Apr 05, 2021 3:00 PM

Author: Kylene Metzger


Pregnancy has its own unique challenges. Throw in a COVID-19 pandemic and the situation becomes more complicated. With little information available about how coronavirus impacts pregnant and lactating women, it’s important to rely on health care professionals for advice. Erin Clark, MD, chief of the Division of Maternal-Fetal Medicine at University of Utah Health, answers questions about COVID-19 and pregnancy.

How has information about COVID-19 and pregnancy changed since last spring?

It was first thought that if COVID-19 was like other viruses in pregnancy, then pregnant women would have an increased risk of getting infected. At the time, we didn’t know if that was the case because there wasn’t much direct information about COVID-19 and pregnancy. Since then, more information has come out. The best data suggests pregnancy is a definitive risk factor for COVID-19. Pregnant women with severe disease are at an increased risk of experiencing severe or critical illness and are at increased risk of experiencing complications.

Is prenatal care any different during the pandemic?

It looks and feel like normal pregnancy care. There’s no question that here at U of U Health we are doing more virtual visits. Virtual prenatal care visits have proven to be safe, effective, and reduces the risk of exposure to COVID-19.

Is it safe to have visitors during labor and delivery?

Over time, we have learned more about exposure to COVID-19 and how to mitigate it. Last spring, visitors outside primary support for labor were not allowed. We have since loosened those rules after realizing how effective masking is and testing women for COVID-19 before delivery. Here at U of U Health, we are now allowing two people to accompany pregnant women during delivery and postpartum care.

How can a newborn be safely introduced to family members who live outside the household?

There is no uniform answer. People need to decide for themselves what is right for them and their family. Some people are waiting for the introduction to occur later, or are doing it via Zoom, or at a safe distance outside. Other people are making introductions in an indoor setting while masked, which poses a higher risk. Vaccinated individuals are a safer introduction setting; however, we don’t yet know whether a vaccinated person can still be an asymptomatic carrier of the virus. Nevertheless, this is still thought to be a safer situation.

Why were women not included in the first clinical trials of COVID-19 vaccines?

There are things that we clearly know that work in terms of risk reduction, such as masking, physical distancing, and washing your hands. Then there are things that fall into a category that we have some uncertainty about—and that includes COVID-19 vaccines and pregnancy.

There’s a lot of controversy over why pregnant women weren’t included in the trials. A lot of people have since advocated for pregnant women to be included so providers know how to counsel them. Pregnant women are usually excluded from initial clinical trials because people want to protect pregnant women, their fetuses, and their children to come. There’s controversy whether that’s the right approach.

Clinical trials evaluating COVID-19 vaccines in pregnant women began in Spring 2021.

How do providers help undecided pregnant women make a decision to get vaccinated or not?

In the absence of direct clinical trial data, we have to weigh the risk and benefit as we best perceive them. I’m always careful to point out to pregnant patients, it’s not risk versus no risk. It’s risk and benefit of vaccination versus risk and benefit of not being vaccinated.

There were some women who were included in the initial clinical vaccine trials inadvertently because they didn’t know they were pregnant at the time. As Dr. Anthony Fauci pointed out, we now also have observational data from 10,000 pregnant women who elected to receive the COVID-19 vaccine in pregnancy. Dr. Fauci said there have been no red flags among pregnant women. We also have some animal data that gives us reassurance about the safely of vaccinations in the various trimesters. In the absence of clinical trial data, there is a knowledge gap. That’s where people need to weigh the risk and benefit.

When I talk to pregnant women about their decision to get vaccinated, we talk about:

  • Their individual exposure risk, such as where they work. An ICU worker may make a different decision than someone who works from home.
  • Their medical comorbidities, such as whether the patient is diabetic, has high blood pressure, is overweight, or has other risk factors that make them more likely to have severe illness if they were to get infected with COVID-19.
  • Whether they live with other vulnerable people in their household.

