Pregnancy and COVID-19 Frequently Asked Questions | Norton Healthcare Louisville, Ky.

Pregnancy and COVID-19 Frequently Asked Questions

There is a lot of misinformation being shared that has understandably led to increased concerns among pregnant individuals, and those who wish to become pregnant, who are worried about themselves and their babies. It is our recommendation that those who have concerns speak with their medical provider/obstetrician and make an informed decision that is best for them during what can be a highly emotional time.

Pregnancy and COVID-19 Vaccine

Should I get the COVID-19 Vaccine if I am pregnant?

Yes, if you are pregnant, you can receive a COVID-19 vaccine. There is a benefit to both mother and baby in avoiding complications of contracting COVID-19 during pregnancy.

You might want to have a conversation with your health care provider to help you decide whether to get vaccinated. While such a conversation might be helpful, it is not required before vaccination.

If it is not yet considered safe for kids under 12 to get a COVID-19 vaccine, how is it safe for an unborn child if the mom gets a COVID-19 vaccination while pregnant?

A person who is pregnant and receives the vaccine is different from the baby receiving the vaccine. Receiving the vaccine directly is active immunity, which is what the mom develops. However, the vaccine does not cross the placenta so it does not impact the baby; the actual vaccine is degraded by the pregnant patient in 10 to 20 days. The baby in utero is not receiving the COVID-19 vaccine.

The vaccinated patient will develop antibodies to COVID-19, which provide active immunity. The antibodies can cross the placenta and hopefully will provide the baby with passive immunity when born.

This is common with pregnant patients who receive the tetanus, diphtheria and acellular pertussis (Tdap) booster vaccine. We vaccinate pregnant patients with the Tdap vaccine so they make pertussis (whooping cough) antibodies, which cross the placenta and provide the baby with passive immunity.

So, this also goes for breastfeeding parents. The vaccine IS NOT in the breast milk and is not going to the baby; just the nursing parent’s antibodies are going to the baby, which will hopefully be protective for the newborn.

Does it matter which vaccine pregnant patients get?

On Aug. 11, the Centers for Disease Control and Prevention (CDC) recommended that anyone who is pregnant be vaccinated against the coronavirus, updating its advice after it found no increased risk of miscarriage among those who have been immunized. The CDC advice applies to all three vaccines available in the U.S., though the one-shot Johnson & Johnson version has not been studied as much as the versions produced by Pfizer and Moderna.

But, it is always recommended that you speak with your medical provider about what is best for you. Norton Healthcare provides the Pfizer vaccine.

Source: New CDC Data: COVID-19 Vaccination Safe for Pregnant People

Is there a certain trimester that it is safer to get the vaccine? Is the COVID-19 vaccine recommended at any gestation?

According to the American College of Obstetricians and Gynecologists, no trimester is better than the others when it comes to getting a coronavirus vaccine.

Getting it as soon as you’re able protects against COVID-19, which can have serious complications.

It’s also understandable, but not necessary, to wait until later — but not too late — in pregnancy.

If you are still concerned, please speak with your medical provider.

If I get a COVID-19 infection during pregnancy, do I have an increased risk of complications?

A study was published Aug. 11, 2021, in the Journal of the American Medical Association (JAMA) examining a large number of pregnant women with a COVID-19 infection. The study looked at nearly 850,000 women and 18,000 pregnant women. The study found that women with COVID-19 giving birth had higher rates of mortality, intubation, intensive care unit (ICU) admission and preterm birth than the women without COVID-19.

Click here for a link to the study published in JAMA.

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Fertility and COVID-19

I am worried about fertility issues with this vaccine and therefore hesitant to get the vaccine:

If trying to get pregnant now or in the future, would-be parents can receive a COVID-19 vaccine.

There is currently no evidence that any vaccines, including COVID-19 vaccines, cause female or male fertility issues — issues getting pregnant.

There is currently no evidence that COVID-19 vaccination causes any issues with pregnancy, including the development of the placenta.

The Centers For Disease Control And Prevention (CDC) does not recommend routine pregnancy testing before COVID-19 vaccination.

If you are trying to become pregnant, you do not need to avoid pregnancy after receiving a COVID-19 vaccine.

As with all vaccines, scientists are studying COVID-19 vaccines carefully for side effects now and will report continued findings as they become available.

