DURHAM, N.C. -- Should a pregnant woman get the COVID vaccine? Might it harm her unborn baby? And what harm might the vaccine bring to a woman’s menstrual cycle?
Dr. Geeta Swamy, a Duke professor of obstetrics and gynecology, tackled these thorny questions – and dispelled some pervasive myths related to the COVID-19 vaccines – Wednesday in a virtual media briefing.
Here are excerpts:
On how vaccines work on pregnant women
“The vaccine works the same way in pregnant women as non-pregnant people. The vaccine has been shown to be effective in preventing infection. Women are no more likely to get the infection than other people, but if they get the infection they’re at higher risk for complications, specifically admission to the hospital, requiring ICU admission, mechanical ventilation, and even a higher risk of mortality or death.”
On whether the vaccine is less effective in pregnant women
“There is no evidence to suggest there’s any difference in how effective the vaccine works in pregnant women. It should work the same.”
On vaccine hesitancy among pregnant women
“There’s a lot of hesitancy about vaccines in our communities across the country, and pregnant women are no difference in that. But at the same time they often have concerns about their developing fetus and future infant to be born.”
“Some of that comes from concern; some of it comes from myths out there and misunderstanding.”
On common concerns voiced by pregnant women about the vaccine
“Pregnant women, I would say, frequently put their developing fetus ahead of the concerns for themselves and their own health. We really try to talk to pregnant women and their families about the fact that in order to have a healthy baby, we really need to make sure we also have a healthy mother. So pregnant women often have questions about whether the vaccine might have an impact on the development of their fetus and if it could have any long-term consequences that we don’t know yet because the vaccines are so new.”
“They also have concerns about how it might impact other aspects of their own health.”
On the best vaccine for a pregnant woman
“If we’re talking about pregnant women in this country, where we have opportunity to choose between the vaccines, right now while we don’t have a preference, generally speaking, we’ve suggested that women under the age of 50, which would generally include almost all pregnant women, may want to consider the risks and benefits of the J&J vaccine.”
“It’s individuals under the age of 50 where we’ve seen the higher incidences of (blood) clotting disorder. So again if there’s the opportunity to choose between one or the other, we know those same risks don’t go along with the (Pfizer and Moderna) mRNA vaccines.”
“However, understand that risk is really, really incredibly small still. In other countries and other areas where the one [J&J] dose may be the only thing you can get – or might be the most convenient way to prevent COVID – your chance of getting COVID infection is incredibly higher than your chance of getting a blood clot or complication.”
On whether vaccination can hurt a pregnancy
“Absolutely not. There is nothing to suggest that vaccination itself leads to anything that can cause pre-term birth.”
On measures pregnant women should take other than a vaccine
“Masking and distancing work. I think as we know with many pregnant women about 40 percent of all births in this country occur to women as their first pregnancy. So that means the 60 percent probably have other children at home and are potentially care-takers of other children. With children in this country having gone back to school now, we are seeing higher incidences of COVID infection among children.”
“So making sure to do the best we can to protect all of our family members, reduce that risk, make sure we’re masking, distancing, hand-washing. Good hand hygiene and so forth are really the keys.”
On whether Ivermectin is a plausible COVID therapy for pregnant women
“Absolutely not.”
“Ivermectin is being studied right now but at present there is nothing that would authorize its use or recommend its use, and quite frankly, it can have side effects.”
On whether a woman trying to conceive should get the vaccine
“Absolutely. It obviously can be a scary time. But there has been no concern whatsoever that a woman trying to conceive, the vaccine would have any impact on their ability to conceive.”
“There is no evidence that vaccination causes early pregnancy loss.”
On when during a pregnancy a woman should be vaccinated
“From a safety or effectiveness standpoint, both for the mother and baby, really we recommend that women should get the vaccine as early as they can. Given the complications related to COVID infections are more likely to occur with later, advancing pregnancy, we really recommend women get the vaccine as early as it can. There’s no difference in how well it will work.”
On whether a pregnant woman who previously had COVID has adequate immunity
“The COVID infection itself does not imply full-on immunity. It probably protects you for some period of months. But given all the ever-changing variants that we see, infection itself shouldn’t be relied upon. We also know vaccination itself can’t be relied upon because what we really need a universal vaccine that we know covers all variants. So we should still make sure we’re following CDC guidelines, which say that even if you’ve had COVID infection, you should still seek vaccination.”
On boosters for pregnant women
“As long as they are eligible based on the recommendations … then pregnant women should be getting the booster vaccine.”
On protecting infants from COVID infections
“Masks are only recommended after a few years or life so we really want to make sure people aren’t trying to use masks on newborn infants. That could cause other potential concerns. But we suggest a strategy that in the past we’ve called cocooning. Surround the infant with protection. If you can make sure that anyone (around) the infant is vaccinated, and if they’re not vaccinated, that you’re thinking about distancing and that you are using the same practices with mask-wearing and hand hygiene around your infant as well.”
On whether vaccinations impact a woman’s menstrual cycle
“There has been data collected to date on that, and so far we’re not seeing anything that is concerning or potentially long-lasting. We know that stress and other types of conditions can certainly interfere with the regularity and specific day-to-day aspects of the menstrual cycle.”
“There has been no concern with the vaccine itself on infertility. That’s been one of the significant myths out there that the vaccine could cause infertility in women and in men. There is absolutely no evidence whatsoever. There is no scientific or biologically plausible reason why the vaccine would cause infertility.”
On misconceptions related to the COVID vaccine
“We know the vaccine -- and the way that it works -- stimulates the maternal immune system.”
“There’s no reason to think that the way that the two COVID vaccine platforms (work) … (they) could have any harm on a developing fetus.”
On the current increase in hospitalizations of pregnant women
“Before COVID, most days we don’t have pregnant women in the ICU, or if we do it’s maybe one, maybe two, and that’s only intermittently. Now we’re seeing more than a handful at any given time.”
“It certainly is more than we would ever expect, and we’re seeing more now with the Delta variant than we were seeing at the beginning of the pandemic. It is a significant concern. And really the only way to prevent that is to prevent infection in the first place.”
On counseling people more afraid of the vaccine than COVID itself
“This is a real disease. These are real deaths that we are seeing.”
“Hands down, make sure that you are getting your data and information from trusted sources. Decide on who you think those trusted sources are. I don’t mean you automatically discount what your friends and family are saying or what you’re seeing in the general public, but confirm those. Figure out who you can trust.”
Faculty participant:
Dr. Geeta Swamy
Dr. Geeta Swamy is a professor of obstetrics and gynecology at the Duke University School of Medicine, where she is also vice dean for scientific integrity and director of the Duke Perinatal Research Center.