In terms of vaccine safety, the theoretic risk that people worry about is getting high fever after vaccination in the first trimester and the potential detrimental effects that can have on a growing embryo. That hasn’t definably shown any harm, but it’s a theoretic risk that patients bring up. For some patients, they decide not to get vaccinated during the first trimester to avoid the theoretic risk when an embryo is developing and the fetus is making all its organs. Anecdotally, many of my patients have opted to get vaccinated because of their exposure risk to COVID-19 and opted to get vaccinated in their first trimesters because of safety data that suggests it’s very likely to be safe.

Are side effects to COVID-19 vaccines impacting pregnant women differently?

The data so far doesn’t suggest pregnant women are more likely to experience more or severe side effects from the vaccine. As far as we know, pregnant women are likely to have the same vaccination benefit as non-pregnant people. We’re going to get more data from real clinical trials that have started that involve pregnant women.   

When will there be clinical trial data about COVID-19 vaccines and pregnancy?

We are just getting started, so it’s going to be some time down the road. What I tell my pregnant patients who want to wait a few months to be vaccinated is that they still have the benefit of having many vaccinated people before them. Although there isn’t much clinical trial data yet, there will be observational data to help people make their decisions.

What information is there about lactating moms who are vaccinated? Can moms give immunity to their baby through breast milk?

All the organizations that weigh in on this topic say there is no reason vaccination shouldn’t be offered to lactating women. There’s no reason to think it would cause any biological harm or that it would impact milk production. There is, hopefully, going to be a benefit in terms of transferring antibodies from mom to the baby to give protection. That’s a mechanism that’s worked for a lot of other diseases processes and vaccines. We just don’t know how well it’s going to work for COVID-19 yet.

How can pregnant moms who decide not to get vaccinated stay safe from contracting COVID-19?

Rigorous mask wearing is encouraged. Some people are even double masking because of the new virus variants. Also, continue to practice physical distancing and frequent hand washing. We are all fatigued, but we just continue to reinforce that this is not over. There’s still the same risk of getting COVID-19—and maybe even a greater risk because of the variants that are emerging that seem to be more infectious. If pregnant women opt not to be vaccinated during pregnancy, we encourage them to be vaccinated once they deliver.

If a mom has already had COVID-19 before pregnancy, is she at a greater risk of contracting it again? Will she experience worse outcomes?

We don’t know for pregnancy. The data that we have so far suggests that the disease is less severe for people who have been infected with COVID-19 before, even if they get re-infected with one of the new variants. What we are telling people is that if they had a prior COVID-19 infection, whether in pregnancy or before pregnancy, that they should have some period of immunity. But we aren’t sure how long.

Can COVID-19 antibodies be passed from mother to baby?

That’s the hope. The big questions are: how well do antibodies pass through the placenta? How well do they protect the infant if their mothers had COVID-19 infection or have been vaccinated? The hope is, if it works like other viruses and vaccines, there’s at least some protection for that newborn. In terms of direct data, we are still trying to figure it out.

What are some myths about COVID-19 vaccines and pregnancy?

The idea of COVID-19 vaccines causing infertility is misinformation. There’s no data whatsoever, either theoretically or observationally, that the vaccine does that. I try to reassure my patients that while we don’t have perfect data, there’s no signal in the safety information of the vaccines that it causes infertility or birth defects. I, again, try to reassure patients that there is real risk in being infected with COVID-19 during pregnancy and then help them make the best decision for themselves.

Is a mask required during labor if the patient has been vaccinated?

U of U Health encourages mask wearing during labor and delivery, but we are also humane individuals and realize that it’s not always possible to keep a mask on during hard labor. We are also screening patients for COVID-19 before they come into labor and delivery—and, sometimes, upon arrival. At U of U Health, we try to give more personalized care and do what’s best for the patient and their family.

How to get a COVID-19 vaccine:

Patients 12 years and older who live in Utah are elligible to receive a COVID-19 vaccine at U of U Health. Patients are encouraged to make a vaccine appointment through MyChart. To see all COVID-19 vaccine locations and scheduling options in Utah, visit the state’s coronavirus website or vaccinefinder.org.

Anyone who has questions about COVID-19 vaccines or needs scheduling assistance can call the U of U Health Hotline at 801-597-0712 or toll free at 844-745-9325.


Kylene Metzger

Public Affairs

coronavirus COVID-19 vaccine pregnancy

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