It’s hard enough to know what to believe about the Covid-19 vaccines without having to worry about pregnancy or breastfeeding on top of it all. The truth is that none of the vaccine trials included pregnant or breastfeeding women. The early take on vaccine safety and efficacy information for pregnant or breastfeeding women, therefore, was simply that there was no information. But as data from recent observations and studies comes in, the results are encouraging.
Still, the Society of Obstetricians and Gynaecologists of Canada (SOGC) does recommend that all pregnant and breastfeeding women be offered one of the authorized covid vaccines. Here is their consensus statement with a link to the full document of supporting evidence.
1. Pregnant individuals should be offered vaccination at any time during pregnancy or while breastfeeding if no contraindications exist.
2. The SOGC supports the use of all available COVID-19 vaccines approved in Canada in any trimester of pregnancy and during breastfeeding in accordance with regional eligibility.
3. The decision to be vaccinated is based on the individual’s personal values, as well as an understanding that the risk of infection and/or morbidity from COVID-19 outweighs the theorized and undescribed risk of being vaccinated during pregnancy or while breastfeeding. Individuals should not be precluded from vaccination based on pregnancy status or breastfeeding.
4. Given that pregnant people are at increased risk of morbidity from COVID-19 infection, all pregnant persons should be eligible to receive a COVID-19 vaccination
Read the full document HERE.
To further understand what considerations pregnant and breastfeeding moms need to take into account, I spoke with Dr. Supriya Sharma, the chief medical advisor to Health Canada.
Why did the Covid-19 vaccine clinical trials not include pregnant or breastfeeding women?
It turns out this is normal. Dr. Sharma said, “The usual practice is to not include pregnant and breastfeeding women in early vaccine trials, the same way there are not usually children in those early trials either.” It is routine for trials to focus on healthy adults and exclude and certain medical conditions until later. They want to make sure the vaccines work well on the typical adult population first. This also allows the trial to proceed without the complications that are often seen during pregnancies in general.
But we are starting to gather information now! Dr. Sharma tells me that Johnson & Johnson and Pfizer, for example, have begun trials on pregnant and breastfeeding women, and Moderna has established a pregnancy registry. (Not your typical baby registry, ha!)
And the information we’re getting looks very good so far. “In fact,” Dr. Sharma said, “there was a study published very recently that looked at over 35,000 women who had received mRNA vaccines [ie. Pfizer and Moderna]. In all of those cases, there were no new safety signals that were raised.”
What do we know about the Covid-19 vaccines so far to indicate that they are safe?
In addition to the data that is starting to come in through studies and registries, we have other reasons to expect the Covid vaccines are safe for pregnant and breastfeeding women.
We know that other vaccines that use live viruses can pose a theoretical risk to the fetus. None of the approved Covid-19 vaccines use live viruses. Dr. Sharma said, “What we do know about the vaccines is that they’re not the ones that could potentially affect the baby, like live vaccines can. Everything we know about the vaccines, is not pointing to the risk of a safety issue. The mRNA vaccines are not thought to be a risk to the fetus or breastfeeding infant.”
Given the encouraging results of this recent study of 35,000 pregnant women, the main concern health professionals have about Covid-19 vaccines and pregnancy is actually more about efficacy than safety. “There have been some questions about whether you would have the same immune response if you’re pregnant,” Dr. Sharma said. “When you’re pregnant, your immune system down regulates a little bit because you are carrying a foreign body. So the question is whether or not people would have the same immune response, but so far it’s been it’s mostly good.”
What are the benefits of getting vaccinated?
While getting vaccinated benefits almost everyone, it is especially important for pregnant women, since they are more susceptible to severe cases of Covid-19. The Society of Obstetricians and Gynaecologists of Canada states that, “An unvaccinated pregnant individual remains at risk of COVID-19 infection and remains at heightened risk of severe morbidity if infected compared to non-pregnant counterparts. Severe infection with COVID-19 carries risks to maternal, fetal and neonatal health.”
Dr. Sharma said that, given the higher risk of severe illness in pregnancy, “the recommendations are to get vaccinated unless you can absolutely be sure that you are not being exposed to COVID-19 at all or if you’re in an area where there isn’t very much circulating and you can maintain all the public health measures. The risks of having severe illness with Covid-19 are much higher than the unknowns about the vaccines.”
What’s more, breastfeeding mothers who get vaccinated might also confer a benefit to their breastfed baby. Dr. Sharma said, “There has been a study that shows antibodies following vaccination are found in breast milk. We don’t know yet if those are protective for the baby, but they may actually be of benefit for the breastfeeding child.”
In fact, Dr. Sharma told me that they used to advise breastfeeding mothers who were very concerned about the lack of trial data to get vaccinated and pause breastfeeding (as in, pump and dump) for a period of time. But now they no longer advice women to stop breastfeeding since it might actually be beneficial to the baby.
Which vaccines are recommended?
The best sources of information we have for pregnant and breastfeeding women right now are for the mRNA vaccines, Pfizer or Moderna. Therefore, Dr. Sharma recommends pregnant and breastfeeding women seek out one of the mRNA vaccines.
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