“Are you planning to get the COVID shot, doctor?” my patient asked, her eyes wide above her face mask. The announcement of vaccine sign-ups for healthcare workers at my hospital system felt like a beacon of hope for a return to normal life. I wanted to encourage her to get vaccinated, but I hesitated. I had a secret — I was in my first trimester. Pregnant women had not been included in the COVID-19 vaccine trials, leaving me uncertain about whether I should get the vaccine. A quick online search failed to provide the clarity I sought. The forums on my pregnancy app were filled with discussions weighing the decision to vaccinate, revealing that I wasn’t alone in my confusion.
If I had been a true “frontline” worker like my colleagues in the ER or ICU, the benefits of getting vaccinated would have been clear-cut. Those professionals care for the most critically ill patients, so their risk of exposure is undoubtedly high. As an outpatient physician, my risk was moderate. I found myself in a category similar to teachers and childcare workers, who often work in close quarters and can’t maintain social distancing. I frequently encounter patients who test positive shortly after our appointments. Even though I wear PPE, I sometimes need to examine patients closely, and some forget to keep their masks on while talking. Outside of work, I avoid socializing, but my toddler attends daycare and isn’t required to wear a mask. With rising infection rates in my city, I could be exposed to COVID-19 at the grocery store or pharmacy. Each day felt like a countdown to potentially contracting the virus.
It’s not surprising that pregnant women were excluded from these trials; they have historically been left out of research for ethical reasons, considering the potential risks to both mother and fetus. The lack of comprehensive testing often leaves pregnant women hesitant to take even necessary medications due to insufficient data regarding fetal safety. Many of my patients have discontinued medications like antidepressants or inhalers while trying to conceive, unaware that a healthy baby relies on a healthy mother, and the risks of untreated conditions may outweigh the minimal risks of medication.
During my first pregnancy, I struggled over whether to use steroid ointment for my psoriasis. Although research supports its safe use in appropriate dosages, I was troubled by a few studies indicating possible growth restrictions from high-potency topicals. Despite reassurances from my obstetrician and dermatologist, the fear that my choices could cause any harm to my unborn child led me to obsess over the decision, a worry I would have found amusing before becoming a mother. I ultimately used the steroids and delivered a healthy baby, as expected.
Without sufficient data on the vaccine, I sought out expert guidance. In the U.S., the American College of Obstetrics and Gynecology and the Society of Maternal-Fetal Medicine issued a joint statement addressing the WHO’s initial recommendations against COVID-19 vaccination for pregnant individuals. They advocated for including pregnant women in clinical trials and for a woman’s right to make vaccination decisions with her healthcare provider. Following public backlash, the WHO retracted its statement. It felt somewhat paternalistic, with experts in their ivory towers allowing women to consult with their doctors and have autonomy over their vaccination choices in the absence of evidence that it posed a threat to mothers or babies.
I approached my decision as I would advise my patients regarding routine vaccinations—by weighing the risks and benefits of the vaccine against the potential dangers of the disease itself. My obstetrician encouraged me without hesitation, stating that the risks of COVID-19 far outweighed any potential vaccine risks. CDC data indicates that pregnant women are at a significantly higher risk than their non-pregnant counterparts for severe outcomes, including ICU admission, intubation, and even death. Some research has linked COVID-19 to an increased risk of preterm delivery and cesarean sections. Additionally, 80% of COVID-19 treatment trials excluded pregnant women, leaving those who contract the virus navigating uncharted territory.
To evaluate the vaccine’s risks, it’s essential to understand how mRNA vaccines work. Both the Moderna and Pfizer vaccines utilize mRNA to instruct our immune systems to produce the coronavirus spike protein. Our bodies naturally use mRNA; the genetic code of our DNA is transcribed into a single-stranded RNA that travels to ribosomes, where proteins are made. The vaccine’s mRNA does not integrate into the host’s genetic material; rather, it serves as an instruction manual. Once the proteins are created, enzymes quickly degrade the mRNA.
The mRNA from the vaccine lasts only a few days, enough time to elicit a robust immune response before being destroyed. Because the mRNA does not merge with genetic material and is rapidly eliminated, the theoretical risk of fetal harm is minimal. Furthermore, the mRNA is believed to remain in local lymph nodes, making it even less likely to cross the placenta. Studies in animals have shown no safety concerns regarding fetal development with the Moderna vaccine. The 18 women who inadvertently became pregnant during the trials have not reported any adverse effects.
I would have preferred to wait for more trial results, but the pandemic is present. In medicine, we frequently encounter scenarios without precedence, and science is about making inferences based on existing knowledge. This is similar to how we recommend routine flu vaccinations for pregnant individuals, despite the vaccine insert stating, “available data are insufficient to inform vaccine-associated risk of adverse developmental outcomes.” Other pregnant physicians have shared their struggles with this decision, and I empathize. The choice to avoid a new vaccine may feel safer than risking exposure to COVID-19.
However, I could not justify succumbing to fear of the unknown when I was aware of the known dangers COVID-19 posed to my baby. I had read alarming stories from patients and the obstetricians who treated them. Would I be able to make a rational choice about my baby’s health versus my own if my delivery was complicated by a preventable virus? Even if I experienced mild symptoms, would I be ready for the months of lingering issues, like shortness of breath and increased blood clot risks, that affected many of my young, otherwise healthy patients?
In the end, I chose to trust science. I received both doses of the vaccine with only mild side effects. My obstetrician’s visits continue to show a reassuring heartbeat. The CDC’s V-safe program collects data on side effects, and I was pleased that one of the questions included my pregnancy status. I also submitted my data to a University of Washington registry focused on COVID-19 vaccination in pregnancy and lactation. Even though I couldn’t participate in a clinical trial, contributing in this way felt meaningful. I got vaccinated to protect myself, my family, my vulnerable patients, my community, and for all the pregnant women who feel overlooked. In a country where many high-risk individuals still await their vaccination, I am deeply grateful for this privilege.
Though it’s still too soon to feel my baby kick, I often find myself placing my hands on my growing belly at night, hoping all is well. But with that worry comes a surge of hope—hope that my baby will benefit from maternal antibodies, be welcomed by grandparents, and enter a world where science is recognized as fact rather than politicized or vilified. Perhaps this emotional rollercoaster—this blend of apprehension and hope for the future—is simply another facet of motherhood.
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Summary:
As a pregnant physician, I grappled with the decision to receive the COVID-19 vaccine due to the absence of clinical trial data for pregnant women. Ultimately, after weighing the risks of the vaccine against the dangers of COVID-19, I chose to get vaccinated. With encouragement from my healthcare provider and guidance from expert organizations, I found hope in protecting myself and my unborn child.
Keyphrase: COVID vaccine and pregnancy
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