From the CDC: On Aug. 11, the CDC updated its advice and stated that pregnant patients should get the coronavirus vaccine. This was decided after finding no increased risk of miscarriage among the vaccinated. Updated guidance was also informed by increased risks of COVID-19 in pregnancy and low vaccination rates among the pregnant population (23%). The rise of the delta variant was also a factor.

I am terrified to receive the vaccine due to my infertility. I have been trying for over a year to get pregnant.

Since each situation is different, it is important that you speak with your OB/GYN or fertility specialist.

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Miscarriages and COVID-19

Has there been any increase in miscarriages or stillbirths from patients who have had a COVID-19 infection?

A large study in the United Kingdom suggests having coronavirus around the time of birth may increase the chance of stillbirths and premature births — although the overall risks remain low.

According to scientists, while most pregnancies are not affected, their findings should encourage pregnant people to receive the vaccine as soon as they are eligible.

The study appears in the American Journal of Obstetrics and Gynecology.

The research, led by the National Maternity and Perinatal Audit, looked at data involving more than 340,000 women who gave birth in England between the end of May 2020 and January 2021.

Have there been any specific studies completed with pregnant patients (outside of those who became pregnant during the trial, and is there follow up to these cases?)

Yes, there have been studies on pregnancy and neonatal outcomes in COVID-19, and they continue. There is a vaccine pregnancy registry with the Centers for Disease Control and Prevention (CDC).

If you are pregnant and have received a COVID-19 vaccine, the CDC encourages you to enroll in v-safe, CDC’s smartphone-based tool that provides personalized health check-ins after vaccination. A v-safe pregnancy registry has been established to gather information on the health of pregnant people who have received a COVID-19 vaccine.

More information is available here.

Have you seen reports about miscarriages after vaccination on the Vaccine Adverse Event Reporting System?

This has been recently refuted via new research. One in 5 people in the general population miscarry, and the percentage is slightly higher for women with COVID-19.

Could a low-grade fever from the COVID-19 vaccine increase the risk of spontaneous abortion in the first trimester of pregnancy and increase the risk of neural tube defects?

There is no evidence of spontaneous abortion if fever is less than 104 degrees Fahrenheit.

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COVID-19 and the Impact on Breastfeeding

Is there evidence to show it is safe for breastfeeding mothers to get the vaccine?

The Centers for Disease Control and Prevention (CDC) recommends COVID-19 for all people ages 12 and older, including people who are breastfeeding. Clinical trials for the COVID-19 vaccines currently used in the United States did not include people who are breastfeeding. Because the vaccines have not been studied in people who are breastfeeding, there is limited data available on the:

  • Safety of COVID-19 vaccines in people who are breastfeeding
  • Effects of vaccination on the breastfed baby
  • Effects on milk production or excretion

However, based on how these vaccines work in the body, COVID-19 vaccines are not thought to be a risk to lactating people or their breastfeeding babies. COVID-19 vaccines cannot cause infection in anyone, including the mother or the baby, and the vaccines are effective at preventing COVID-19 in people who are breastfeeding. Therefore, lactating people can receive a COVID-19 vaccine.

Recent reports have shown that breastfeeding people who have received mRNA COVID-19 vaccines have antibodies in their breastmilk, which could help protect their babies. More data is needed to determine what protection these antibodies may provide to the baby.

Source: CDC

How can it be OK for a newborn to nurse if the mom had a COVID-19 vaccine, as the vaccine has not yet been considered safe for kids under age 12?

Immunizing a baby with a vaccine is not the same as a baby receiving antibodies in breastmilk. Giving a vaccine to a baby is active immunization. The baby’s own immune system is stimulated by vaccine.

Receiving antibodies in breastmilk is very different. It is a form of passive immunization and does not stimulate the baby’s own immune system. Babies receive many different kinds of antibodies in breast milk.

We are still learning if COVID-19 antibodies in breast milk could help protect babies from infection, similar to the way babies are protected when their mothers pass along flu antibodies or whooping cough antibodies.

They are not going to hurt the baby and they may help. Some newborns may arrive in the world already protected from the deadly virus that caused the pandemic. Babies may not yet be eligible for the COVID-19 vaccine, but if their mother gets vaccinated, they can glean immunity either in the womb or through breastmilk, recent studies suggest. There is evidence that antibodies created by the vaccine can travel through the placenta to the baby before birth and also during breastfeeding.

