don’t seem to floss (both the dance move and what you do with your teeth and gums) or wear Spanx. And their immune systems and physiologies aren’t exactly like yours either. Therefore, don’t assume that whatever happens in rats necessarily holds for humans.

On the other hand, nothing about the Covid-19 vaccines suggests that they should be particularly unsafe for pregnancy. They don’t contain live Covid-19 coronavirus so can’t give you or your fetus Covid-19. Instead, they consist of mRNA with the little “m” standing for “messenger” unlike the “M’s” in the song “MMMBop.” Messenger RNA simply serve as blueprints for your cells to produce the spike proteins that line the surface of the Covid-19 coronavirus.

Recall that a Covid-19 coronavirus looks like one of those spiked balls at the end of maces used for battle in Medieval times and for BDSM in today’s times. After your cells use the mRNA to produce the spike protein, your immune system is supposed to generate a response against the spike protein. At no time should the mRNA interact with or alter your genetic material. In fact, it shouldn’t even enter the nuclei of your cells. In fact, mRNA is like the egos of some political leaders, pretty fragile and broken down by your body fairly quickly.

For all these reasons, the CDC currently deems getting vaccinated if you are pregnant as “a personal choice.” It’s a good idea to talk to your doctor to review your risk of being exposed to the SARS-CoV2 and weighing it against the current unknowns about the Covid-19 vaccine. Similarly, on January 29, 2021, the WHO changed their viewpoint to they “don’t have any specific reason to believe there will be specific risks that would outweigh the benefits of vaccination for pregnant women. For this reason, those pregnant women at high risk of exposure to SARS-CoV-2 (e.g. health workers) or who have comorbidities which add to their risk of severe disease, may be vaccinated in consultation with their health care provider that pregnant people at high risk of exposure (i.e., healthcare workers) may consider vaccination because of the higher risk of severe Covid-19 infection in pregnancy.”

As time passes and more and more pregnant people choose to get vaccinated, more and more data will emerge. Members of the National Institutes of Health (NIH) have called for research studies on Covid-19 vaccination to include pregnant and lactating people. Here’s a tweet on the recent Viewpoint article in JAMA written by Diana W. Bianchi, M.D., Director of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), part of the NIH, and her colleagues at NICHD, Lisa Kaeser, JD and Alison N. Cernich, PhD:

Also, the CDC and the U.S. Department of Health and Human Services have been maintaining databases of people who have gotten the vaccines and reported side effects.

In the meantime, don’t simply rely on what you happen to see on social media. That would be like making major life decisions such as whom to marry, what career to pursue, and whether to wear Crocs based largely on what strangers are telling you on Facebook, Instagram, or Twitter. For example, take a look at what happened after @CandiceCodyMD posted the following:

As you can see, she did not say get the vaccine if you are pregnant. Rather she said read primary sources and ask. Yet, some of the responses to the post were, shall we say, not very friendly. In fact, some claimed that she’s an actress or that the needle is not real.

News flash, people and perhaps bots are spreading misinformation and disinformation about the Covid-19 vaccine. This has included claims that miscarriages have been due to the vaccine for people despite no real link between the two having been established. Just because someone suffered a miscarriage doesn’t mean that the vaccine was to blame. That would be like blaming all miscarriages in 2021 on the Capitol riots or the TV show Celebrity Wheel of Fortune, which debuted on January 6, not that the latter are linked in any way.

That being said. Nothing in life is without its unknowns and risks. For example, playing poker with your cat could end up very badly. Yet, that doesn’t keep you from firing up several rounds of Texas Hold ’em with your feline friend every now and then, right? Similarly, there are still unknowns about the Covid-19 vaccine. But so far, there’s nothing to suggest that being pregnant means more problems from the vaccine. At the same time, there is mounting evidence that you may be worse off should you get Covid-19 while pregnant compared to those who are not pregnant.

Again, the CDC considers the decision to get vaccinated when you are pregnant as “a personal choice,” at this point. This may change to a stronger recommendation as more and more information emerges. So for now, if you are pregnant, weighing the risks between getting Covid-19 and the current unknowns about the vaccine may tilt you towards or away from getting the Covid-19 vaccine. For example, working in a health care setting may mean that you are regularly exposed to the virus and really need to find better ways to protect yourself. So, in such a situation, your doctor may determine that getting a Covid-19 vaccine is the right option. Of course, these days, wanting to get vaccinated and actually being able to get vaccinated are still two very different things.