Expecting Answers

Posted May 6, 2021

After working as a nurse in New York City during the peak of the pandemic, and mourning hospital colleagues who succumbed to COVID-19, Elizabeth Trudell, RN, of Fairfield, Vermont, says there was “never a question” she would get the vaccination when she became eligible – especially because she was pregnant.

“I felt confident in the science behind the vaccine and I love preventative medicine,” says Trudell, who earned a bachelor of science in nursing at University of Vermont’s College of Nursing and now works in the neonatal intensive care unit at UVM Children’s Hospital. She received her first dose during her third trimester before giving birth to a healthy boy, Gavin, on April 12. Her second dose came three days after delivery. “I thought getting the vaccine was the best way to give my baby the best start in life,” she says.

Because pregnant women were excluded from initial vaccine clinical trials, there has been limited data to definitively prove the vaccine is safe for them and their babies. However, a preliminary report from the largest study on COVID-19 vaccine safety in pregnant women found no evidence that the mRNA vaccines are unsafe during pregnancy.

According to the peer-reviewed report based on data collected from the Centers for Disease Control and Prevention (CDC) and Federal Drug Administration (FDA), published April 21 in the New England Journal of Medicine, researchers found no "obvious safety signals," or evidence that there were worse pregnancy outcomes, in any of the 35,691 people followed who received the Pfizer or Moderna vaccine during or shortly before their pregnancy.

However, the report concluded, “more longitudinal follow-up, including follow-up of large numbers of women vaccinated earlier in pregnancy, is necessary to inform maternal, pregnancy and infant outcomes.”

Guidance from the CDC stops just short of recommending the COVID-19 vaccine for those who are pregnant, suggesting women talk with their health care provider to help them make a personal choice.

Marjorie Meyer, MD, division chief of Maternal Fetal Medicine at UVM Medical Center, has counseled many pregnant patients trying to make a decision about whether to get vaccinated. “After a conversation involving shared decision-making with the patient, in general my recommendation has been: The benefits of the vaccine far outweigh the risks,” she says. “And that is the fundamental basis of medical decision-making.”

There are risks associated with not getting vaccinated: The CDC notes that pregnant women are more likely to get severely ill with COVID-19 than non-pregnant women and that pregnant women with COVID-19 might be at increased risk of adverse pregnancy outcomes, such as preterm birth, compared with those without COVID-19. Conversely, there is evidence that vaccinations can make both mother and baby safer. Research suggests that immunity can transfer to babies in utero and, according to the CDC, moms who have received either the Pfizer or Moderna COVID-19 mRNA vaccines have antibodies in their breastmilk, which could also help protect their babies.

Still, the decision can feel fraught for pregnant women whose maternal instinct compels them to scrutinize anything and everything they put into their bodies.

“The news makes it very confusing, and I can’t blame my patients who are not in the medical field for being wary,” says Caroline Hamel, MD, chief of obstetrics at UVM Health Network – Champlain Valley Physicians Hospital. “Obviously pregnant people are very worried about not causing harm to the baby. And we reassure them that the vaccine is safe.”

Because fever can be a side effect of vaccination, any elevated body temperature can be harmful to a developing fetus during the first 12 weeks of pregnancy, Dr. Hamel advises her patients to receive the vaccine after the first trimester.

Sarah Moore, RN, spent an hour on the phone with Dr. Meyer after her nurse midwife recommended she get vaccinated, based on guidance from the American College of Obstetricians and Gynecologists published in December. “The decision was not a simple one. When you’re pregnant, you’re very aware of what you’re putting into your body. So I wanted to know everything I could about the vaccine,” says Moore, a UVM Medical Center nurse on the unit that cares for critically ill COVID-19 patients.

Moore decided to get both doses toward the end of her second trimester and gave birth to her healthy son, Max, on April 13: “Dr. Meyer and I went over a lot of the science and I felt satisfied that it was safer to get the vaccine than to risk getting COVID, especially since I work in health care.”

Colleen Horan, MD, medical director of Women’s Health at UVM Health Network – Central Vermont Medical Center, uses a decision support tool with her patients that reviews each person’s risk for COVID exposure based on lifestyle or employment and their tolerance for uncertainty due to the newness of the vaccine. “I tell them that based on what we know, we think it is safe but that we will respect whatever decision they make,” says Dr. Horan, adding that she advises all pregnant patients to encourage their family members to get vaccinated. “Having a safe vaccinated circle around a family with a new baby is important so that they can safely take advantage of the social supports that every new mom needs.”

For Kathryn Svec, who received both shots during her third trimester, it helped to talk over the decision with others who are pregnant. “Hearing that other parents are making the same decision is huge,” says Svec, a graduate student in cell biology at University of Vermont. “Pregnancy itself can be such an isolating experience even in the best of times and the pandemic has only made that worse. In fact, that’s one of the huge pluses I saw in getting vaccinated: the opportunity to become less isolated which is good for both my health and the baby’s!”

Ashley Walenty, who received her second dose at 20 weeks and is due to give birth to twins – a girl and a boy – on August 21 at UVM Medical Center’s Birthing Center, agrees: “Overall I am feeling a lot more optimistic about having our babies in the newly vaccinated world.”