Please also see the answer to question Question 2 under Pregnancy. Research is currently under way related to vaccines for children under 12.

Regarding breastfeeding mothers who have had the vaccine, is there any evidence on protection for my infant as well?

Recent reports have shown that breastfeeding people who have received COVID-19 mRNA vaccines have antibodies in their breastmilk, which could help protect their babies. More studies are needed to determine what protection these antibodies may provide to the baby. (See the answer for Question 2 above for additional information.)

I’d like to have my breastmilk studied after I get vaccinated. I am breastfeeding my 9- month old. How can I find and become part of a study?

There is a vaccine pregnancy registry with the Centers for Disease Control and Prevention. You may search online for studies. You may reach out to the Norton Healthcare Research Office for additional information at (502) 629-3500.

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Other COVID-19 Questions

What information is available to show data on menstrual cycle changes after vaccination or being ill with COVID-19? I personally experienced menstrual issues after having COVID-19 and am aware of many others who had changes to their cycle after being ill with COVID-19 or having the vaccine.

There have been many anecdotal reports of menstrual cycle changes, and experts are exploring a potential link between COVID-19 vaccines and changes to periods and menstrual cycles in some people.

While data is just in the initial stages of analysis, it seems to reinforce the hypotheses that this vaccine triggers a huge immune response, and the associated inflammatory processes that lead to things like the fever or the fatigue, that some of those cellular physiological processes are likely impacting the inflammatory processes that regulate menstrual cycles in some people who are getting the vaccine.  More information may be found here.

Can you review ways to protect against the delta variant for children who are currently under age 12 and not eligible for a vaccine?

Most important is to mask (children ages 2 and older), avoid large crowds, wash hands often, keep fingers away from eyes/nose/mouth, keep surfaces clean and practice good hygiene when it comes to sneezing and coughing by practicing the “vampire” move (teach children to sneeze or cough into their elbow).

Pay attention to symptoms and don’t hesitate to contact your medical provider — sniffles may mean many things — cold, allergies, COVID-19, respiratory syncytial virus (RSV). Children who are sick should stay home from school or day care.

Is there any evidence that the vaccine does or doesn’t cause placental inflammation or long-term effects to the placenta? I’ve seen things saying that the vaccine attacks a similar protein that is in the placenta— will this put women at risk for pregnancy in the future or is this true?

Below is some of the most recent research that was published in August 2021.  The first is a nice summary article of the research from Children’s Hospital of San Antonio and below that link is the link to the full article from the Journal of Obstetrics and Gynecology. The good news is the study shows there is no effect on the placenta.

Research shows COVID-19 vaccine does no harm to placenta

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Vaccination in Pregnancy: Measures of Immunity and Placental Histopathology

Also, below is a link to an article that also highlights the importance of vaccination during pregnancy as COVID-19 presents a significant risk for patients who are pregnant. This is a very recent study as well.  The vaccine really is important to decrease the risk of adverse effects during pregnancy.

Characteristics and Outcomes of Women With COVID-19 Giving Birth at US Academic Centers During the COVID-19 Pandemic

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Medical Reviewers:

  • Kristina A. Bryant, M.D., Norton Children’s Infectious Diseases
  • Steven T. Hester, M.D., division president, provider operations, and system chief medical officer, Norton Healthcare
  • Maria R. Schweichler, M.D., OB/GYN, medical director for women’s services for Norton Women’s & Children’s Hospital.
  • Jonathan W. Weeks, M.D., executive medical director for maternal-fetal medicine and the Norton Maternal Opiate and Substance Treatment (MOST) Program at Norton Women’s & Children’s Hospital.

Research Links

https://chofsablog.org/2021/05/14/research-shows-covid-19-vaccine-does-no-harm-to-placenta/

https://journals.lww.com/greenjournal/Fulltext/2021/08000/Severe_Acute_Respiratory_Syndrome_Coronavirus_2.16.aspx

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2782978?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=081121

https://www.pharmaceutical-technology.com/features/covid-19-vaccines-periods-menstrual/

https://www.washingtonpost.com/health/2021

https://www.gov.uk/government/news/new-study-into-covid-19-vaccine-dose-interval-for-pregnant-women

https://www.sciencedirect.com/science/article/pii/S2667193X21000193

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